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Phenomenon: While part-time clinical work options are popular for physicians, part-time residency training is uncommon. Some residency training programs have offered trainees the option to complete their training on a modified schedule in the past. These part-time tracks often involved extending training in order to complete equivalent hours on a part-time basis. Having experience with trainees in such programs, we sought to explore the impact of completing residency training part-time on the professional and private lives of physicians. Approach: Between 2019 and 2020, we conducted interviews with physicians who completed portions of their residency training part-time between 1995 and 2005 in our institution's pediatrics, combined medicine-pediatrics, and family medicine programs. Findings: Seven female physicians who completed at least some portion of residency part-time were interviewed. To better characterize their experiences, we chose phenomenology as our analytic framework. Members of the research team independently coded each interview and met to resolve conflicts. Codes were then combined and discussed to determine four overarching themes as reasons and benefits of part-time training: The pursuit of extended-time training, logistics, effects on career trajectory, and wellness. These themes highlighted the utility of part-time training and the need for programmatic support to ensure their success. Insights: Based on our findings, adaptability for training and a sense of agency from their part-time experiences persisted throughout interviewees' careers. Each felt empowered to make career choices that fit their personal and professional needs. These findings suggest further investigation into the benefits of offering time-variable training in residency programs.

The importance of preparing students and practitioners in the health professions to understand and be equipped to address the social determinants of health (SDOH) has become increasingly urgent. To help support this goal, faculty and staff from the National Collaborative for Education to Address the Social Determinants of Health built a digital platform for health professions educators to access and share curricular work related to SDOH. As of 2022, this online resource included more than 200 curricula focused on SDOH and additional content related to both SDOH and health equity. Educators in undergraduate and graduate medicine, nursing, pharmacy, continuing education, and other fields may find these resources relevant to their teaching practice and consider this platform as a way to disseminate their work in this field to others., Competing Interests: Conflicts of interest: Dr Persell receives unrelated research support from Omron Healthcare Co Ltd. The other authors report no competing interests., (© 2023 Annals of Family Medicine, Inc.)

Studies have linked the diffusion of medical innovations to a distinctive professional project. In this project, physician specialists embrace an innovation, work to advance its successes, link these successes to their core-skill definitions, and use this linkage in boundary work to promote their professional identities and expand their jurisdictions, largely by distinguishing themselves from others within their profession. Drawing from a case study examining the diffusion of laparoscopic sterilization procedures in American ob/gyn, this article suggests that a specific type of revitalization movement may serve as an unwitting catalyst for these innovation/professional projects. To promote a"new"specialist identity, this revitalization movement employs foil labeling in its boundary work that dishonors, not outsiders, but established clinicians within the specialty. This dishonoring motivates these clinicians, as a generational cohort, to embrace radical innovations and break established work patterns. Radical innovations may spread across medical fields, not so much through projects bonding professionals to a unified collective, but through reactive projects within highly specialized fields prone to fragment along generational lines., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: The choice of medical specialty is related to multiple factors, students' values, and specialty perceptions. Research in this area is needed in low- and middle-income countries, where the alignment of specialty training with national healthcare needs has a complex local interdependency. The study aimed to identify factors that influence specialty choice among medical students., Methods: Senior students at the National Autonomous University of Mexico (UNAM) Faculty of Medicine answered a questionnaire covering demographics, personal experiences, vocational features, and other factors related to specialty choice. Chi-square tests and factor analyses were performed., Results: The questionnaire was applied to 714 fifth-year students, and 697 provided complete responses (response rate 81%). The instrument Cronbach's alpha was 0.8. The mean age was 24 ± 1 years; 65% were women. Eighty percent of the students wanted to specialize, and 60% had participated in congresses related to the specialty of interest. Only 5% wanted to remain as general practitioners. The majority (80%) wanted to enter a core specialty: internal medicine (29%), general surgery (24%), pediatrics (11%), gynecology and obstetrics (11%) and family medicine (4%). The relevant variables for specialty choice were grouped in three dimensions: personal values that develop and change during undergraduate training, career needs to be satisfied, and perception of specialty characteristics., Conclusions: Specialty choice of medical students in a middle-income country public university is influenced by the undergraduate experience, the desire to study a subspecialty and other factors (including having skills related to the specialty and type of patients).

Abstract Background With the proliferation of Hospital at Home (HaH) programmes globally, there is a need to equip junior doctors with the skills necessary for provision of HaH care. The ideal training structure and clinical requirements for junior doctors to be considered competent in providing HaH care is still poorly understood. This study examines the perceptions of junior doctors towards HaH, and aims to determine the learning needs that might be helpful for future curriculum planning. Methods We conducted a cross-sectional study of residents at the National University Health System (NUHS) Singapore. Using a 45-item questionnaire, we explored the knowledge, attitudes and perceptions of residents towards HaH, and their interest in participating in HaH as part of residency training. Results One hundred six residents responded. Overall knowledge and attitudes were mostly average. Perceptions were neutral but comparatively lower in the domains of safety, efficiency and equity. 69% of residents showed a positive attitude and interest to participate in HaH as part of residency rotations. 80% of respondents were keen to have a 2–4 week rotation incorporated into routine training. Demographic factors that influenced higher scores in various domains included type of residency programme and years of work experience. Conclusion Our findings suggest that residents are interested in participating in HaH. Incorporation of HaH rotations in residency training will allow juniors doctors to receive greater exposure and training in the skills specific to provision of HaH care. Further studies on the introduction of a HaH curriculum and Entrustable Professional Activities (EPAs) specific for HaH in residency training may be useful to to ensure that we have a competent HaH workforce that can support and keep up with the growth of HaH globally.

Resident training is a necessary path to cultivate excellent clinical doctors. Based on the Consensus on Core Competency Framework for Residency Education Among China Consortium of Elite Teaching Hospitals for Residency Education, Department of Neurology from Peking Union Medical College Hospital has established a training program for neurology residents with a graded evaluation system and a progressive clinical responsibility concept guided by core competency. Overcoming the teaching difficulties of neurology and considering the clinical characteristics of neurology, we have established a series of replicable and promotable neurology residency training curriculum through inheritance and innovation, which provides reference for the continuous improvement of China's neurology residency training program.

