Engaging Pathology Residents in Clinical Chemistry: The Essential Ingredient Is a Committed Teacher

Background Pathology residents are thought to show a lack of interest in clinical chemistry, therefore potentially graduating from training programs unprepared to function as laboratory directors and clinical consultants. Methods A structured program of tutorials based primarily on Henry’s textbook, supplemented by recent review articles; a question bank of about 600 questions to emphasize key concepts; requirement for performing and presenting quality improvement projects; participation in on-site CAP inspections; review of reference laboratory test requests; and involving residents in scholarly activity have resulted in sustained, transferable, and significant improvements in engagement, knowledge, competence, and examination scores. Results The primary parameter for measuring change in resident competence and engagement were improvements in resident in-service examination (RISE) scores, publications in peer-reviewed journals, and receipt of awards. The revised program produced significant improvement in RISE scores in clinical chemistry, over and above the improvements in the general residency program. The residents were authors on 12 publications in peer-reviewed PubMed listed journals in the 5-year period since revision in the clinical chemistry curriculum compared to no publications in clinical chemistry in the 5-year period before the new curriculum. Over the past 2 years, 6 of the 11 publications by graduating residents were in clinical chemistry, and 6 of 7 awards for research were garnered by residents engaged in clinical chemistry investigations. All of the residents passed their clinical pathology boards on first attempt since the change compared to 2 failures in the prior 5-year period. Conclusions The structured program described here is important as a template that could be adopted by any pathology training program. The question bank developed by this program is a valuable and transferable aid. However, success of such a program is dependent on the commitment of a knowledgeable, dedicated, and passionate teacher.

Breastfeeding Education in Family Medicine Residencies: A 2019 CERA Program Directors Survey

Background and Objectives: Breastfeeding counseling is an integral skill for all family physicians, regardless of whether they ultimately practice maternal child health (MCH). Evidence on time spent in breastfeeding education and resident competence is lacking. This study aimed to identify program characteristics associated with an increase the amount of breastfeeding education and program directors’ (PDs) perceived competence of residents’ breastfeeding counseling skills. Methods: A national survey of family medicine PDs including breastfeeding questions was conducted as part of the 2019 CERA survey. We specifically sought to identify variables that correlate with increased breastfeeding education time and perceived competence. Results: Family medicine programs with greatest breastfeeding education time and perceived resident competence included lactation consultants, had more MCH visits in resident continuity clinic, more graduates that practice MCH, and included competency evaluations by faculty. There was more volume of breastfeeding education in programs with group prenatal care and an academic affiliation. There was greater perceived competence among programs with more hours of breastfeeding training overall. Conclusions: This study defines associations with curricular targets for improved breastfeeding counseling competence among family medicine residents. Inclusion of lactation consultants, regular faculty observation of counseling skills, and group prenatal care may be gradually introduced in programs to strengthen resident education and skills in breastfeeding counseling. The body of evidence in this field remains lacking, and further research is needed to characterize curricular interventions that increase resident competence in this important skill.

2017 Program Director Survey

ObjectiveTo survey adult neurology program directors (PDs) and inform the future development of neurology training programs.MethodsAll US adult neurology PDs were invited to complete the survey. The goals were to determine the demographic makeup of residency programs, characterize curricula, understand PD and program needs, and compare results to those of a similar survey in 2007.ResultsThe response rate was 70.6%. PD demographics for age, faculty track status, and academic rank remain unchanged over the last decade. The proportion of female PDs and assistant PDs has increased significantly. The mean number of residents per training program has also increased significantly. Female PDs are more likely to have a junior academic rank than their male colleagues. Disparities remain between the PDs' time spent on teaching/program administration and salary support. Most PDs support moving fellowship applications later in the training cycle. The majority of PDs find the Clinical Competency Committee process useful in assessing resident competence. A minority of PDs feel that the Accreditation Council for Graduate Medical Education Milestones meet their intended purpose. Half of programs include a curriculum to supplement the clinical experience on child neurology rotations. A third of programs include a supplemental curriculum for psychiatry rotations. The majority of programs offer a general fund for residents to use to support their education.ConclusionDeficiencies exist in compensation for PDs' teaching and administrative time and for academic promotion for female PDs. These results serve as a benchmark for comparison across programs and the basis to advocate for further improvements and support for neurology residency training.

A Cross-Specialty Examination of Resident Error Disclosure and Communication Skills Using Simulation

ABSTRACT Background Disclosure of medical errors is important to patients and physicians, but formal disclosure training during the graduate medical education curriculum is limited. Objective We examined resident competence related to error disclosure, using standardized patient (SP) ratings of resident communication skills. Methods All first-year residents from medicine, radiology, emergency medicine, orthopedic surgery, and neurological surgery completed a 20-minute simulated session in which they were provided background information on a medical error they had made and were asked to disclose the error to an SP acting as a family member. Residents were then debriefed and completed a postscenario questionnaire. The SPs completed an 11-item communication assessment and 3 milestone rating tools on professionalism (PROF-1, PROF-3) and interpersonal and communication skills (ICS-1). Results Ninety-six residents from a single institution participated toward the end of the intern year. Communication assessment scores ranged from 23% to 100% (mean [SD], 80.6 [17.0]). Mean (SD) milestone ratings across specialties were 2.80 ± 0.92 for PROF-1, 2.48 ± 0.92 for PROF-3, and 2.45 ± 0.92 for ICS-1. One-way analysis of variance revealed no significant differences among specialties on milestone or communication ratings. Residents who accepted personal responsibility for the error (84.55 [14.06]) received significantly higher communication ratings from SPs compared with residents who did not (66.67 [19.52], P < .001). Conclusions This SP assessment of error disclosure by first-year residents from multiple specialties was feasible and acceptable. It revealed areas of improvement as well as considerable variation in communication skills and professionalism among residents.