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Introduction: Novel teaching curricula using simulated patients (SP) and a team-based approach are needed to teach pediatric residents how to approach behavioral health (BH) conditions in an integrated care setting. Method: This mixed-methods study evaluated a pilot curriculum on BH integration in pediatric primary care. Two 1-hour didactic sessions and 3 hours of SP encounters focused on attention-deficit/hyperactivity disorder (ADHD) and anxiety, followed by facilitated debriefings that included interdisciplinary team members. Residents completed pre- and postcurriculum surveys on self-efficacy in patient assessment and management. A subset of residents participated in semistructured interviews, reviewing video recordings of their SP encounters to facilitate reflection on their learning. We conducted qualitative analysis of interview transcripts until we reached thematic saturation. Results: Residents (n = 31) reported significantly improved self-efficacy in the majority of BH skills (p [less than or equal to] .05 to p < .0001), including assessing and discussing concerns with families, using screening tools, developing management plans, prescribing medications, and performing warm handoffs with BH clinicians. In analysis of 15 interviews, four themes emerged: shared experiences, mutual engagement, contextual meaning, and behavioral change, which aligned with the components of the communities of practice framework. Sharing experiences within an integrated BH-pediatric primary care learning community enhanced activated, self-reflective learning and consequent behavioral change that contributed to identity formation. Discussion: Resident participation in the integrated BH-pediatric curriculum improved self-efficacy in patient care for anxiety and ADHD. Curricula implemented in integrated learning communities could help promote reflection and improve integrated pediatric-BH care, including warm handoffs from pediatric to BH providers. Keywords: behavioral health, integrated primary care, pediatric residents, simulated patients, warm handoff, Behavioral health (BH) conditions affect at least 20% of the pediatric population. Skillful management of complex behavioral problems requires active listening and implementing evidence-based practice that interfaces with BH professionals. [...]

Context The advanced access (AA) model is based on several core pillars, including balancing appointment supply and demand, regularly adjusting supply, optimizing appointment systems and collaboration practices. Exposure of family medicine resident to AA within university family medicine groups (U-FMGs) is a promising strategy to widen its dissemination. It is also essential to reflect on aspects of the model that could be adopted as well as those requiring adaptation to improve the residency experience. Objective Determine compatibility of U-FMG residency programs with AA pillars. Study Design and Analysis Cross-sectional survey of local residency program characteristics with respect to AA pillars. Program compatibility with 4 AA pillars was categorized inductively by a research team that included clinicians, AA experts, a residency program expert and 4 family medicine residents. Setting 46 U-FMGs in Quebec, Canada Population studied The chief resident and academic director of each U-FMG Instrument A de novo online survey questionnaire piloted with 3 former chief residents. The survey included 32 questions about family group practices, residency rotation programs, opportunities to collaborate with other professionals and training received on AA. The questionnaire and 2 reminders were sent by email to all respondents. Outcome measures Characteristics of residency programs were grouped by AA pillar. A three-level score (compatible, moderately compatible, or not very compatible with the principles of AA) was assigned to each group of characteristics of local U-FMG residency programs. Results 38 of 46 U-FMGs participated (82.6%). No U-FMG obtained a score of compatible for all 4 pillars considered. Balancing appointment supply and demand appeared to be adequate for >70% of U-FMGs. However, 60% of U-FMG appointment systems were not very compatible with the AA model, mostly because the proportion of the schedule reserved for urgent appointments was insufficient. Opportunities for collaboration were compatible with AA principles in 32% of programs. Almost 66% of programs offered training on AA. Conclusions Our study highlights the heterogeneity among residency programs with respect to their compatibility with AA. Our theoretical approach limits the objective assessment of the impact on timely access for patients. A second part of the project correlating AA indicators with residency program characteristics is ongoing., Presenters Marie-Eve Boulais, MD, BSc, David Perrier, MD, BSc, Francois Racine-Hemmings, MD, MSc, Nadia Deville-Stoetzel, Mylaine Breton, PhD, Isabelle Gaboury, [...]