Background Competency development is the core of residency training in general practice, as well as the key to training qualified general practitioners. Summative assessment can evaluate overall training outcome and the attainment of general practitioner competencies. Summative assessment in general practice is still in developing in China, and its relevance to competencies is relatively weak. Objective To develop competency based summative assessment indicator framework of residency training in general practice, and to provide reference for improving the summative assessment system in China. Methods From 2023-04-25 to 30, 32 experts from 10 provinces, including Beijing, Shanghai, Hebei, Jiangsu, Zhejiang, Liaoning, Inner Mongolia Autonomous Region, Hainan, Ningxia Hui Autonomous Region and Sichuan Province were invited to participate in Delphi Expert Survey. The indicator framework of summative assessment was established through literature review and Delphi expert survey. The weight of indicators was determined by multiplicative model. Results In both the first and second rounds of expert survey, 32 questionnaires were issued and 32 were recovered, which were all valid. The positive coefficient was 100.0%, the authority coefficient was > 0.8, the importance coordination coefficient of indicators at all levels respectively was 0.382, 0.284, 0.265, and the feasibility coordination coefficient was 0.415, 0.359, 0.332. The final summative assessment indicator framework consisted of 6 first-tier indicators, 24 second-tier indicators and 50 third-tier indicators. The first-tier indicators include application of clinical professional knowledge and skills, the ability to take care of the family, the ability to provide basic public health services, the ability to communicate, cooperate and coordinate, humanistic ability and professionalism, clinical teaching and scientific research ability, and the weights were 0.505, 0.061, 0.109, 0.134, 0.125 and 0.066, respectively. Conclusion This study preliminarily explored and constructed competency based summative assessment indicator framework of residency training in general practice, which provides reference for further research on the contents of summative assessment and on the improvement of summative assessment system in China. The framework is important for improving the quality of residency training and competencies of general practitioners.

Abstract Background Discrimination is common in medical education. Resident physicians of races and ethnicities underrepresented in medicine experience daily discrimination which has been proven to negatively impact training. There is limited data on the impact of resident race/ethnicity on OB/GYN surgical training. The objective of this study was to investigate the impact of race/ethnicity on procedural experience in OB/GYN training. Methods A retrospective analysis of graduated OB/GYN resident case logs from 2009 to 2019 was performed at a single urban academic institution. Self-reported race/ethnicity data was collected. Association between URM and non-URM were analyzed using t-tests. Trainees were categorized by self-reported race/ethnicity into underrepresented in medicine (URM) (Black, Hispanic, Native American) and non-URM (White, Asian). Results The cohort consisted of 84 residents: 19% URM (N = 16) and 79% non-URM (n = 66). Difference between URM and non-URM status and average case volume was analyzed using t-tests. There was no difference between non-URM and URM trainees and reported mean number of Total GYN (349 vs. 334, p = 0.31) and Total OB (624 vs. 597, P = 0.11) case logs. However, compared with non-URM, on average URM performed fewer Total procedures (1562 vs. 1469, P = 0.04). Analyzing individual procedures showed a difference in average number of abortions performed between URM and non-URM (76 vs. 53, P = 0.02). There were no other statistically significant differences between the two groups. Conclusions This single institution study highlights potential differences in trainee experience by race/ethnicity. Larger national studies are warranted to further explore these differences to identify bias and discrimination, and to ensure equitable experience for all trainees.

Abstract Background Accurate self-assessment is crucial for the professional development of physicians. There has been sparse data on the accuracy of self-assessments on Anesthesiology Milestones. The aim of this study was to investigate the differences between resident self-assessments and faculty-assessments on Anesthesiology Milestones and the associated factors. Methods This was a cross-sectional study conducted in a general tertiary university-affiliated hospital. We included anesthesia residents who were enrolled in the standardized residency training program in postgraduate year two and three at the time of the Milestone evaluation. We requested evaluations of competencies from both the Clinical Competency Committee faculty and the anesthesia residents themselves, utilizing the Chinese version of Anesthesiology Milestones in January 2023 and January 2024. The primary outcome was the differences between self- and faculty-assessments, calculated by subtracting the faculty-rated score from the self-rated score on each subcompetency. Results A total of 46 and 42 residents were evaluated in year 2023 and 2024, respectively. The self-rated sum score was significantly higher than that rated by faculty [mean (standardized deviation): 120.39 (32.41) vs. 114.44 (23.71), P = 0.008 in paired t test] with an intraclass correlation coefficient of 0.55 [95% confidence interval (CI): 0.31 to 0.70]. The Bland–Altman plots revealed significant overestimation in patient care (bias 0.32, 95% CI: 0.05 to 0.60), practice-based learning and improvement (bias 0.45, 95% CI: 0.07 to 0.84), and professionalism (bias 0.37, 95% CI: 0.02 to 0.72). Ratings from residents with master’s degrees (mean difference: -1.06, 95% CI: -1.80 to -0.32, P = 0.005) and doctorate degrees (mean difference: -1.14, 95% CI: -1.91 to -0.38, P = 0.003) were closer to the faculty-assessments than residents with bachelor's degrees. Compared with patient care, the differences between self- and faculty- rated scores were smaller in medical knowledge (mean difference: -0.18, 95% CI: -0.35 to -0.02, P = 0.031) and interpersonal and communication skills (mean difference: -0.41, 95% CI: -0.64 to -0.19, P

Abstract Background System contributors to resident burnout and well-being have been under-studied. We sought to determine factors associated with resident burnout and identify at risk groups. Methods We performed a US national survey between July 15 2022 and April 21, 2023 of residents in 36 specialties in 14 institutions, using the validated Mini ReZ survey with three 5 item subscales: 1) supportive workplace, 2) work pace/electronic medical record (EMR) stress, and 3) residency-specific factors (sleep, peer support, recognition by program, interruptions and staff relationships). Multilevel regressions and thematic analysis of 497 comments determined factors related to burnout. Results Of 1118 respondents (approximate median response rate 32%), 48% were female, 57% White, 21% Asian, 6% LatinX and 4% Black, with 25% PGY 1 s, 25% PGY 2 s, and 22% PGY 3 s. Programs included internal medicine (15.1%) and family medicine (11.3%) among 36 specialties. Burnout (found in 42%) was higher in females (51% vs 30% in males, p = 0.001) and PGY 2’s (48% vs 35% in PGY-1 s, p = 0.029). Challenges included chaotic environments (41%) and sleep impairment (32%); favorable aspects included teamwork (94%), peer support (93%), staff support (87%) and program recognition (68%). Worklife subscales were consistently lower in females while PGY-2’s reported the least supportive work environments. Worklife challenges relating to burnout included sleep impairment (adjusted Odds Ratio (aOR) 2.82 (95% CIs 1.94, 4.19), absolute risk difference (ARD) in burnout 15.9%), poor work control (aOR 2.25 (1.42, 3.58), ARD 12.2%) and chaos (aOR 1.73 (1.22, 2.47), ARD 7.9%); program recognition was related to lower burnout (aOR 0.520 (0.356, 0.760), ARD 9.3%). These variables explained 55% of burnout variance. Qualitative data confirmed sleep impairment, lack of schedule control, excess EMR and patient volume as stressors. Conclusions These data provide a nomenclature and systematic method for addressing well-being during residency. Work conditions for females and PGY 2’s may merit attention first.

