Pediatric neurosurgery training during residency in the United States: a program director survey

OBJECTIVEPediatric neurosurgery is a core component of neurosurgical residency training. Pediatric case minimums are established by the Neurosurgery Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME). Case minimums, by themselves, allow for great variability in training between programs. There are no prior data on how the residency programs meet these requirements. The authors’ objective was to gather information on pediatric neurosurgical education among the ACGME-accredited neurosurgery training programs in order to shape further pediatric neurosurgical educational efforts.METHODSA 25-question survey about pediatric neurosurgical education was created by the Education Committee of the Section on Pediatric Neurological Surgery of the American Association of Neurological Surgeons/Congress of Neurological Surgeons and distributed to program directors of all 111 ACGME-accredited neurosurgery training programs.RESULTSThe response rate was 77% (86/111). In 55% of programs the residents are rotated to a responder-designated “freestanding” children’s hospital, and 39% of programs rotate residents to a children’s hospital within a larger adult hospital or a general hospital. There are 4 or fewer pediatric neurosurgical faculty in 91% of programs. In 12% of programs less than 100 cases are performed per year, and in 45% more than 500 are performed. In 31% of responding neurosurgery residency programs there is also a pediatric neurosurgery fellowship program supported by the same sponsoring institution. Seventy-seven percent of programs have at least one specific pediatric neurosurgery rotation, with 71% of those rotations occurring during postgraduate year 3 and 50% occurring during postgraduate year 4. The duration of pediatric rotation varies from no specific rotation to more than 1 year, with 48% of residents spending 4–6 months on a pediatric rotation and 12% spending 7–11 months. Last, 17% of programs send their residents to external sites sponsoring other residency programs for their pediatric rotation.CONCLUSIONSThere is great variety between neurosurgery training programs with regard to resident education in pediatric neurosurgery. This study’s data will serve as a baseline for future studies, and the authors hope the findings will guide further efforts in pediatric neurosurgical education in residency training programs.

The Role of the American Board of Surgery in the Development of Surgical Residencies in Post–World War II America

The creation of Boards fundamentally altered the American medical landscape and transformed the process of educating physicians. The American Board of Surgery, founded in 1937, epitomized this role. It established expectations, implemented an inspection system to enforce those standards, and ultimately collaborated with other professional organizations to create the Residency Review Committee that endures today. Using surgery as an example, we show how the appeal of board certification imbued Boards with the power and authority to reshape graduate medical education in their image in post–World War II America.

Training in paediatric cardiac surgery and the American Board of Thoracic Surgery

Congenital heart surgery has evolved into its own specialty requiring unique techniques and skills. Recognizing the need to establish a special certification in congenital heart surgery, the American Board of Thoracic Surgery began the process in 2005, eventually granting the first certifications to qualified applicants in 2009. The American Council for Graduate Medical Education and the Thoracic Surgery Residency Review Committee have now approved specific training programs throughout the United States that will help to ensure the proper training of congenital heart surgeons for the future.

Role of an Audience Response System in Didactic Attendance and Assessment

Background The Residency Review Committee for Emergency Medicine mandates conference participation, but tracking attendance is difficult and fraught with errors. Feedback on didactic sessions, if not collected in real time, is challenging to obtain. Objective We assessed whether an audience response system (ARS) would (1) encourage residents to arrive on time for lectures, and (2) increase anonymous real-time audience feedback. Methods The ARS (Poll Everywhere) provided date/time-stamped responses to polls from residents, including a question to verify attendance and questions to gather immediate, anonymous postconference evaluations. Fisher exact test was used to calculate proportions. Results The proportion of residents who completed evaluations prior to the institution of the ARS was 8.75, and it was 59.42 after (P < .001). The proportion of faculty who completed evaluations prior to using the ARS was 6.12, and it was 85.71 after (P < .001). The proportion of residents who reported they had attended the conference session was 55 for the 3 weeks prior to initiating the ARS, decreasing to 46.67 for the 3 weeks during which the ARS was used to take attendance (P = .46). The proportion of faculty who reported attending the conference was 5.56 for the 3 weeks prior to ARS initiation, decreasing to 4.44 for the 3 weeks while using the ARS (P = .81). Conclusions Audience response systems are an effective way to verify attendance and tardiness, eliminating the subjective effect of attendance takers' leniency and increasing completion of evaluations for didactic sessions.

Length of Training Debate in Family Medicine: Idealism Versus Realism?