Context: Women's health procedures are essential services few family medicine (FM) residents provide upon graduation. Improving training and confirming these skills' acquisition is crucial for safe health care delivery. Objective: The objective of this study was to develop and provide preliminary validity evidence for two performance rating instruments for intrauterine device insertion, endometrial biopsy, punch biopsy of the vulva, and routine pessary care. Study Design: Modified Delphi consensus and descriptive prospective study. Setting: Nine Canadian universities. Participants: Academic family physicians and gynaecologists. Instrument/Intervention: Procedure-specific checklists were developed based on empirical evidence and content expert opinion. Academic family physicians (n=12) and gynecologists (n=4)participated in a modified Delphi to finalize the items for the checklists. Consensus was defined as a priori. A previously validated global rating scale was modified to accommodate women's health procedures in ambulatory settings. Academic family physicians (n=19) piloted the procedure-specific checklists and the global rating scales. They rated two videos (one first- year and one second-year FM resident) performing the four procedures while blinded to their level of training. They also evaluated the ease of use and acceptability of two instruments. Average scores for the procedure-specific checklists and the global rating scales for each procedure were calculated and correlated with the year of training for each procedure. Results: Consensus on items for the final checklists was reached after two rounds of a modified Delphi. Although Procedure-specific checklists' scores did not correlate with the level of training, the global rating scales' scores did. Both instruments received high average overall scores (31/36) for ease of use and acceptability for all four procedures. Conclusion: We designed performance rating instruments for four women's health procedures and provided evidence for content validity through rigorous checklist development informed by the literature and a panel of Canadian experts. Piloting the instruments demonstrated validity for the response process, with raters describing the scales as easy to use and understand. The positive correlation of the global rating scale with training year provides preliminary data on validity for relation to other variables. These instruments may facilitate the training and assessment of FM residents., Presenters Parisa Rezaiefar, CCFP, Douglas Archibald, PhD, Nisha Waqas, MD, Susan [...]

PURPOSE The purpose of this study was to characterize graduates of family medicine (FM) residencies from 1994 to 2017 and determine whether they continue to practice family medicine after residency. METHOD We sampled physicians who completed FM residency training from 1994-2017 using 2017 American Medical Association (AMA) Physician Masterfile linked with administrative files of the American Board of Family Medicine (ABFM). The main outcomes measured were characteristics of FM residency graduates, including medical degree type (Doctor of Medicine, MD vs Doctor of Osteopathic Medicine, DO), international medical school graduates (IMGs) vs US graduates, sex, ABFM certification status, and self-designated primary specialty. Family medicine residency graduates were grouped into 4-year cohorts by year of residency completion. RESULTS From 1994 to 2017, 66,778 residents completed training in an ACGME accredited FM residency, averaging 2,782 graduates per year. The number of FM residency graduates peaked in 1998-2001, averaging 3,053 each year. The composition of FM residents diversified with large increases in DOs, IMGs, and female graduates over the past 24 years. Of all the FM residency graduates, 91.9% claimed FM as their primary specialty and 81% were certified with ABFM in 2017. FM/sport medicine (2.1%), FM/geriatric medicine (0.9%), internal medicine/geriatrics (0.8%), and emergency medicine (0.7%) were the most common non-FM primary specialties reported. CONCLUSIONS DOs, IMGs, and female family medicine residency graduates increased from 1994 to 2017. With 9 in 10 graduates of family medicine residencies designating FM as their primary specialty, FM residency programs not only train but supply family physicians who are likely to remain in the primary care workforce. Key words: family medicine; residency graduates; primary specialty https://doi.org/10.1370/afm.2535., INTRODUCTION Exacerbating the projected shortage of primary care physicians, (1) only 10.9% US medical students entered family medicine (FM) training in 2016. (2) In response, the American Academy of Family [...]

Background: This study's aim was to evaluate the performance of senior orthopedic residents during simulated arthroscopic anterior stabilization (Bankart repair) before and after a national shoulder review course. Methods: Participants were assessed before and after the Annual Shoulder Review Course over a 3-day period, using a multiple-choice examination and surgery performance assessment. The surgical evaluation was completed by fellowship-trained surgeons using a standardized procedure checklist and a global rating scale. All Canadian senior orthopedic residents were invited to participate in the course. Results: The 57 participants showed improvement following the course. The written knowledge evaluation mean score increased, and all 3 surgical performance measurements improved: surgical task time improved from 4:40 min to 2:53 min (p < 0.001), surgical technique evaluation increased from 56% to 67% after the procedure checklist (p < 0.001), and anchor placement improved for all 3 aspects. Anchor entry point was the sole measure not to improve enough to reach statistical significance (p = 0.37). Conclusion: Our data support the inclusion of dry model surgical simulation as part of a surgical skills course for both training and assessment of orthopedic surgery residents. Contexte : Le but de cette étude était d'évaluer le rendement des résidents seniors en orthopédie durant une simulation de stabilisation arthroscopique antérieure (intervention de Bankart) avant et après un cours de révision national sur l'articulation de l'épaule. Méthodes: Les participants ont été évalués avant et après l'Annual Shoulder Review Course sur une période de 3 jours, à l'aide d'un examen à choix multiples et d'une épreuve chirurgicale pratique. L'évaluation chirurgicale était effectuée par des chirurgiens spécialisés, à l'aide d'une liste de vérification normalisée des procédures et d'une échelle d'évaluation globale. Tous les résidents séniors canadiens en orthopédie étaient invités à participer au cours. Résultats: Les 57 participants ont montré une amélioration après le cours. Les résultats à l'examen écrit ont augmenté, tout comme ceux des 3 évaluations chirurgicales : le temps chirurgical a diminué, passant de 4:40 min à 2:53 min (p < 0,001), l'évaluation de la technique chirurgicale a augmenté de 56% à 67% selon la liste de vérification (p < 0,001) et le positionnement des ancres s'est aussi amélioré pour les 3 positionnements. Le point d'entrée des ancres a été la seule mesure à ne pas s'améliorer suffisamment pour atteindre une portée statistique (p = 0,37). Conclusion: Nos données appuient l'inclusion d'un modèle de simulation sec pour la formation et l'évaluation des résidents en chirurgie orthopédique., Learning surgical skills can be understood with Fitts and Posner's 3-phase framework for acquiring motor skills. (1,2) The initial cognitive phase is characterized by learners understanding the skills and watching [...]