Abstract Background District Residency Programme (DRP) was introduced by National Medical Commission as mandatory three-months training program for postgraduate residents. The program was for the first time implemented in April 2023 in Rajasthan. However, it ran into several teething problems, especially for residents. With a lack of any precedence, this study was planned to explore experiences and challenges of residents posted in DRP. Methods Cross-sectional study was conducted at 12 DRP sites attached to SMS Medical College, Jaipur between August-October 2023. A self-administered questionnaire was used to collect information from residents who had completed DRP. Questions were scored on a five-point Likert scale. Mann-Whitney U test and Kruskal-Wallis H test was used to show association. Results Only around 17% residents felt that the learning objectives of DRP were fulfilled and nearly 60% residents felt isolated from academic activities and parent department. Over half of the residents were never posted with their concerned specialty services. Around four-fifth residents felt concerned about safety at least sometimes and more than three-fourth residents were dissatisfied with basic amenities. Kruskal-Wallis and Mann-Whitney tests showed significant association of gender and specialisation strata with multiple outcome variables. Conclusion The study finds high degree of dissatisfaction among residents towards learning objectives, academic learning, and basic amenities during DRP. There was also a clear lack of specialty-exposure and high concerns of safety, especially for female residents. The study findings should alarm and inform policymakers and administrators to improve DRP implementation so as to better achieve laid objectives.

Introduction: Due to a surge of cases from the COVID-19 pandemic, senior residents (SRs) from the Physical Medicine and Rehabilitation Residency (PM and R) Programme, in a tertiary hospital, were deployed to manage COVID-19 cases. This was a stark difference to their usual job scope and training. This qualitative study used a phenomenological approach to understand the perceptions and experiences of PM and R SRs in a Singapore-based tertiary hospital during the COVID-19 pandemic. Materials and Methods: The study was conducted from 1st June 2020 to 30th November 2020. Eleven participants were enrolled through purposive sampling. Semi-structured in-depth interviews were conducted and transcribed. Using an inductive approach, the data were coded, and thematic analysis was performed. Results: Ten participants (90.9%) cited negative impacts of COVID-19 on their training. Four key themes with corresponding subthemes were identified: (1) curtailed training, (2) career in jeopardy, (3) psychological distress caused by uncertainties and (4) role fulfilment. An overarching concept of ‘ Struggles: Front-stage versus back-stage’ experienced by the SRs was derived from the themes and data. Conclusions: The interdependent relationship of these issues necessitates the multifaceted support of the frontline training physician. The pandemic exerted a significant effect on the mental health of people worldwide. We explored the public and personal roles and duties borne by the training PM and R physicians and the struggles that emerge from them. In humanising the training of frontline physicians, and acknowledging their familial and societal roles, we can lay down steps to better assist training doctors in the next pandemic/epidemic.

Abstract Background Hypopituitarism, including growth hormone deficiency (GHD), is a common sequela of traumatic brain injury (TBI). This study explored the coverage of education and training of TBI-induced hypopituitarism in general and GHD in particular, in postgraduate program curricula to identify knowledge gaps and opportunities. Methods An online survey and qualitative interviews (focus groups) were conducted among endocrinology, neurology, and physiatry postgraduate program directors in the United States (US). The study received an IRB exemption. Results A total of 419 fellowship and residency programs were invited to participate; 60 program directors completed the survey and 11 of these participated in the focus groups. About half of the respondents considered TBI-induced hypopituitarism important or fairly important to include in the curriculum, and nearly two-thirds considered it an appropriate training component. Neurology program directors considered education regarding hypopituitarism following TBI less important and relevant for their curricula compared with endocrinology and physiatry program directors. About half (53%) of the programs responded that they included TBI-induced pituitary disorders in their curricula. About two-thirds (68%) of endocrinology programs, compared with only one-quarter (25%) of neurology programs, covered TBI-induced pituitary disorders. Respondents identified multiple barriers to expanding hypopituitarism following TBI in the curriculum, including the rarity of condition and lack of time/room in the curriculum. Respondents reported that consensus clinical guidelines and the availability of more data on TBI-induced hypopituitarism, including GHD, would greatly impact the development of educational curricula on this topic. Conclusions To improve the management of TBI-induced hypopituitarism, education and training should be expanded in US fellowship and residency programs to prepare trainees to effectively screen, diagnose, and treat TBI-induced hypopituitarism, including GHD.

Objective: This study assessed the prevalence and clinical characteristics of inpatient dermatologic diseases, examined trends over 3 academic years in a tertiary care hospital in Thailand, and evaluated their relevance to the current dermatology residency curriculum. Materials and Methods: A retrospective review was performed at the Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Consultation records from July 2018 to June 2021 were assessed. Data extracted included patient age, sex, referring departments, and diagnoses. Results: Of the 1964 consultations, 2002 diagnoses were identified. Consistent with previous findings, the predominant diagnostic categories were drug eruptions (28.02%; 561), eczema (16.18%; 324), and viral infections (9.29%; 186). Internal medicine made the most requests, followed by surgery and orthopedics. While the prevalence of consulted diseases remained constant over the 3 academic years, the total number of consultations increased. Most of the consulted conditions were already covered in the “must-know” section of the dermatology residency curriculum, with a few exceptions. The consultation cases satisfied the inpatient evaluation requirements of Entrustable Professional Activity. Conclusion: The prevalence of inpatient dermatologic diseases was highest for drug eruptions, followed by eczema and viral infections. The consistent trend in the prevalence of these consulted diseases underscores the significance of inpatient dermatology. Incorporating these insights into revisions of the dermatology residency curriculum may enhance the training of dermatologists.

Abstract Background Headache disorders are the most common neurological disorders worldwide. Despite their widespread prevalence and importance, the topic of headache is inconsistently taught at both the undergraduate and postgraduate levels. The goal of this study is to establish a better picture of the current state of Headache Medicine (HM) training in Neurology postgraduate programs in Canada and describe the impact of the current pandemic on training in this domain. Methods Online surveys were sent to senior residents of adult Neurology programs in Canada. We also conducted telephone interviews with Neurology Program Directors. Descriptive statistics were analyzed, and thematic analysis was used to review free text. Results A total of 36 residents, and 3 Program Directors participated in the study. Most of the teaching in HM is done by headache specialists and general neurology faculty. Formal teaching is mainly given during academic half day. Most of the programs expose their residents to Onabotulinum toxin A injections and peripheral nerve blocks, but they don’t offer much formal teaching regarding these procedures. Residents consider HM teaching important and they would like to have more. They don’t feel comfortable performing interventional headache treatments, despite feeling this should be part of the skillset of a general neurologist. Conclusion Our study is the first to establish the current state of headache teaching in post-graduate neurology programs as perceived by trainees and program directors in Canada. The current educational offerings leave residents feeling poorly prepared to manage headaches, including procedural interventions. There is a need to diversify the source of teaching, so the educational burden doesn’t lie mostly upon Headache specialists who are already in short supply. Neurology Residency programs need to adapt their curriculum to face the current need in HM.

