A cross-sectional study of the impact of the COVID-19 pandemic on an ophthalmology consult service in four Michigan community hospitals

Purpose: During the coronavirus disease 2019 (COVID?19) pandemic, private practice, inpatient consult services, and academic residency programs in ophthalmology saw a decrease in patient encounters. This study elucidates how community hospital ophthalmology consult (OC) services were affected during the pandemic. We aim to determine whether there was a change in resident OC volume in a community?based ophthalmology program consult service during the COVID?19 pandemic. Secondary objectives included analyzing the change in the types of diagnoses and the number of patients seen for diabetic retinopathy over the same time. Methods: A retrospective cross?sectional study was conducted reviewing the electronic health record (EHR) charts from OCs for the period 2017–2021. Records were categorized by referral source and the nature of OCs (trauma, acute, or chronic); OCs were further grouped by year and weak of referral. An intermonth analysis of weekly OC counts in each category was performed for the average number of consults in February–April 2017–2019 and for February–April 2020. A one?tailed t?test was performed. All t?tests assumed equal variances. Results: Weekly OCs in 2020 revealed no statistically significant differences in overall cases or in acute or chronic cases when the volume before the COVID?19 pandemic was compared to the volume after the onset of the pandemic. However, a statistically significant increase in the average weekly trauma cases was noted when 2020 (an average of 2.7 cases per week) was compared to the weekly average for the same weeks of years 2017– 2019 (0.4; P = 0.016). This statistically significant increase in trauma in 2020 disappeared when comparing weeks 11–17 in 2020 (2.2 cases per week) and the average of 2017–2019 (1.1).Conclusion: This report outlines no significant change in OCs before and after the onset of the pandemic compared to three previous years. There was, however, an increase in trauma consults during the pandemic and an increase in the number (though not the proportion) of diabetic retinopathy (DR+) patients seen by residents. This report uniquely describes no significant changes in the resident volume of patients seen during the COVID?19 global pandemic

Ensino das habilidades básicas de colonoscopia: os padrões de qualidade e segurança podem ser atendidos em um centro universitário / Teaching basic colonoscopy skills: quality and safety standards can be fulfilled in an outpatient university center

ABSTRACT BACKGROUND: Recent studies have shown that endoscopy fellows can perform colonoscopy effectively and safely. However, little is known about the performance of surgical residents without prior knowledge of endoscopic techniques. OBJECTIVE: To assess whether quality indicators were met at an outpatient endoscopy center and whether surgical residents, without prior upper or lower endoscopy skills, could perform colonoscopy adequately. METHODS: A prospective non-randomized cohort study was undertaken. All exams were performed either by assistant physicians or by residents. Quality measures were compared between those groups. RESULTS: A total of 2720 colonoscopies were analyzed. In the resident group, we observed older patients (57.7±12.7 years vs 51.5±14.5 years, P<0.001), a higher prevalence of screening colonoscopies (52% vs 39.4%, P<0.001) and a higher prevalence of colorectal cancer (6.4% vs 1.8%, P<0.001). The cecal intubation rate was higher in the attending group (99.9% vs 89.3%; P<0.001). The polyp detection rate was 40.8%, and no differences were observed between the studied groups. The residents had a higher rate of perforation in all exams (0.4% vs 0%; P=0.02). Postpolypectomy bleeding and 7-day readmission rates were the same (0.2%). All readmissions in 7 days occurred due to low digestive bleeding, and none required intervention. CONCLUSION: Quality indicators were met at a university outpatient endoscopy center; however, medical residents achieved lower rates of cecal intubation and higher rates of perforation than the attending physicians.

