Pathology Resident Evaluation During the Pandemic: Testing and Implementation of a Comprehensive Online Pathology Exam

Despite global digitization, evaluating pathology trainees by paper exams remains the norm. As new social distancing practices require new ways of administering exams, we assessed the viability of an online format for in-house exams from the resident and examiner perspectives. First, pathology residents participated in a practice exam, while staff who were experienced in creating exams were given an online exam-creation demonstration. Subsequently, residents completed a formal 3-hour online exam comprised of multiple-choice, matching, short answer, and whole slide images in place of the paper exam regularly used to evaluate trainees. The experience of the participants was evaluated by surveys. Eighteen residents completed the practice exam; 67% were receptive to the new format and 94% were in favor of moving to digital exams. Seven staff evaluated the digital format and 6 were in favor of it. For the formal online in-house exam, 20 residents participated and 14 completed the survey. Feedback was generally positive with the most common issue being slow-loading digital slides. Exam scores stratified by postgraduate training years in a statistically significant manner, showing positive correlation with resident training level. The online exam format was preferred over paper exams by trainees, with support from both staff and trainees for a permanent transition. Online exams have clear advantages, but technical issues should be addressed before widespread implementation. Our study demonstrates that online exams are a feasible alternative for trainee assessment, especially in socially distanced environments.

Impact of a financial incentive on the completion of educational metrics

Background The Accreditation Council for Graduate Medical Education (ACGME) requires all emergency medicine (EM) training programs to evaluate resident performance and also requires core faculty to attend didactic conference. Assuring faculty participation in these activities can be challenging. Previously, our institution did not have a formal tracking program nor financial incentive for participation in these activities. In 2017, we initiated an educational dashboard which tracked and published all full-time university faculty conference attendance and participation in resident evaluations and other educational activities. Objectives We sought to determine if the implementation of a financially-incentivized educational dashboard would lead to an increase in faculty conference attendance and the number of completed resident evaluations. Methods We conducted a pre- and post-intervention observational study at our EM residency training program between July 2017 and July 2019. Participants were 17 full-time EM attendings at one training site. We compared the number of completed online resident evaluations (MedHub) and number of conference days attended (call-in verification) before and after the introduction of our financial incentive in June 2018. The incentive required 100% completion of resident evaluations and at least 25% attendance at eligible didactic conference days. We calculated pre- and post-intervention averages, and comparisons were made using a chi-square test. Results Prior to implementation of the intervention, the 90-day resident evaluation completion rate was 71.8%. This increased to 100% after implementation (p < 0.001). Conference attendance prior to implementation was 43.8%, which remained unchanged at 41.3% after implementation of the financial incentive (p = 0.920). Conclusions Attaching a financial incentive to a tracked educational dashboard increased faculty participation in resident evaluations but did not change conference attendance. This difference likely reflects the minimum thresholds required to obtain the financial incentive.

An evaluation of telehealth expansion in U.S. nursing homes

Objective This research brief contains results from a national survey about telehealth use reported in a random sample of U.S. nursing homes. Methods and Materials The sample includes nursing homes (N = 664) that completed surveys about information technology maturity, including telehealth use, beginning January 1, 2019, and ending August 4, 2020. A pre/post design was employed to examine differences in nursing home telehealth use for nursing homes completing surveys prior to and after telehealth expansion, on March 6, 2020. We calculated a cumulative telehealth score using survey data from 6 questions about extent of nursing home telehealth use (score range 0-42). We calculated proportions of nursing homes using telehealth and used logistic regression to look for differences in nursing homes based on organizational characteristics and odds ratios. Results Significant relationships were found between nursing home characteristics and telehealth use, and specifically, larger metropolitan homes reported greater telehealth use. Ownership had little effect on telehealth use. Nursing homes postexpansion used telehealth applications for resident evaluation 11.24 times more (P &lt; .01) than did nursing homes pre-expansion. Discussion Administrators completing our survey reported a wide range of telehealth use, including approximately 16% having no telehealth use and 5% having the maximum amount of telehealth use. Mean telehealth use scores reported by the majority of these nursing homes is on the lower end of the range. Conclusions One solution for the current pandemic is to encourage the proliferation of telehealth with continued relaxed regulations, which can reduce isolation and preserve limited resources (eg, personal protective equipment) while maintaining proper distancing parameters.

The Fundamentals of Resident Dismissal

Residents have the rights and responsibilities of both students and employees. Dismissal of a resident from a training program is traumatic and has lasting repercussions for the program director, the faculty, the dismissed resident, and the residency. A review of English language literature was performed using PUBMED and OVID databases, using the search terms, resident dismissal, resident termination, student dismissal, student and resident evaluation, legal aspects of education, and remediation. The references of each publication were also reviewed to identify additional appropriate citations. If the Just Cause threshold has been met, educators have the absolute discretion to evaluate academic and clinical performance. Legal opinion has stated that it is not necessary to wait until a patient is harmed to dismiss a resident. Evaluations should be standard and robust. Negative evaluations are not defamatory as the resident gave consent to be evaluated. Provided departmental and institutional polices have been followed, a resident can be dismissed without a formal hearing. Residencies are entitled to modify academic requirements and dismissal is not considered a breach of contract. Although there is anxiety regarding resident dismissal, the courts have uniformly supported faculty having this role. When indicated, failure to dismiss a resident also places the program director and the faculty at risk for educational malpractice.

Resident Evaluation and Expectation of Social Services in Guangzhou

China's welfare system is a typical “residual welfare regime”, which did not manifest too many flaws in the planned economy era. However, economic reform and market-oriented transformations in recent decades have shaken the original well-balanced “residual” and “needs” pattern. The decline of the “work unit system” has led to two consequences: First, it radically transformed the social and economic structures, which gave rise to increased and diversified needs of social welfare. Second, the government is being pressed to shoulder more responsibility for social welfare provisions. This article adopts a case study approach to examine changing social welfare needs and expectations in Guangzhou, a relatively developed city in southern China. With particular focus on the major strategies adopted by the Guangzhou government in addressing people's welfare needs, this article critically examines how far the new measures have met the changing welfare expectations of citizens in mainland China.