Unmasking Resident Physician Burnout During the COVID-19 Era.

Burnout is not a new concept in the health care field. Most, if not all, resident physicians (residents) experience burnout at least once during their training. However, the COVID-19 pandemic placed a large strain on the health care system and exacerbated stressors that contribute to burnout, including anxiety, depression, and work overload. The authors reviewed the literature on resident burnout in the era of COVID-19 to elucidate common stressors across the specialties and identify successful interventions or initiatives that may be most effective for residency programs.

Virtual Interviews: Outcomes and Lessons Learned.

BACKGROUND AND OBJECTIVES: The family medicine residency application process is arduous and competitive. An important part of the application is the in-person interview process, which was affected during the last two interview cycles (2021-2022) due to restrictions imposed by the COVID-19 pandemic. Virtual interviews eliminate traveling costs associated with applications, potentially improving underrepresented minorities' access to interviewing opportunities. Our goal was to assess if virtual interviews at our institution have negative or positive effects on access for underrepresented in medicine (URiM) applicants and our residency match results.   Methods: We analyzed data from 2019-2022 to compare application volumes, applicant demographics, and match results between two in-person cycles (2019 and 2020) and two virtual cycles (2021-2022). Data were analyzed using Pearson χ2 criteria and P=.05 defined significance. Differences between years for expected counts were determined using single sample χ2 tests.  Results: No statistical significance was noted on number of applications by URiM to our program despite decrease costs associated with virtual interview process. The number of URiM applicants matching to our program did not improve by simply implementing virtual interviews when compared to in-person interview seasons in the past. CONCLUSIONS: Virtual interviews at our institution did not increase URiM applications to our program from substantial equivalent medical schools. Further research in this area from programs in other states may enhance our understanding of the impact of virtual interviews on URiM applications to residency and match results.

Designing for digital transformation of residency education - a post-pandemic pedagogical response.

BACKGROUND: The forced transition to emergency remote teaching (ERT) during the COVID-19 pandemic has significantly impacted health professions education worldwide. In Sweden, the need for alternative solutions for the training of junior doctors became urgent, as many of the mandatory onsite courses required for residents to qualify as specialists were canceled. The purpose of this study was to understand course leaders' perceptions and experiences of using digital technologies, such as video conferencing, to teach medical residents (ST) during the pandemic and beyond. METHODS: A qualitative study using semi-structured interviews was conducted with seven course leaders responsible for residency courses during the first year of the pandemic to capture their perceptions and experiences. The interviews were transcribed verbatim and analyzed using thematic analysis, drawing on the technology affordances and constraints theory (TACT) as a framework to explore pedagogical strategies and new teaching practices emerging from the forced use of digital technologies for remote teaching. RESULTS: The data analysis revealed affordances of, as well as constraints to, teaching specialist medical training during the pandemic. The findings show that the use of digital conference technologies for ERT can both enable and inhibit social interactions, the interactive learning environment and the utilization of technological features, depending on the individual course leaders' goals of using the technology and the situated context of the teaching. CONCLUSIONS: The study reflects the course leaders' pedagogical response to the pandemic, as remote teaching became the only way to provide residency education. Initially, the sudden shift was perceived as constraining, but over time they found new affordances through the enforced use of digital technology that helped them not only to cope with the transition but also to innovate their pedagogical methods. After a rapid, forced shift from on-site to digital courses, it is crucial to utilize experiences to create better preconditions for digital technology to facilitate learning in the future.

Exploring residents and supervisors' workplace learning needs during postgraduate medical education.

Objectives: To identify the main enablers and challenges for workplace learning during postgraduate medical education among residents and their supervisors involved in training hospital specialists across different medical specialties and clinical teaching departments. Methods: A qualitative explorative study using semi-structured focus group interviews was employed. A purposeful sampling method was utilized to invite participants who were involved in postgraduate medical education for hospital specialist medicine at two universities. Hospital physicians in training, also called residents (n=876) and supervisors (n=66), were invited by email to participate. Three focus groups were organized: two with residents and one with supervisors. Due to the COVID-19 pandemic rules prohibiting real group meetings, these focus groups were online and asynchronous. The data was analyzed following an inductive thematic analysis. Results: The following overarching themes were identified: 1) the dual learning path, which balances working in the hospital and formal courses, 2) feedback, where quality, quantity, and frequency are discussed, and 3) learning support, including residents' self-directed learning, supervisors' guidance, and ePortfolio support. Conclusions: Different enablers and challenges for postgraduate medical education were identified. These results can guide all stakeholders involved with workplace learning to develop a better understanding of how workplace learning can be optimized to improve the postgraduate medical education experience. Future studies could focus on confirming the results of this study in a broader, perhaps international setting and exploring strategies for aligning residencies to improve quality.