Abstract Background Informal workplace learning (WPL) has no concrete learning objective and takes place without a responsible supervisor, which makes it difficult to assess its learning outcomes. Formal learning situations, as they are known from universities or schools, do not exist in this context and make a conventional assessment of learning goals and achievements impossible. Informal learning in the workplace is of central importance, and the assessment of informal learning outcomes in medical education is an under-researched area. The aim of our study was to adapt and validate an informal WPL questionnaire (originally developed for social workers) to assess learning outcomes due to informal WPL in residency training. Methods A total of 528 residents (n = 339 female; age: M = 29.79; SD = 3.37 years) completed an adapted questionnaire on informal WPL outcomes and the Freiburg Questionnaire to Assess Competencies in Medicine (i.e. medical knowledge, communication, and scholarship). Exploratory factor analysis was used to determine the underlying factor structure. The reliability of the factors was tested using McDonald’s omega, and the correlation between the factors and the three subscales of the Freiburg questionnaire was tested using Spearman’s rho correlation coefficient. To investigate construct validity, a structural equation model was calculated to examine the relationships between medical competencies and informal learning outcomes. Results The exploratory factor analysis yielded a four-factor solution that best fit the data. The scores of all four factors (GLO-CD: generic learning outcomes—competence development, GLO-R: generic learning outcomes—reflection, JSLO: job-specific learning outcomes, and OLLO: organisational learning outcomes) showed good internal consistency (Ω ≥ .69). The structural equation model showed that "medical expertise" had an impact on all four factors of informal learning at work. “Scholarship” seemed to predict GLO-CD and GLO-R. Conclusions Our four-factor model reveals meaningful determinants of informal WPL in relation to residency training. The instrument is therefore the first promising attempt to assess informal WPL in the broader context of medical education during residency, thus supporting its construct validity.

Abstract Background Feedback plays a pivotal role in graduate medical education, where medical residents are expected to acquire a wide range of practical and professional competencies. Assessing the feedback delivery status is a preliminary step for educators to enhance the quality of feedback provided. This study aims to develop an instrument to assess the various aspects of feedback delivery in medical residency training. Methods The fifteen-item REFLECT (Residency Education Feedback Level Evaluation in Clinical Training) questionnaire was developed. The content validity was evaluated according to a panel member consisting of fourteen clinical professors and medical education instructors. After evaluating the test-retest reliability, the questionnaire was distributed to a sample of 154 medical residents and was further assessed in terms of internal consistency and factor analysis. Results Content validity analysis resulted in an appropriate content validity ratio and content validity index for the final 15 items. The test-retest reliability resulted in an ICC of 0.949 (95% C.I. 0.870–0.980), indicating excellent reliability. The Cronbach’s alpha for the 15-item questionnaire was α = 0.85, demonstrating good internal consistency. The factor analysis resulted in a four-factor structure: “attitude towards feedback”, “quality of feedback”, “perceived importance of feedback”, and “reaction to feedback”. Conclusions REFLECT proved to a reliable tool that could be utilized as a quick assessment method of feedback delivery, making it a suitable aid for educational managers and faculties to design necessary interventions aiming to enhance the quantity and quality of feedback provided.

Abstract Background The healthcare system experienced various challenges during the coronavirus disease 2019 (COVID-19) pandemic, and a wide range of safety measures were implemented, including limiting the number of patients allowed to visit primary care clinics and follow-up through telemedicine clinics. These changes have accelerated the growth of telemedicine in medical education and affected the training of family medicine residents throughout Saudi Arabia. Therefore, this study aimed to evaluate the experiences of family medicine residents with telemedicine clinics as a part of their clinical training during the COVID-19 pandemic. Methods A cross-sectional study was conducted with 60 family medicine residents at King Saud University Medical City, Riyadh, Saudi Arabia. An anonymous 20-item survey was administered between March and April 2022. Results The participants included 30 junior and 30 senior residents, with a 100% response rate. The results revealed that most (71.7%) participants preferred in-person visits during residency training, and only 10% preferred telemedicine. In addition, 76.7% of the residents accepted the inclusion of telemedicine clinics in training if such clinics constituted not more than 25% of the training program. Moreover, most participants reported receiving less clinical experience, less supervision, and less discussion time with the attending supervisor when training in telemedicine clinics compared with in-person visits. However, most (68.3%) participants gained communication skills through telemedicine. Conclusions Implementing telemedicine in residency training can create various challenges in education and influence clinical training through less experience and less clinical interaction with patients if it is not structured well. With the growth of digital healthcare, further structuring and testing of a paradigm that involves using telemedicine in residents’ training programs prior to implementation should be considered for better training and patient care.

Objectives: To explore the benefits of rotation- and milestone-specific learning objectives in the form of self-assessment questionnaires to facilitate rehabilitation residency training. Materials and methods: Control and intervention groups were formed during academic years 2020 and 2021, respectively. The group participants were residents undergoing training in rehabilitation medicine. Before entering their rotations, the intervention group participants were provided rotation- and milestone-specific learning objectives in the form of self-assessment questionnaires. The participants of both groups self-assessed their confidence levels for each learning objective after the rotations, using a 5-level Likert scale. The self-rated scores of the 2 groups were compared. Results: Twenty-five and 28 residents were enrolled in control and intervention groups, respectively. There were 12 sets of learning objectives (4 rotations; 3 milestones). Only 2 sets revealed higher self-rated scores for the intervention group (the pediatric and the pain rotations of the second-year residents). The groups’ scores for Entrustable Professional Activities (EPAs) and tests of participants’ knowledge of the learning objectives showed no differences. Conclusions: Providing learning objectives and conducting self-assessments are crucial for successful learning. Although there is limited evidence of the benefits of our intervention, the advantages of specific learning objectives might be enhanced when combined with other measures that support residency training.