RESUMO CONTEXTO: Estudos recentes mostraram que médicos em treinamento podem realizar a colonoscopia de maneira eficaz e segura. No entanto, pouco se sabe sobre a performance dos médicos residentes de cirurgia sem o conhecimento prévio das técnicas endoscópicas. OBJETIVO: Avaliar se os indicadores de qualidade foram atendidos em um centro de endoscopia ambulatorial e se os residentes de cirurgia, sem habilidades anteriores em endoscopia alta ou baixa, realizaram a colonoscopia de forma adequada. MÉTODOS: Foi realizado um estudo de coorte prospectivo não randomizado. Todos os exames foram realizados por médicos assistentes ou residentes. Os indicadores de qualidade foram comparados entre esses grupos. RESULTADOS: Um total de 2.720 colonoscopias foram analisadas. No grupo de médicos residentes, observamos pacientes mais velhos (57,7±12,7 anos vs 51,5±14,5 anos, P<0,001), maior prevalência de colonoscopias de rastreamento (52% vs 39,4%, P<0,001) e maior prevalência de câncer colorretal (6,4% vs 1,8%, P<0,001). A taxa de intubação cecal foi maior no grupo de médicos assistentes (99,9% vs 89,3%; P<0,001). A taxa de detecção de pólipos foi de 40,8% e não foram observadas diferenças entre os grupos estudados. Os médicos residentes tiveram maior índice de perfuração (0,4% vs 0%; P=0,02). O sangramento pós-polipectomia e as taxas de readmissão em 7 dias foram iguais (0,2%). Todas as readmissões em 7 dias ocorreram devido a hemorragia digestiva baixa e nenhuma intervenção foi necessária. CONCLUSÃO: Os indicadores de qualidade foram alcançados em um centro de endoscopia universitário; no entanto, os médicos residentes alcançaram taxas mais baixas de intubação cecal e taxas mais altas de perfuração do que os médicos assistentes.

Novel Changes in Resident Education during a Pandemic: Strategies and Approaches to Maximize Residency Education and Safety

Abstract Introduction The COVID-19 pandemic has led to a reduction in surgical and clinical volume, which has altered the traditional training experience of the otolaryngology resident. Objective To describe the strategies we utilized to maximize resident education as well as ensure patient and staff safety during the pandemic. Methods We developed a system that emphasized three key elements. First and foremost, patient care remained the core priority. Next, clinical duties were restructured to avoid unnecessary exposure of residents. The third component was ensuring continuation of resident education and maximizing learning experiences. Results To implement these key elements, our residency divided up our five hospitals into three functional groups based on geographical location and clinical volume. Each team works for three days at their assigned location before being replaced by the next three-person team at our two busiest sites. Resident teams are kept completely separate from each other, so that they do not interact with those working at other sites. Conclusions Despite the daily challenges encountered as we navigate through the COVID-19 pandemic, our otolaryngology residency program has been able to establish a suitable balance between maintenance of resident safety and well-being without compromise to patient care.

“This above all: to thine own self be true…” the effects of the COVID-19 pandemic on surgical residency training and education

COVID-19 has drastically affected the current surgical training paradigm. Fellows anticipate a 10-25% decrease in procedural volumes for this year because of the pandemic. With a reduction in elective cases, surgical programs have transitioned to resident coverage cutbacks and/or reassigning trainees to non-surgical wards to assist with pandemic relief.

Simulation-based ultrasound-guided regional anesthesia curriculum for anesthesiology residents / 대한마취과학회지

Proficiency in ultrasound-guided regional anesthesia (UGRA) requires the practitioner to acquire cognitive and technical skills. For anesthesiology residents, an assortment of challenges has been identified in learning UGRA skills. Currently, a validated UGRA curriculum for residents does not exist, and the level of UGRA proficiency achieved during residency training can vary considerably. Simulated practice has been shown to enhance proficiency in UGRA, and a competency-based education with simulation training has been endorsed for anesthesiology residents. The objective of this review is to outline simulation-based training that can be implemented in a UGRA curriculum and to explore educational tools like gamification to facilitate competency in regional anesthesiology.

Development of a Diverse Learning Experience for Diverse Psychiatry Resident Needs: A Four-Year Biological Psychiatry Curriculum Incorporating Principles of Neurobiology, Psychopharmacology, and Evidence-Based Practice

OBJECTIVE: A clinically relevant approach to patient care grounded in neurobiological constructs and evidence based practice which emphasizes a relevant psychopharmacology is needed to optimally train psychiatry residents. METHODS: We implemented a biological psychiatry course that now incorporates neurobiology, psychopharmacology, and evidence-based practice in conjunction with a Research Domain Criteria (RDoC) perspective. A survey launched prior to course implementation and following each class session, served as the outcome metric of residents' attitudes toward the new curriculum and followed a baseline attitudinal survey designed to evaluate the program. RESULTS: Greater than 90% of the psychiatry residents at Duke University who took the attitudinal survey agreed or strongly agreed with needing a course that helped them develop an understanding of neurobiology, psychopharmacology, and evidence-based practice concepts. Most residents also indicated a less than adequate understanding of the neurobiology and psychopharmacology of psychiatric disorders prior to sessions. CONCLUSION: Our biological psychiatry curriculum was associated with enthusiasm among residents regarding the incorporation of neurobiology, psychopharmacology, and evidence-based practice into course topics and discussions. A biological psychiatry curriculum with integrated neurobiology and psychopharmacology built on an evidence base approach is possible, well-received, and needed in training of future psychiatrists.