The Importance of General Surgery Residency Program's Online Presence Varies Among Applicant Groups.

INTRODUCTION: The COVID-19 pandemic necessitated an exclusively virtual 2021 residency application cycle. We hypothesized that residency programs' online presence would have increased utility and influence for applicants. METHODS: Substantial surgery residency website modifications were undertaken in the summer of 2020. Page views were gathered by our institution's information technology office for comparison across years and programs. An anonymous, voluntary, online survey was sent to all interviewed applicants for our 2021 general surgery program match. Five-point Likert-scale questions evaluated applicants' perspective on the online experience. RESULTS: Our residency website received 10,650 page views in 2019 and 12,688 in 2020 (P = 0.14). Page views increased with a greater margin compared to a different specialty residency program's (P < 0.01). From 108 interviewees, 75 completed the survey (69.4%). Respondents indicated our website was satisfactory or very satisfactory compared to other programs (83.9%), and none found it unsatisfactory. Applicants overall stated our institution's online presence impacted their decision to interview (51.6%). Programs' online presence impacted the decision to interview for nonWhite applicants (68%) but significantly less for white applicants (31%, P < 0.03). We observed a trend that those with fewer than this cohort's median interviews (17 or less) put more weight on online presence (65%), compared to those with 18 or greater interviews (35%). CONCLUSIONS: Applicants utilized program websites more during the 2021 virtual application cycle; our data show most applicants depend on institutions' websites to supplement their decision-making; however, there are subgroup differences in the influence online presence has on applicant decisions. Efforts to enhance residency webpages and online resources for candidates may positively influence prospective surgical trainees, and especially those underrepresented in medicine, to decide to interview.

Internal Medicine Resident Perspectives on Virtual Recruitment.

This survey study describes the perceived implications of virtual-only recruitment and the preferred application process for residents and fellows.

Resident Education on the Surgical Treatment of Distal Radius Fractures Using a Point-of-View Camera.

Background: In the coronavirus disease 2019 (COVID-19) era, surgical resident education depends largely on virtual materials. With the help of point-of-view (POV) cameras, educational videos have become widely used for surgical training. A video recorded from the surgeon's POV helps demonstrate the procedure. We made training movies of the surgical approach to distal radius fractures for residents using a head-mounted video recording system with a laser point targeting device (LPTD). Methods: A 15-minnute movie of the trans-flexor carpi radialis approach for distal radius fractures was made. A POV camera was assembled with an LPTD and strapped on the surgeon's head. This enabled maintenance of the surgical field while recording the procedure. A shorter version of the clip was also made to investigate trainee preference. We asked 24 trainees to watch the two versions of the video and complete a short questionnaire. Results: All trainees felt that the movie made with a POV camera was more efficient than existing materials. Only 1 (4.2%) felt that the laser pointer hindered the view. Four of the 23 trainees (16.7%) felt dizzy while watching the video. Of the two versions, 16 trainees (66.7%) preferred the shorter, edited version. The average score for the video was 8.42 out of 10. Conclusions: A video recording system in the operating room that uses an LPTD-POV camera is an efficient way to produce educational material, particularly for surgical residents during the COVID-19 era.

An Educational Needs Assessment of Telehealth in Primary Care Among US Internal Medicine Residents.

OBJECTIVES: As a result of the coronavirus disease 2019 pandemic, many Internal Medicine (IM) residency programs converted to telehealth for primary care. Our objectives in this study were to better understand resident past and present telehealth education, their perceived barriers to telehealth practice, and their perceived solutions to improving telehealth use and education. METHODS: We performed a cross-sectional needs assessment survey between November 2020 and February 2021 among residents at 10 IM residency programs across the United States. Our primary measures were telehealth use in resident continuity clinics before and during the coronavirus disease 2019 pandemic, telehealth training, and confidence and barriers in using telehealth. RESULTS: Of 857 residents contacted, 314 (36.6%) responded. Residents reported low rates of education in telehealth prepandemic with significant improvements after the start of the pandemic across all visit domains (range of 10.7%-19.6% prepandemic compared with 25.6%-55.7% postpandemic, all P < 0.001). Resident confidence levels were significantly lower (P < 0.001) for video visits and telephone visits compared with in-person visiting across domains of communication, history taking, using an interpreter, making a diagnosis, counseling patients, providing psychosocial support, performing medical management, and coordinating after-visit care. Reported barriers included patient resources, clinic resources, lack of preceptor feedback, and lack of observation. Reported resources for improvement included tutorials on physical examination techniques, clinical space for telehealth, and patient resources for telehealth. CONCLUSIONS: To effectively address the educational needs for telehealth practice by IM residents, educators must consider not only curricular needs but also clinical, preceptor, and patient barriers to the high-quality use of telehealth for primary care.

