From doing to leading: PGY-1 to PGY-2 transition.

BACKGROUND: Clinical trainees experience several professional transitions throughout their career, which can be exciting, anxiety-provoking or both. The first to second post-graduate year (PGY) transition for residents (junior doctors) in North America involves assuming new roles such as team leader, clinical supervisor, and teacher, often with minimal preparation. We explored resident experiences and emotions during this transition, and obtained their strategies for navigating this transition, through the lens of Bridges' transition model. This model has three stages: (1) ending, losing and letting go, (2) the neutral zone and (3) the new beginning. METHODS: We conducted one in-person focus group and subsequent one-on-one virtual semistructured interviews (due to COVID-19) of PGY-2 and PGY-3 residents who had previously undergone the transition. These sessions were recorded and transcribed, and thematic analysis was performed. FINDINGS: Four residents participated in the focus group, and 14 participated in one-on-one interviews. We identified five key themes: (1) not just a cog in the wheel, (2) contributing to growth of near-peers, (3) being flexible and adaptive, (4) emulating resident role models and (5) relationships with attendings. Residents suggested a transitions-focused retreat, simulation training to lead clinical emergencies, supervised opportunities for PGY-1s to act as PGY-2s coached by senior residents, and pairing PGY-1s with senior residents to help prepare for the transition. CONCLUSION: Professional transitions are both anxiety-provoking and exciting. Clinical trainees need preparation to successfully navigate multiple transitions. The Bridges' transition model could be useful in conceptualising transitions and planning curricula.

'Surviving to thriving': Leading health professions' education through change, crisis & uncertainty

Introduction: The COVID-19 pandemic has caused huge change and uncertainty for universities, faculty, and students around the world. For many health professions' education (HPE) leaders, the pandemic has caused unforeseen crises, such as closure of campuses, uncertainty over student numbers and finances and an almost overnight shift to online learning and assessment. Methods: In this article, we explore a range of leadership approaches, some of which are more applicable to times of crisis, and others which will be required to take forward a vision for an uncertain future. We focus on leadership and change, crisis and uncertainty, conceptualising 'leadership' as comprising the three interrelated elements of leadership, management and followership. These elements operate at various levels - intrapersonal, interpersonal, organisational and global systems levels. Results: Effective leaders are often seen as being able to thrive in times of crisis - the traditional 'hero leader' - however, leadership in rapidly changing, complex and uncertain situations needs to be much more nuanced, adaptive and flexible. Conclusion: From the many leadership theories and approaches available, we suggest some specific approaches that leaders might choose in order to work with their teams and organisations through these rapidly changing and challenging times. [ABSTRACT FROM AUTHOR] Copyright of Asia Pacific Scholar is the property of Centre for Medical Education (CenMed) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Training Residents in Virtual Advance Care Planning: A New Twist in Telehealth.

CONTEXT: Advance care planning (ACP) conversations represent an important physician skill, a need further highlighted by the COVID-19 pandemic. Most resident ACP training occurs in inpatient, settings, often featuring goals of care (GOC) conversations during a crisis. Outpatient clinics are valuable but underutilized settings to provide skills training for residents, yet little research has been done in these spaces. OBJECTIVE: We sought to 1) create an ACP curriculum harnessing the principles of a community of practice in a virtual format, and 2) obtain residents' perspectives regarding their skills and confidence in having early GOC conversations in the outpatient setting. METHODS: We interviewed 48 internal medicine residents using questionnaires, reflective narratives, and transcripts of debriefing conversations. We created a virtual curriculum during the ambulatory week which included didactics, virtual role plays, ACP phone conversations with five patients, and group debriefings. Quantitative data were analyzed for changes in resident confidence. Qualitative data were coded using thematic analysis, guided by instructor field notes. RESULTS: Residents reported decreased confidence in navigating advance directive conversations following training [Z=2.24, P=0.03, r = 0.33]. Resident reflections indicated that they felt more practiced at inpatient late GOC conversation skills, and that these skills were not fully transferable to the outpatient early GOC setting. Residents also endorsed the ambulatory environment as the best space for ACP conversations. CONCLUSION: This study illustrates the feasibility of a virtual format for ACP curriculum. The virtual community of practice created space for a metacognitive unmasking of prior resident unconscious incompetence. Also, inpatient, crisis-oriented late GOC conversation skills may translate poorly to the outpatient setting requiring early and ongoing GOC skills. Residents need more training to navigate ACP conversations in ambulatory environments.

Capturing the wisdom of the crowd: health professions' educators meet at a virtual world café.

BACKGROUND: Conversations about educational challenges and potential solutions among a globally and culturally diverse group of health professions' educators can facilitate identity formation, mentoring relationships and professional network building. The COVID-19 pandemic has made it even more important to co-create and disseminate knowledge, specifically regarding online and flexible learning formats. APPROACH: Based on the principles of social learning, we combined speed mentoring and world café formats to offer a virtual Zoom™ workshop, with large and small group discussions, to reach health professions' educators across the globe. The goal was to establish a psychologically safe space for dialogue regarding adaptation to online teaching-learning formats. EVALUATION: We aimed to establish psychological safety to stimulate thought-provoking discussions within the various small groups and obtain valuable contributions from participants. From these conversations, we were able to formulate 'hot tips' on how to adapt to (sometimes new) online teaching-learning formats while nurturing teacher and student wellbeing. REFLECTION: Through this virtual workshop we realized that despite contextual differences, many challenges are common worldwide. We experienced technological difficulties during the session, which needed rapid adaptation by the organising team. We encouraged, but did not pressure, participants to use video and audio during breakout discussions as we wanted them to feel safe and comfortable. The large audience size and different time zones were challenging; therefore, leadership had to be resilient and focussed. Although this virtual format was triggered by the pandemic, the format can be continued in the future to discuss other relevant global education topics.

Breathing life into bedside teaching in the era of COVID-19.

Bedside skills have been declining over the last two decades, with multiple studies reporting increasing reliance on investigations and technology in making diagnostic decisions. During the Covid-19 crisis, even less time is spent at the bedside, and physical examinations seem markedly truncated or non-existent. It is possible that cost of health care, doctor-patient relationships, and the clinical reasoning skills could be seriously impacted by ongoing decrease in bedside skills and the teaching of these skills. Careful history taking and hypothesis-driven physical examination still form the backbone of clinical reasoning and lead to parsimonious investigations. Overreliance on investigations could drive up costs of healthcare if every diagnosis depends on a head to toe scan. In this paper, we describe strategies for bedside teaching that are relevant and applicable even during the pandemic and an era of physical distancing. These strategies are categorised as: before, during and after patient interactions at the bedside. These strategies can be adapted to normal clinical teaching situations as well as challenging situations such as the current pandemic when physical distancing is mandated.