With the continuous worldwide development of the 3rd generation of reformation in medical education, China is in urgent need to develop its own core competency framework for residency training that conforms to China's conditions. For the purpose of supporting and facilitating the reformation of medical education, educational experts, educational administrators and frontline faculties from China Consortium of Elite Teaching Hospitals for Residency Education formed this consensus after repeated discussion, argumentation and modification according to domestic and international research. The framework consists of six core competences: professionalism, medical knowledge and skill, patient care, communication and collaboration, teaching and life long learning. Each core competency has 3 to 4 specific items. In this consensus, all the items were definied to help readers understand the core competency framework. A hexagonal logo with 6 different colors was designed to illustrate the framework. This consensus can provide an important basis for future exploration of reform in residency education on aspects such as setting training goal, curriculum design, assessment and evaluation, faculty development and teaching-resources improvement, etc.

Background: Nigeria has been faced with the challenge of massive efflux of senior trainees and young consultants. It is commonly believed that the emigration is for economic reasons. Aim: We studied the trainer's and trainee's perception of residency in Nigeria and its influence on brain drain. Materials and Methods: This cross-sectional study was carried out using an online survey platform. Invitation to complete the survey was sent out through closed social media groups (Facebook, WhatsApp, and Telegram) and e-mail. These groups were specifically for doctors who had their basic medical education in Nigeria and presently working in Nigeria or outside the borders of Nigeria. Results: Most respondents were in training and were between 25 and 44 years old. The top reason for emigration for trainees already abroad was to improve the quality of their training while the top reason for trainees planning to emigrate was to get better training. There was a discordance between the mentorship methods employed by trainers and preferences of trainees. While majority of the trainees already abroad were unlikely to return, most of the trainees considering emigration were willing to stay if training improved. Conclusion: Nigerian trainers and trainees have similar perceptions about residency training, and the brain drain being experienced presently may be reversible with improvement in training in the country.

The novel coronavirus disease 2019 (COVID-19) pandemic has impacted the lives of physicians at all levels. The workloads and working hours have increased tremendously which affected the time spent on administrative and academic duties. The COVID-19 pandemic imposed a lot of challenges on academic institutions in term of providing quality of care to patients and maintaining the quality of education for trainee. Herein, we discuss the challenges and impact of the pandemic on residents training.

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has greatly affected medical education in addition to clinical systems. Residency training has probably been the most affected aspect of medical education during the pandemic, and research on this topic is crucial for educators and clinical teachers. The aim of this study was to understand the effect of the COVID-19 pandemic comprehensively through a systematic review and analysis of related published articles. Methods A systematic review was conducted based on a predesigned protocol. We searched MEDLINE and EMBASE databases until November 30, 2020, for eligible articles. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data were summarized and analyzed. Results In total, 53 original articles that investigated the effect of the COVID-19 pandemic on residency training were included. Studies from various regions were included in the research, with the largest percentage from the United States (n = 25, 47.2%). Most of these original articles were questionnaire-based studies (n = 44, 83%), and the research target groups included residents (79.55%), program directors (13.64%), or both (6.82%). The majority of the articles (n = 37, 84.0%) were published in countries severely affected by the pandemic. Surgery (n = 36, 67.92%) was the most commonly studied field. Conclusions The COVID-19 pandemic has greatly affected residency training globally, particularly surgical and interventional medical fields. Decreased clinical experience, reduced case volume, and disrupted education activities are major concerns. Further studies should be conducted with a focus on the learning outcomes of residency training during the pandemic and the effectiveness of assisted teaching methods.

The Wayne State University Office of Graduate Medical Education (WSUGME) uses an objective structured clinical examination (OSCE) to assess its programs’ contribution to enhancing residents’ communication skills. In response to revisions in Michigan’s opioid-prescribing mandates in 2017, WSUGME developed a pain management case in collaboration with faculty and the Wayne State University School of Medicine to educate residents about these mandates while gauging their skills in Systems-Based Practice (SBP), an Accreditation Council for Graduate Medical Education Core Competency. This study examined whether resident OSCE performance predicted year-end milestones scores in SBP1 (coordinates patient care within various health care delivery settings), SBP2 (works in interdisciplinary teams to enhance patient safety and improve patient care quality), and SBP3 (practices and advocates for cost-effective, responsible care). Participants included two cohorts of first- (PRG-1) and second-year (PRG-2) residents in 6 programs: one cohort from academic year 2018-2019 (n = 33), the other from 2019-2020 (n = 37). Before the OSCE, WSUGME emailed residents the new state prescription requirements. During the simulated encounter, standardized patients rated residents on a validated communication instrument, and WSUGME conducted a linear regression of patient ratings on resident SBP milestone scores. The ratings of communication skills of PRG-1 residents did not predict any of the year-end SBP milestones. However, ratings of communication skills of PRG-2 residents predicted SBP1 and SBP2, though not SBP3, milestones. The OSCE opioid case proved to be a valid measure of PRG-2 residents’ competence gained across the first year but was less meaningful when applied to PRG-1 residents.

Little is known about the current experiences of Public Health/General Preventive Medicine (PH/GPM) residents and graduates in the United States. This cross-sectional study of PH/GPM residents and graduates examined their knowledge of the field and career choices after graduation. We developed a questionnaire to address medical education, graduate medical training prior to Preventive Medicine (PM), current PM training, and post-graduation goals. Data was stratified by residency status (resident vs graduate), and board-eligibility (dual-eligible vs solely PH/GPM). Bivariate analysis of quantitative data was performed using Fisher’s test. Qualitative data were organized into themes and analyzed quantitatively. Of those invited to participate, a total of 153 (18.25%) PH/GPM residents and graduates responded to the survey. We found diversity in prior medical education/training among respondents. Overall, debt burden at the start of training was low compared to national trends. Compared to residents, a higher proportion of graduates were board-eligible in another specialty (p

Background: Residency training develops trainees to practice evidence-based medicine using knowledge acquired through researches. Resident doctors are not just expected to be consumers of good researches but are also expected to build their competencies in conducting researches in their fields of specialization. They are expected to engage in journal clubs as well as scientific paper presentations in local and international conferences under the mentorship and guidance of their trainers. In addition, trainers in residency training supervise the compulsory dissertation of senior residents under them. Objectives: We aimed to assess research engagement of resident doctors in training and pattern of submission and approval of their dissertation proposal. Methodology: It was a descriptive cross-sectional descriptive study involving resident doctors in accredited hospitals in Northwestern Nigeria. Electronic questionnaires were distributed to respondents via their verified electronic media contacts. Data were collected within a period of 1 month from July 10 to August 6, 2020. Data were analyzed using mean, standard deviation, simple tables as well as Z-test and Chi-square test. The level of significance was set at 0.05 for decision purposes. Results: A total of 120 questionnaires were completed. The mean age of respondents was 38.0 ± 3.8 years, with majority being males 88 (83.3%), and 107 (89.2%) being married. Only 12 (10%) and 44 (36.7%) respondents had published manuscript before and since commencement of residency training, respectively. There was a significant difference between manuscript publication before and since commencement of residency training (P = 0.012). Only 32% of the respondents who submitted their dissertation proposal to the colleges did so within 12 months of success in their Part 1 fellowship examination. There was no association between the publication of manuscript during residency training and submission of dissertation to either National Postgraduate Medical College of Nigeria (P = 0.190), West African College of Surgeons (P = 0.686), or West African College of Physicians (P = 0.317). Conclusion: Research engagement by resident doctors from this study was not satisfactory. Publication of manuscript by resident doctors was associated with prior publication before commencement of residency training and type of training hospital.