Background: There is a notably steep learning curve to arthroscopy. In a time-constrained residency, simulation provides an additional medium to practice. However, as residents progress through a competency-based program, it [...]

Background: In procedural-based medicine, technical ability is a critical determinant of patient outcomes. Psychomotor performance occurs in real-time, hence a continuous assessment is necessary to provide action-oriented feedback and error [...]

Background: Concerns about the achievement of surgical proficiency during residency are increasing. To objectify surgical skills, the Objective Structured Assessment of Technical Skills (OSATS) was developed and proven valid, feasible and reliable for use in laboratory settings. This study aimed to evaluate the value of this tool for intraoperative use. Methods: Residents were assessed with an OSATS after every procedure they performed as the primary surgeon during a 3-month clinical rotation in gynecological surgery. We mapped individual learning curves (OSATS scores plotted against experience) and established the average procedure-specific learning curve. We used linear mixed models to assess the relation between performance and experience. Results: Nine residents were recruited and 319 OSATS analyzed. Individual learning curves revealed progression beyond 24 of 30 OSATS points for 7 residents. Performance on the average procedure improved with experience, and the OSATS score increased by an average of 1.10 points per assessed procedure (p = 0.008, 95%confidence interval 0.44-1.77). Median OSATS scores ranged from 18 to 30 among the 21 assessors. Conclusion: Intraoperative implementation of OSATS seems to offer important advantages: structured feedback is facilitated, and learning curves enable insight into individual progression. However, doubts have been raised about the objectivity of the tool. Therefore, caution is warranted in using it for graduation and certification. Contexte : La maitrise de la chirurgie acquise au cours de la residence preoccupe de plus en plus. Pour rendre les techniques chirurgicales objectives, on a mis au point revaluation structuree objective des habiletes techniques (Objective Structured Assessment of Technical Skills; OSATS) et on en a demontre la viabilite, la faisabilite et la fiabilite pour utilisation en laboratoire. Cette etude vise a determiner la valeur de cet outil au cours des interventions. Methodes : Les medecins residents ont ete soumis a une evaluation OSATS apres chaque intervention qu'ils ont pratiquee comme chirurgien principal au cours d'un stage clinique de 3 mois en chirurgie gynecologique. Nous avons etabli les courbes d'apprentissage individuelles (courbes des resultats OSATS en fonction de l'experience), ainsi que la courbe d'apprentissage moyenne particuliere a l'intervention. Nous avons utilise des modeles mixtes lineaires pour evaluer le lien entre le rendement et l'experience. Resultats : Nous avons recrute 9 medecins residents et analyse 319 evaluations OSATS. Les courbes d'apprentissage individuelles ont revele un progres superieur a 24 points OSATS sur 30 chez 7 medecins residents. L'execution de l'intervention moyenne s'est amelioree avec l'experience et le resultat de l'evaluation OSATS a augmente en moyenne de 1,10 point par intervention evaluee (p = 0,008, intervalle de confiance a 95 %, 0,44-1,77). Les resultats medians de l'evaluation OSATS ont varie de 18 a 30 chez les 21 evaluateurs. Conclusion : L'application de devaluation OSATS aux interventions semble offrir des avantages importants : les commentaires structures sont facilites et les courbes d'apprentissage donnent une idee de l'evolution de chaque medecin. On a toutefois souleve des doutes quant a l'objectivite de l'outil. La prudence s'impose donc dans l'utilisation de celui-ci aux fins d'obtention du diplome et du certificat., Nowadays, it is becoming more and more difficult to achieve surgical proficiency. Residents experience less training owing to reduced working hours and a decreased surgical caseload. (1) Additionally, with the [...]