Emergency department operations and management education in emergency medicine training / 世界急诊医学杂志（英文）

BACKGROUND: This study was undertaken to examine the current level of operations and management education within US-based Emergency Medicine Residency programs.METHODS: Residency program directors at all US-based Emergency Medicine Residency programs were anonymously surveyed via a web-based instrument. Participants indicated their levels of residency education dedicated to documentation, billing/coding, core measure/quality indicator compliance, and operations management. Data were analyzed using descriptive statistics for the ordinal data / Likert scales.RESULTS: One hundred and six (106) program directors completed the study instrument of one hundred and fifty-six (156) programs (70％). Of these, 82.6％ indicated emergency department (ED) operations and management education within the training curriculum. Dedicated documentation training was noted in all but 1 program (99％). Program educational offerings also included billing/coding (83％), core measure/quality indicators (78％) and operations management training (71％). In all areas, the most common means of educating came through didactic sessions and direct attending feedback or 69％-94％ and 72％-98％ respectively. Residency leadership was most confident with resident understanding of quality documentation (80％) and less so with core measures (72％), billing/coding/RVUs (58％), and operations management tools (23％).CONCLUSIONS: While most EM residency programs integrate basic operational education related to documentation and billing/coding, a smaller number provide focused education on the day-to-day management and operations of the ED. Residency leadership perceives graduating resident understanding of operational management tools to be limited. All respondents value further resident curriculum development of ED operations and management.

Graduating 4th year radiology residents' perception of optimal imaging modalities for neoplasm and trauma: a pilot study from four U.S. universities / Percepção de médicos residentes em radiologia de 4º ano sobre as melhores modalidades de imagem na investigação de neoplasias e trauma: um estudo piloto de quatro universidades americanas

OBJECTIVE: Our purpose was to assess 4th year radiology residents' perception of the optimal imaging modality to investigate neoplasm and trauma. MATERIALS AND METHODS: Twenty-seven 4th year radiology residents from four residency programs were surveyed. They were asked about the best imaging modality to evaluate the brain and spine, lungs, abdomen, and the musculoskeletal system. Imaging modalities available were MRI, CT, ultrasound, PET, and X-ray. All findings were compared to the ACR appropriateness criteria. RESULTS: MRI was chosen as the best imaging modality to evaluate brain, spine, abdominal, and musculoskeletal neoplasm in 96.3 percent, 100 percent, 70.4 percent, and 63 percent of residents, respectively. CT was chosen by 88.9 percent to evaluate neoplasm of the lung. Optimal imaging modality to evaluate trauma was CT for brain injuries (100 percent), spine (92.6 percent), lung (96.3 percent), abdomen (92.6 percent), and major musculoskeletal trauma (74.1 percent); MRI was chosen for sports injury (96.3 percent). There was agreement with ACR appropriateness criteria. CONCLUSION: Residents' perception of the best imaging modalities for neoplasm and trauma concurred with the appropriateness criteria by the ACR.

OBJETIVO: Avaliar a percepção de médicos residentes em radiologia de 4º ano sobre as melhores modalidades de imagem na investigação de neoplasias e trauma. MATERIAIS E MÉTODOS: Vinte e sete médicos residentes de 4º ano de quatro programas de residência em radiologia americanos participaram do estudo. Aos participantes foi perguntado sobre a melhor modalidade de imagem para se avaliar o cérebro e a coluna vertebral, pulmões, abdome e o sistema musculoesquelético. As modalidades de imagem disponíveis foram: RM, TC, ultrassonografia, PET e radiografia simples. Todos os achados foram comparados com os Critérios de Adequação de Exames de Imagem e Radioterapia do ACR. RESULTADOS: A RM foi escolhida como melhor modalidade de imagem para se avaliar neoplasias encefálicas, espinhais, abdominais e musculoesqueléticas por 96,3 por cento, 100 por cento, 70,4 por cento e 63 por cento dos residentes, respectivamente. A TC foi escolhida por 88,9 por cento dos residentes para avaliar neoplasias pulmonares. A modalidade de imagem ótima para se avaliar trauma foi a TC para lesões encefálicas (100 por cento), espinhais (92,6 por cento), pulmonares (96,3 por cento), abdominais (92,6 por cento) e grandes lesões traumáticas musculoesqueléticas (74,1 por cento); a RM foi escolhida para lesões esportivas (96,3 por cento). Observou-se concordância com os critérios de adequação do ACR. CONCLUSÃO: Houve concordância entre a percepção dos residentes sobre as melhores modalidades de imagem para avaliação de neoplasias e trauma e os critérios de adequação do ACR.