Background: Residency training is a postgraduate medical education where graduate doctors are mentored toward becoming independent specialists. In Nigeria currently, the Medical Residency Training Act (MRTA) 2017 guides residency training under the regulation of three postgraduate medical colleges: the National Postgraduate Medical College of Nigeria (NPMCN), West African College of Surgeons (WACS), and West African College of Physicians (WACP). For the respective colleges, resident doctors are expected to attempt Part One and Part Two fellowship examinations after completing their junior and senior residency training, respectively, within stipulated durations. Objectives: The aim of this study is to assess resident doctors' performance in training and predictive factors. Methodology: Electronic questionnaires was distributed to respondents through their contacts or emails. Data was collected within a period of one month, from July 10 to August 6, 2020. Data was analyzed using mean, standard deviation, simple tables as well as t-test and Chi-square test. The level of significance was set at 0.05 for decision purposes. Results: A total of 120 participants were involved in the study. The mean age of respondents was 38.0 ± 3.8 years, with a majority of 88 (83.3%) males and 107 (89.2%) married. On the first attempt, 48 (65.8%), 37 (60.6%), and 15 (57.7%) respondents were successful in NPMCN, WACS, and WACP Part One fellowship examinations, respectively. There was no significant difference in the success in Part One between the three postgraduate medical colleges. There was significant difference in the duration between the first attempt and success in Part One examinations for the three colleges, respectively (NPMCN – P = 0.001, WACS – P < 0.001, WACP – P = 0.036). Conclusion: There was a comparable success in Part One fellowship examination between the three postgraduate medical colleges, with over half of respondents recording success in their first attempt. However, there were significant delays between the first attempt and success in Part One examination for the three postgraduate medical colleges.

Abstract Background Residency training includes positive and negative aspects. Well-trained doctors must be educated, but the process may bring additional risks to patients. Anesthesiologists’ performance when conducting neuraxial anesthesia is related to their experience. We hypothesized that a modified neuraxial anesthesia method would improve both residency training and patient safety. Methods We recruited 518 patients who were scheduled for a cesarean section and used spinal anesthesia (n = 256), epidural anesthesia (n = 154), and combined spinal–epidural anesthesia (SEA; n = 108). We observed and evaluated the anesthesia performance of five second-year resident anesthesiologists in elective cesarean sections using the conventional and modified methods. The number of attempts, implant error rate, and the incidence of complications were recorded and analyzed. Results Better success puncture attempts occurred in all three groups when the modified method was applied. For the groups with an implant assessment, the complication rate and implant error rate were lower when using the modified method. We employed generalized estimating equation (GEE) analysis to correct for possible confounding factors. When using the conventional method, the resident anesthesiologists required more attempts, made more implant errors, and caused more complications in patients. Conclusions We found that a modified method for neuraxial anesthesia could improve residency performance and patient safety. The modified method may be a suitable training process for resident anesthesiologists when practicing neuraxial anesthesia. Trial registration The study was approved by the Research Ethics Committee of National Taiwan University (IRB:200812040R) Clinicaltrials register: NCT03389672 .

Abstract Background Soon after Bhutan’s first medical university was established in 2012, Faculty Development Programmes (FDPs) were adopted for efficient delivery of postgraduate medical curriculum. Medical education was an additional responsibility for the clinicians who already had multi-dimensional roles in the healthcare system where there is acute shortage of healthcare professionals. We studied the impact of FDPs on postgraduate medical education in Bhutan. Methods This was a mixed-methods study with a quantitative (cohort study – quasi-experimental with 18 participants) and concurrent explanatory qualitative component (focused group discussion (FGD) with 11 teaching faculty members). The 18 participants were given a structured FDP designed by the University. The FGD assessed teacher self-efficacy and competency using standard tools before and after the FDP. Thematic analysis of the FGD explored the impact of FDPs in the delivery of postgraduate residency programmes. Results There were significant increase in the teacher self-efficacy (31 vs 34, p = 0.009) and competency scores (56 vs 64, p = 0.011). There were significant improvements in self-efficacy in the domain of the teaching relevant subject contents and developing creative ways to cope with system constraints. In teaching-learning assessments, there was a significant appreciation of the effectiveness of lectures and tutorials and the use of essay questions. The FGD demonstrated the acceptance of FDPs and its importance in quality improvement of postgraduate medical education, professional development of teachers and improvement of their communication skills. The teachers have now migrated from the conventional methods of teaching to workplace-based teaching and assessment. The FDPs also resulted in review and revision of postgraduate medical curriculum soon after the first batch graduated in 2018. Lack of adequate support from relevant stakeholders and lack of a medical education centre in the University were seen as major challenges. Conclusions The FDPs have brought tangible professionalization of postgraduate medical education at an early stage of the medical university. There is a need for continued efforts to strengthen, sustain and consolidate the gains made thus far.

Abstract Background The choice of medical specialty is related to multiple factors, students’ values, and specialty perceptions. Research in this area is needed in low- and middle-income countries, where the alignment of specialty training with national healthcare needs has a complex local interdependency. The study aimed to identify factors that influence specialty choice among medical students. Methods Senior students at the National Autonomous University of Mexico (UNAM) Faculty of Medicine answered a questionnaire covering demographics, personal experiences, vocational features, and other factors related to specialty choice. Chi-square tests and factor analyses were performed. Results The questionnaire was applied to 714 fifth-year students, and 697 provided complete responses (response rate 81%). The instrument Cronbach’s alpha was 0.8. The mean age was 24 ± 1 years; 65% were women. Eighty percent of the students wanted to specialize, and 60% had participated in congresses related to the specialty of interest. Only 5% wanted to remain as general practitioners. The majority (80%) wanted to enter a core specialty: internal medicine (29%), general surgery (24%), pediatrics (11%), gynecology and obstetrics (11%) and family medicine (4%). The relevant variables for specialty choice were grouped in three dimensions: personal values that develop and change during undergraduate training, career needs to be satisfied, and perception of specialty characteristics. Conclusions Specialty choice of medical students in a middle-income country public university is influenced by the undergraduate experience, the desire to study a subspecialty and other factors (including having skills related to the specialty and type of patients).