Laparoscopic pyeloplasty proficiency during a residency program after adoption of a standardized simulation training program is maintained during the COVID pandemic despite reduced surgery volume.

PURPOSE: To evaluate the effect of the standardized laparoscopic simulation training program in pyeloplasty, following its implementation and during the COVID-19 pandemic. MATERIAL AND METHODS: A retrospective chart review was performed at Hospital de Clínicas de Porto Alegre, a tertiary referral center in south Brazil, in which 151 patients underwent laparoscopic pyeloplasty performed by residents between 2006-2021. They were divided into three groups: before and after adoption of a standardized laparoscopic simulation training program and during the COVID-19 pandemic. The main outcome was a combined negative outcome of conversion to open surgery, major postoperative complications (Clavien-Dindo III or higher) or unsuccessful procedure, defined as need for redo pyeloplasty. RESULTS: There was a significant reduction in the combined negative outcome (21.1% vs 6.3%), surgical time (mean 200.0 min vs 177.4 min) and length of stay (median 5 days vs 3 days) after the adoption of simulation training program. These results were maintained during the COVID-19 pandemic (combined negative outcome of 6.3%, mean surgical time of 160.1 min and median length of stay of 3 days) despite a reduction in 55.4% of the surgical volume. CONCLUSION: A structured laparoscopic simulation program can improve outcomes of laparoscopic pyeloplasty during the learning curve.

A Canadian survey of residency applicants' and interviewers' perceptions of the 2021 CaRMS R1 virtual interviews.

BACKGROUND: All Canadian Residency Matching Service (CaRMS) R1 interviews were conducted virtually for the first time in 2021. We explored the facilitators, barriers, and implications of the virtual interview process for the CaRMS R1 match and provide recommendations for improvement. METHODS: We conducted a cross-sectional survey study of CaRMS R1 residency applicants and interviewers across Canada in 2021. Surveys were distributed by email to the interviewers, and by email, social media, or newsletter to the applicants. Inductive thematic analysis was used for open-ended items. Recommendations were provided as frequencies to demonstrate strength. Close-ended items were described and compared across groups using Chi-Square Fisher's Exact tests. RESULTS: A total of 127 applicants and 400 interviewers, including 127 program directors, responded to the survey. 193/380 (50.8%) interviewers and 90/118 (76.3%) applicants preferred virtual over in-person interview formats. Facilitators of the virtual interview format included cost and time savings, ease of scheduling, reduced environmental impact, greater equity, less stress, greater reach and participation, and safety. Barriers of the virtual interview format included reduced informal conversations, limited ability for applicants to explore programs at different locations, limited ability for programs to assess applicants' interest, technological issues, concern for interview integrity, limited non-verbal communication, and reduced networking. The most helpful media for applicants to learn about residency programs were program websites, the CaRMS/AFMC websites, and recruitment videos. Additionally, panel interviews were preferred by applicants for their ability to showcase themselves and build connections with multiple interviewers. Respondents provided recommendations regarding: (1) dissemination of program information, (2) the use of technology, and (3) the virtual interview format. CONCLUSIONS: Perceptions of 2021 CaRMS R1 virtual interviews were favourable among applicants and interviewers. Recommendations from this study can help improve future iterations of virtual interviews.

Let's Hang On! Ramping Up Nurse Resident Retention Strategies After the Pandemic.

The nurse residency program (NRP) was developed as a recruitment strategy for new graduate registered nurses (NGRNs). The 2020 COVID-19 pandemic impacted health care in many ways, including causing a decline in NGRN retention rates. Post-pandemic, the NRP needed to incorporate strategies that would promote nursing retention. Effective collaboration and innovative strategies were found to be key elements in promoting successful NGRN retention. [J Contin Educ Nurs. 2023;54(6):245-247.].

First Year Outcomes: Program Evaluation of a Statewide Nurse Residency Program.

In New Jersey, a statewide nurse residency program was implemented using an apprenticeship model. The pandemic created disruption to registered nurse residency programs. This included rapid restructuring of program delivery to online methods and a need to adapt curricula to reflect changing practice and guidelines. As a result of the pandemic, new graduates had educational gaps and nurse leaders experienced staffing shortages. First year program outcomes demonstrated a 90% retention of new graduates and financial benefits for organizations participating in the statewide nurse residency program.