The Education Programs of Cardiopulmonary Resuscitation for Resident and their Effects Assessed by Anesthesiologists / 대한마취과학회지

BACKGROUND: The survival rate of cardiopulmonary resuscitation (CPR) is low in Korea. We believe the cause of this low survival rate is caused by the absence of instrumentation, the lack of manpower and by poor education quality of in-hospital CPR. The purpose of this study was to evaluate the current state of resident education with respect to cardiopulmonary resuscitation and its likely effect. METHODS: We surveyed anesthesiologists who attended the Korean Society of Anesthesiologist Congress. The questionnaire items concerned the followings; 1) The type of supplementary materials used during CPR education; 2) The Duration and frequency of CPR education according to resident grades and hospital scales; 3) The actual CPR participation frequency in a year; 4) The composition of the CPR teams in wards and ICUs; and 5) The effectiveness of CPR education as assessed by anesthesiologists. RESULTS: Most of participating anesthesiologists in this survey worked at large hospitals with more than 500 beds. They had received an irregular schedule of CPR education. Most education programs consisted of lectures, and education time was less than 2 hours. The number of actual CPR participations was about 10 per year. Usually the trainees, other than certified anesthesiologists, had resuscitated patients in wards. Most of the responders believed that current education was ineffective. CONCLUSIONS: We conclude that CPR education is not fully effective. If we want to increase the survival rate of CPR, we should pay more attention to the education program and to its utility and training requirements.

Developing a General Medicine Residency Curriculum: Lessons Learned from Family Practice Residency Training in the United States / 医学教育

Systematic residency education curricula can provide students and residents opportunities to learn a broad range of clinical skills. One curricular model for Japanese general medicine departments <I>(sogoshinryo-bu)</I> is family-practice residencies in the United States. The values of family practice include first-contact care, continuity, comprehensiveness, coordination, community health, and care of the person. The precepting system is the pillar of resident education and provides the structure for physician-teachers to guide a medical school graduate to become a competent family physician by the end of 3 years of clinical training. Family-practice centers, community-based clinics where university faculty and residents provide care, have a proven record in the United States as clinical classrooms for teaching the values and skills needed for high-quality primary care and could greatly facilitate practice-focused training in Japan.

A Comparative Study on Residency Education in General Surgery / 한국의학교육

PURPOSE: The role of graduate medical education(GME) has become more important at the flood of knowledge and technical development. The korean board system in general surgery has a short history and has been developed mostly by the executive authorities rather than by autonomous civil organizations which is the case in america and europe. The aim and curriculum of our residency education is not yet well established, so that there requires the need to evaluate and analyze the training system of other well-established countries. METHODS: The structures of residency education and their characteristics in U.S.A., England and Germany were reviewed from the literatures and internet sites in terms of aims and objects of learning during the training period. The korean system was compared to these characteristics. RESULTS: Comparing the residency training programmes of U.S.A., Germany and England to our system there found some characteristic points as following that would be recommendable to be adopted for the renewal of our training programme. 1) Autonomous civil organizations endeavor for the regulations of educational goal, requirements and their accreditation. 2) The understanding of basic sciences that provide the fundamental principles of surgery was emphasized during the education. 3) Modern surgical techniques as a part of minimal invasive surgery can be easily acquired during the training course. 4) Participation in emergency medicine and intensive medicine was almost mandatory. 5) Interdisciplinary training and effective rotation schedule were highly recommended. All these characteristics could be actively integrated into our education, if we elaborate more well-established educational goal and curriculum for the residentship.