Background: Twitter has emerged as a powerful networking and educational tool within the health care community. The instantaneous and casual nature of Twitter allows for easy access to a near limitless pool of medical professionals and the opportunity to share intra‐ and interprofessional knowledge. Beyond individual development, Twitter has the potential to positively impact pharmacy residency programs in a multitude of ways. Objective: This article serves as a practical guide for pharmacy residency programs to implement and maintain a successful Twitter account. Recommendations At the program level, a Twitter account creates an official voice and brand while simultaneously providing detail and perspective beyond what a residency website may offer. Additionally, it allows for dynamic ground‐level engagement with prospective residency candidates, current residents, and preceptors which is mutually beneficial to the program audience. In the age of virtual recruitment, successfully utilizing digital tools to meet candidates where they are is essential for attracting the right candidate for the program. Implementation of a successful social media strategy has potential barriers that include garnering buy‐in from departmental leadership, operationalizing a social media team, and maintaining engagement momentum. Conclusion: Pharmacy residency programs should consider starting an official Twitter account. [ABSTRACT FROM AUTHOR]

The development of residency training and evaluating system is very important. Besides training in clinical skills, it is necessary to implement a comprehensive training program including the capacity building of scientific research. This review aims to discuss the necessity and the challenges of research training at present and also discuss how to increase residency research productivity, and hope to improve the quality of residency training.

Medical residents in difficulty struggle to comply with educational requirements. They pose a liability to patient safety and they have problems to adapt to the professional role of a doctor. Consequently, being a resident in difficulty may cause identity crisis and have the potential to disrupt the resident's professional identity as a doctor. Only few studies explore the tipping point between becoming a resident in difficulty or not, and these studies rarely reflect the surrounding sociocultural aspects of the residents' difficulties such as organisational culture in the workplace. This article explores how medical residency training culture influence on residents' risk of ending in difficulty. Our study was based on six focus-group interviews with residents (n=28) and in-depth interviews with residents in difficulty (n=10). The interpretation of data employed sociologist Pierre Bourdieu's theoretical framework around dispositions. Across the data, we identified four themes: Conflicting games in the field of medical education, altruism, organisational hierarchy, and coping with stress. We found a (mis)match between legitimate rules in the field of medicine and the residents' dispositions to appreciate those rules. These results can inform clinical supervisors and consultants in their decisions for supporting residents in difficulty and increasing educational achievement among struggling residents.

Abstract Background Physical inactivity is a global public health challenge. Physical activity (PA) promotion in healthcare delivery systems is effective to reduce physical inactivity. A primary care setting provides an appropriate environment for PA counseling since it is a primary contact with primary care or family physicians encounter the majority of the population. Lack of knowledge and inadequate training in PA counseling is one of the most important barriers to PA promotion. The purpose of this systematic review was to evaluate PA counseling training in primary care residency programs. Methods The authors systematically searched PubMed, Web of Science, Scopus and The Cochrane Library for articles published in English from 2000 to 2017. Articles regarding PA counseling in primary care residency training were extracted and outcomes assessed for this systematic review. Results Based on the initial review, 378 articles were excluded (362 articles excluded based on titles and abstracts and 16 articles excluded based on full texts). Four articles were included in this review, addressed PA counseling curricula in primary care residency training. All studies included PA counseling training as part of obesity and healthy lifestyle training. The training improved knowledge among primary care residents, but may not necessarily result in better attitudes or self-efficacy, which could be improved by elective rotations that focus on improved attitudes, self-efficacy, and professional norms for PA counseling. Brief training in counseling did not improve quality nor increase the rate of counseling. Conclusions This systematic review demonstrates a lack of evidence due to a small number of included studies. The heterogeneous outcomes from the minimal programs are needed to carefully interpret. However, this review sheds light on the importance of training in PA counseling in primary care residency programs. The development of training in PA counseling should focus on an approach that improves attitudes and the self-efficacy of primary care residents. Elective rotations, where residents voluntarily choose their subject, may provide the appropriate training period for PA counseling. Policymakers and academics should play an active role in the implementation of PA counseling as an essential competency for primary care physicians.

Abstract Background Medical billing and coding are critical components of residency programs since they determine the revenues and vitality of residencies. It has been suggested that residents are less likely to bill higher evaluation and management (E/M) codes compared with attending physicians. The purpose of this study is to assess the variation in billing patterns between residents and attending physicians, considering provider, patient, and visit characteristics. Method A retrospective cohort study of all established outpatient visits at a family medicine residency clinic over a 5-year period was performed. We employed the logistic regression methodology to identify residents’ and attending physicians’ variations in coding E/M service levels. We also employed Poisson regression to test the sensitivity of our result. Results Between January 5, 2009 and September 25, 2015, 98,601 visits to 116 residents and 18 attending physicians were reviewed. After adjusting for provider, patient, and visit characteristics, residents billed higher E/M codes less often compared with attending physicians for comparable visits. In comparison with attending physicians, the odds ratios for billing higher E/M codes were 0.58 (p = 0.01), 0.56 (p = 0.01), and 0.63 (p = 0.01) for the third, second, and first years of postgraduate training, respectively. In addition to the main factors of patient age, medical conditions, and number of addressed problems, the gender of the provider was also implicated in the billing variations. Conclusion Residents are less likely to bill higher E/M codes than attending physicians are for similar visits. While these variations are known to contribute to lost revenues, further studies are required to explore their effect on patient care in relation to attendings’ direct involvement in higher E/M-coded versus their indirect involvement in lower E/M-coded visits.

Introduction: Persistent imbalance between work demands and resources seems to be a crucial contributor to the development of burnout among medical professionals. Yet, it seems that Middle East is lacking studies analyzing psychological well-being's of medical residents. Hence, we aimed to conduct a nationwide study to understand and address burnout and depression in medical residents in the UAE. Methods: A multicenter, cross-sectional study was designed to evaluate professional burnout and depression among medical residents to address the gap. Results: Our results indicate that 75.5% (216/286) of UAE medical residents had moderate-to-high emotional exhaustion (EE), 84% (249/298) had high depersonalization (DP), and 74% (216/291) had a low sense of personal accomplishment. In aggregate, 70% (212/302) of medical residents were considered to be experiencing at least one symptom of burnout based on a high EE score or a high DP score. Depression ranging from 6% to 22%, depending on the specialty was also noted. Noticeably, 83% (40/48) of medical residents who had high scores for depression also reported burnout. Conclusions: This study shows that burnout and depression are high among medical residents in UAE. There is a crucial need to address burnout through effective interventions at both the individual and institutional levels. Professional counseling services for residents will certainly be a step forward to manage resident burnout provided the social stigma associated with counseling can be eliminated with awareness. The work hour regulations suggested by the Accreditation Council for Graduate Medical Education partly provides a solution to improve patient safety and care quality. There is an urge to reconfigure the approach to medical training for the well-being of the next generation of physicians in the Arab world.