A Simulation of the Effect of Interview Caps on the National Resident Matching Program Match in Otolaryngology.

Concerns regarding interview hoarding in the Match process have led to calls for a cap on the number of interviews an applicant can accept. However, no study has examined the effects of interview caps on applicants or a specialty. The authors created a simulation otolaryngology Match to analyze the effects of interview caps. The simulation included 120 residency programs, 360 positions, and 570 applicants (each assigned a competitiveness weighted value). Programs created interview lists (subject to 4 different interview cap conditions: no, 16, 12, and 8 cap) using weighted random selection and the competitiveness weighted values. Programs then selected 3 interviewees to fill their positions via weighted random selection using the competitiveness weighted values. Data analysis explored the effects of interview caps on individual applicants' probability of matching, the probability of matching with a certain number of interviews, and the average matched applicant competitiveness rank using one-way analysis of variance. The introduction of interview caps caused interviews to be distributed more equally among applicants. The 12-interview cap caused the applicants in the 100th competitiveness percentile to see their probability of matching fall from 99.3% to 67.2% ( P < .001). Applicants with ≥ 12 interviews had a probability of matching of 94.4% when there was no cap, compared to 76.9% with a 12-interview cap ( P < .001). The average competitiveness rank of matched applicants fell from 191 with no cap to 245 with a 12-interview cap ( P < .001). Interview caps in the otolaryngology Match may create major distortions in the probability of matching, leading to much lower chances of matching for more competitive applicants, lower probabilities of matching with certain numbers of interviews, and a decreased average competitiveness of matched applicants.

Otolaryngology residency selection: are we doing it right?

PURPOSE OF REVIEW: This article will provide an overview of recent disruptions to the otolaryngology residency match process and conclude with questions and resources that can guide future selection system design. RECENT FINDINGS: During the implementation of the single accreditation system, the loss of osteopathic programs, reduction of osteopathic leadership positions, and lack of interest in Osteopathic Recognition represent serious threats to the profession; this has implications for the distribution of the otolaryngology workforce, plausibly decreasing healthcare access in less-populated communities. Next, the impacts of COVID-19 reverberated throughout the application process, including the reduction/elimination of away rotations, modification of application requirements, conversion to virtual interviews, and initiation of preference signaling. Soon, the transition to pass/fail scoring for the United States Medical Licensing Exam Step 1 could stimulate a paradigm shift, with a heightened emphasis on holistic review. SUMMARY: The last two match cycles have been the most dynamic and unpredictable in decades. Out of the commotion, the otolaryngology community has an opportunity for a fresh start, combining insights from past literature with recent articles compiled for this review. Moving forward, it will be advantageous to approach residency selection as a well-executed quality improvement project, requiring continuous assessment and adjustment.

Healthcare utilization and adverse outcomes stratified by sex, age and long-term care residency using the Alberta COVID-19 Analytics and Research Database (ACARD): a population-based descriptive study.

BACKGROUND: Understanding the epidemiology of Coronavirus Disease of 2019 (COVID-19) in a local context is valuable for both future pandemic preparedness and potential increases in COVID-19 case volume, particularly due to variant strains. METHODS: Our work allowed us to complete a population-based study on patients who tested positive for COVID-19 in Alberta from March 1, 2020 to December 15, 2021. We completed a multi-centre, retrospective population-based descriptive study using secondary data sources in Alberta, Canada. We identified all adult patients (≥ 18 years of age) tested and subsequently positive for COVID-19 (including only the first incident case of COVID-19) on a laboratory test. We determined positive COVID-19 tests, gender, age, comorbidities, residency in a long-term care (LTC) facility, time to hospitalization, length of stay (LOS) in hospital, and mortality. Patients were followed for 60 days from a COVID-19 positive test. RESULTS: Between March 1, 2020 and December 15, 2021, 255,037 adults were identified with COVID-19 in Alberta. Most confirmed cases occurred among those less than 60 years of age (84.3%); however, most deaths (89.3%) occurred among those older than 60 years. Overall hospitalization rate among those who tested positive was 5.9%. Being a resident of LTC was associated with substantial mortality of 24.6% within 60 days of a positive COVID-19 test. The most common comorbidity among those with COVID-19 was depression. Across all patients 17.3% of males and 18.6% of females had an unplanned ambulatory visit subsequent to their positive COVID-19 test. CONCLUSIONS: COVID-19 is associated with extensive healthcare utilization. Residents of LTC were substantially impacted during the COVID-19 pandemic with high associated mortality. Further work should be done to better understand the economic burden associated with related healthcare utilization following a COVID-19 infection to inform healthcare system resource allocation, planning, and forecasting.