How long a resident must train to achieve competency is an ongoing debate in medicine. For family medicine, there is an Accreditation Council for Graduate Medical Education (ACGME)–approved proposal to examine the benefits of lengthening family medicine training from 3 to 4 years. The rationale for adding another year of residency in family medicine has included the following: (1) overcoming the effect of the duty hour limits in further reducing educational opportunities, (2) reversing the growing number of first-time takers of the American Board of Family Medicine primary board who fail to pass the exam, (3) enhancing the family medicine training experience by “decompressing” the ever-growing number of Residency Review Committee requirements to maintain accreditation, and (4) improving the overall quality of family medicine graduates.

A Multidisciplinary Approach for Teaching Systems-Based Practice to Internal Medicine Residents

Background Rapid growth in the complexity of the health care environment (including monitoring systems for health care quality and patient safety) may result in graduating internists not being adequately prepared for the demands the system places on them. In response, the Residency Review Committee for Internal Medicine created the Educational Innovations Project (EIP) to encourage select residency training programs to develop new strategies and methods to meet changing demands in graduate medical education. Methods As part of the EIP, our program created an innovative administrative internship. This multiyear curriculum provides systems-based practice training and consists of a series of rotations that take place during the 3 years of internal medicine residency. Each session involves close interaction with the nonphysician personnel who are instrumental in making our institution a functional and cohesive unit. To assess the potential impact of the rotations, we survey senior residents, recent graduates, and faculty educators. In conjunction with the Performance and Patient Experience departments of the hospital, we track several systems-based practice metrics for residents, including compliance with core health care measures, length of stay, and patient satisfaction. Results Residents recognize the need to develop systems-based practice skills, to readily participate in structured curricula designed to enhance such skills, and to provide leadership in organizing and publishing quality improvement initiatives, and upon graduation, they may lament that they did not receive even more vigorous training in these areas. Conclusion Although internal medicine residencies continue to improve their training in systems-based practice, our experience suggests that an even greater emphasis on these skills may be warranted.

Automated Data Mining: An Innovative and Efficient Web-Based Approach to Maintaining Resident Case Logs

Background Use of resident case logs has been considered by the Residency Review Committee for Neurology of the Accreditation Council for Graduate Medical Education (ACGME). Objective This study explores the effectiveness of a data-mining program for creating resident logs and compares the results to a manual data-entry system. Other potential applications of data mining to enhancing resident education are also explored. Design/Methods Patient notes dictated by residents were extracted from the Hospital Information System and analyzed using an unstructured mining program. History, examination and ICD codes were obtained and compared to the existing manual log. The automated data History, examination, and ICD codes were gathered for a 30-day period and compared to manual case logs. Results The automated method extracted all resident dictations with the dates of encounter and transcription. The automated data-miner processed information from all 19 residents, while only 4 residents logged manually. The manual method identified only broad categories of diseases; the major categories were stroke or vascular disorder 53 (27.6%), epilepsy 28 (14.7%), and pain syndromes 26 (13.5%). In the automated method, epilepsy 114 (21.1%), cerebral atherosclerosis 114 (21.1%), and headache 105 (19.4%) were the most frequent primary diagnoses, and headache 89 (16.5%), seizures 94 (17.4%), and low back pain 47 (9%) were the most common chief complaints. More detailed patient information such as tobacco use 227 (42%), alcohol use 205 (38%), and drug use 38 (7%) were extracted by the data-mining method. Conclusions Manual case logs are time-consuming, provide limited information, and may be unpopular with residents. Data mining is a time-effective tool that may aid in the assessment of resident experience or the ACGME core competencies or in resident clinical research. More study of this method in larger numbers of residency programs is needed.

An Institutional Approach to Assist Program Directors and Coordinators With Meeting the Challenges of Graduate Medical Education

Objective To investigate whether a multimethod approach, including a new position dedicated to graduate medical education (GME) educator, online education modules, and program file audits, was associated with quality improvement in our residency programs. Method Data related to GME audits, residency review committee citations and cycle lengths were entered into a database. We conducted statistical analyses and calculated effect sizes to explore whether these resources were associated with program quality, as measured by maintaining necessary program policies and files, implementation of multiple assessments, increased residency review committee cycle lengths, and reductions in the number of citations. Results The statistical analyses support the implementation of the GME educator, file audits, and online courses designed to improve the quality of residency education. Conclusions The GME office will continue to conduct audits, develop online learning resources, and provide one-on-one communication between the GME educator and program coordinators and directors. Our approach could serve as a model for other institutions interested in enhancing institutional oversight and the quality of their programs.