Introduction: It is well known that family medicine (FM) is a cornerstone for developing a community-based health-care system, and training family physicians is critical for the society. In Middle East, only 5%–10% of physicians, nurses, and health technicians are citizens. This demands more efforts toward having national FM practitioners in the country. The development of FM residency training program through the past two decades in Dubai has played a crucial rule in this aspect. Methods: The primary purpose of this study is to review the status of FM specialty training in the Emirates of Dubai throughout the past two decades. Results: The FM residency training program started since 1993 and had intake of 230 residents till 2017; out of which, 200 (87%) were female and 211 (92%) were the United Arab Emirates national. From 176 residents who are supposed to be graduated by 2017, 162 (92%) completed 4-year training, 132 (75%) has got the Arab Board certificate, and 116 (66%) qualified by the Membership of the Royal College of General Practitioners (MRCGP) international. Conclusion: The present study revealed that despite all challenges, the well-structured FM program enabled the graduates to reach high clinical, administrative, leadership, and academic positions such as consultant (40), chief executive officer (1), chief advisor for primary care (1), director (9), head of sections (9), head/deputy head of primary health center (55), head of academic affair center (1), chair of MRCGP international (1), program director of FM (4), MRCGP convener (6), MRCGP coordinator (6), and MRCGP examiner (42). However, the program is still lacking certification by an international accreditation body. This will help in reaching a better balance between education and clinical duties for all trainers and faculty; and will positively advocate support for an environment conducive to learning for residents as well as faculty members.

With a growing trend in the popularity of web-based resources, it is important to evaluate residency program websites for providing accurate information for dermatology residency applicants. Little is known about the quality of dermatology residency websites in Taiwan. The aim of the study is to assesses the quality of official websites of dermatology training programs in Taiwan. A literature search for all related studies from inception to 31 July 2020 was performed using PubMed without restriction on language. We used criteria that had 6 domains and 25 items to evaluate 23 official websites of the dermatology training programs in Taiwan from August to September 2020. Of the 23 training programs, only 6 (26%) of the websites met more than half of the criteria. Notably, the items “features of the department” and “comprehensive faculty listing” were included in all websites. The criteria for interview process, board pass rates, social activities and information on the surrounding area were not met by all websites. Evidently, there is much room for improvement for the dermatology training program websites in Taiwan.

Abstract Background E-learning—the use of Internet technologies to enhance knowledge and performance—has become a widely accepted instructional approach. Little is known about the current use of e-learning in postgraduate medical education. To determine utilization of e-learning by United States internal medicine residency programs, program director (PD) perceptions of e-learning, and associations between e-learning use and residency program characteristics. Methods We conducted a national survey in collaboration with the Association of Program Directors in Internal Medicine of all United States internal medicine residency programs. Results Of the 368 PDs, 214 (58.2%) completed the e-learning survey. Use of synchronous e-learning at least sometimes, somewhat often, or very often was reported by 85 (39.7%); 153 programs (71.5%) use asynchronous e-learning at least sometimes, somewhat often, or very often. Most programs (168; 79%) do not have a budget to integrate e-learning. Mean (SD) scores for the PD perceptions of e-learning ranged from 3.01 (0.94) to 3.86 (0.72) on a 5-point scale. The odds of synchronous e-learning use were higher in programs with a budget for its implementation (odds ratio, 3.0 [95% CI, 1.04–8.7]; P = .04). Conclusions Residency programs could be better resourced to integrate e-learning technologies. Asynchronous e-learning was used more than synchronous, which may be to accommodate busy resident schedules and duty-hour restrictions. PD perceptions of e-learning are relatively moderate and future research should determine whether PD reluctance to adopt e-learning is based on unawareness of the evidence, perceptions that e-learning is expensive, or judgments about value versus effectiveness.

Objective: To study the factors for choosing residency training programs of medical students. Material and Method: Cross-sectional study was conducted to survey all the sixth year medical students, Faculty of Medicine, Prince of Songkla University in 2015 and 2016. Questionnaires for demographic data and factors for choosing residency training programs were used. Frequency, percentage, mean, standard deviation, and chi-square were used to analyze the data. Results: There were 275 medical students (69.9%) who completed the questionnaires. Of the medical students, 56.0% were female; mean age was 23.5 years old. The top three residency training programs chosen were: internal medicine, surgery, and pediatrics (15.6%, 14.2%, and 13.8%). Factors for choosing residency training programs were individual interest (73.5%), impression of staff role models and jobs, the patients of these departments, and the experience gained before choosing. Conclusion: Medical students chose the top three residency training programs: internal medicine, surgery and pediatric. The factors for choosing residency training were individual interest.

We present a novel airway simulation tool that recreates the dynamic challenges associated with emergency airways. The Suction-Assisted Laryngoscopy Assisted Decontamination (SALAD) simulation system trains providers to use suction to manage emesis and bleeding complicating intubation. We modified a standard difficult-airway mannequin head (Nasco, Ft. Atkinson, WI) with hardwarestore equipment to enable simulation of vomiting or hemorrhage during intubation. A pre- and post-survey was used to assess the effectiveness of the SALAD simulator. We used a 1-5 Likert scale to assess confidence in managing the airway of a vomiting patient and comfort with suction techniques before and after the training exercise. Forty learners participated in the simulation, including emergency physicians, anesthesiologists, paramedics, respiratory therapists, and registered nurses. The average Likert score of confidence in managing the airway of a vomiting or hemorrhaging patient pre-session was 3.10±0.49, and post-session 4.13±0.22. The average score of self-perceived skill with suction techniques in the airway scenario presession was 3.30±0.43, and post-session 4.03±0.26. The average score for usefulness of the session was 4.68±0.15, and the score for realism of the simulator was 4.65±0.17. A training session with the SALAD simulator improved trainee’s confidence in managing the airway of a vomiting or hemorrhaging patient. The SALAD simulation system recreates the dynamic challenges associated with emergency airways and holds promise as an airway training tool. [West J Emerg Med. 2017;18(1)117-120.]