"We are the ones who will have to make the change": Cuban health cooperation and the integration of Cuban medical graduates into practice in the Pacific.

BACKGROUND: This paper responds to Asante et al. (in Hum Resour Health, 2014), providing an updated picture of the impacts of Cuban medical training in the Pacific region based on research carried out in 2019-2021, which focused on the experiences of Pacific Island doctors trained in Cuba and their integration into practice in their home countries. METHODS: The research focussed on two case studies-Solomon Islands and Kiribati. Study methods for this research included multi-sited ethnographic methods and semi-structured interviews as well as qualitative analysis of policy documents, reports, and media sources. RESULTS: The Cuban health assistance programme has had a significant impact on the medical workforce in the Pacific region increasing the number of doctors employed by Pacific Ministries of Health between 2012 and 2019. Qualitatively, there have been some notable improvements in the medical workforce and health delivery over this period. However, the integration of the Cuban-trained doctors into practise has been challenging, with criticisms of their clinical, procedural and communication skills, and the need for the rapid development of bridging and internship training programmes (ITPs) which were inadequately planned for at the outset of the programme. CONCLUSIONS: The Cuban programme in the Pacific is an important model of development assistance for health in the region. While Cuba's offer of scholarships was the trigger for a range of positive outcomes, the success of the programme has relied on input from a range of actors including support from other governments and institutions, and much hard work by the graduates themselves, often in the face of considerable criticism. Key impacts of the programme to date include the raw increase in the number of doctors and the development of the ITPs and career pathways for the graduates, although this has also led to the reorientation of Cuban graduates from preventative to curative health. There is considerable potential for these graduates to contribute to improved health outcomes across the region, particularly if their primary and preventative health care skills are utilised.

Impact of COVID-19 pandemic on cardiology fellows academic training: beyond the clinical impact.

OBJETIVO: Determinar la percepción de los médicos internos residentes (MIR) de cardiología de España sobre el efecto de la pandemia por COVID-19 en su formación y la adaptación realizada por sus servicios. MÉTODOS: Estudio de corte transversal a través de una plataforma de encuesta digital con el objetivo de conocer la opinión individual de los MIR de cardiología sobre la influencia de la pandemia en su formación. Se realiza un análisis estadístico para determinar los factores que influyeron en la percepción de la formación afectada. RESULTADOS: Participó un total de 180 MIR de las 17 comunidades autónomas (CA). Los MIR de tercer año fueron los más afectados, junto con los que rotaban en imagen cardíaca. Los residentes de las CA con una prevalencia >5 casos/1,000 habitantes fueron los que mayor probabilidad tuvieron de ser desplazados de sus servicios. CONCLUSIONES: Según la opinión de los participantes, el efecto de la pandemia por COVID-19 en su formación fue más negativa en los residentes de tercer año y los que rotaban en imagen cardíaca. OBJECTIVE: The objectives were to analyze the perception of the Cardiology Fellows in Training (FIT) of Spain about the impact of the COVID-19 pandemic on their academic training and to know the adaptative changes performed by their department. METHODS: A cross-sectional study performed through a digital survey platform for Cardiology FIT. Chi2 analysis and logistic regression were performed to determine the factors that influenced on the perception of an affected training. RESULTS: A total of 180 FIT from the 17 regions of Spain participated. Third year FIT and those rotating in cardiac imaging were the most affected with statistically significant difference. The residents of the regions with a prevalence of >5 cases/1,000 inhabitants were the most likely to be displaced from their departments. CONCLUSIONS: According to the opinion of the participants, the impact of the COVID-19 pandemic on their academic training was more negative in third year FITs and those rotating in cardiac imaging.

Integration of Interprofessional Learning Into an Accredited Nurse Residency Program.

The American Nurses Credentialing Center (ANCC) Practice Transition Accreditation Program® (PTAP) annually awards the Program Director of the Year at the ANCC Transition to Practice (TPP) Symposium. This year the Commission on Accreditation in Practice Transition Programs (COA-PTP) and ANCC PTAP/APPFA team is ecstatic to announce Dr. Simmy King, from Children's National Hospital, as the awardee. Dr. King's dedication to nurses in transition and quality improvement is impressive. Learn about the Children's National Hospital's ANCC PTAP journey and how they integrated interprofessional learning into their nurse residency. [J Contin Educ Nurs. 2023;54(5):197-200.].