Mystery behind the match: an undergraduate medical education-graduate medical education collaborative approach to understanding match goals and outcomes.

BACKGROUND: There is a paucity of information regarding institutional targets for the number of undergraduate medical education (UME) graduates being matched to graduate medical education (GME) programs at their home institutions. At our institution, the Duke University, the number of UME graduates matched to GME programs declined dramatically in 2011. To better understand why this decline may have happened, we sought to identify perceived quality metrics for UME and GME learners, evaluate trends in match outcomes and educational program characteristics, and explore whether there is an ideal retention rate for UME graduates in their home institutions' GME programs. METHODS: We analyzed the number of Duke University UME graduates remaining at Duke for GME training over the past 5 years. We collected data to assess for changing characteristics of UME and GME, and performed descriptive analysis of trends over time to investigate the potential impact on match outcomes. RESULTS: A one-sample t-test analysis showed no statistically significant difference in the number of Duke UME graduates who stayed for GME training. For both UME and GME, no significant changes in the characteristics of either program were found. DISCUSSION: We created a process for monitoring data related to the characteristics or perceived quality of UME and GME programs and developed a shared understanding of what may impact match lists for both UME graduates and GME programs, leaving the Match somewhat less mysterious. While we understand the trend of graduates remaining at their home institutions for GME training, we are uncertain whether setting a goal for retention is reasonable, and so some mystery remains. We believe there is an invaluable opportunity for collaboration between UME and GME stakeholders to facilitate discussion about setting shared institutional goals.

Fostering creativity: how the Duke Graduate Medical Education Quasi-Endowment encourages innovation in GME.

The Duke Medicine Graduate Medical Education Quasi-Endowment, established in 2006, provides infrastructure support and encourages educational innovation. The authors describe Duke's experience with the "grassroots innovation" part of the fund, the Duke Innovation Fund, and discuss the Innovation Fund's processes for application, review, and implementation, and also outcomes, impact, and intended and unintended consequences.In the five years of the Innovation Fund described (2007-2011), 105 projects have been submitted, and 78 have been funded. Thirty-seven projects have been completed. Approved funding ranged from $2,363 to $348,750, with an average award of $66,391. This represents 42% of funding originally requested. Funding could be requested for a period of 6 months to 3 years. The average duration of projects was 27 months, with a range from 6 months to 36 months. Eighty percent of projects were completed on time. Two projects were closed because of lack of progress and failure to adhere to reporting requirements. Thirty-nine are ongoing.Program directors report great success in meeting project outcomes and concrete impacts on resident and faculty attitudes and performance. Ninety-two percent report that their projects would have never been accomplished without this funding. Projects have resulted in at least 68 posters, abstracts, and peer-reviewed presentations. At least 12 peer-reviewed manuscripts were published.There has been tremendous diversity of projects; all 13 clinical departments have been represented. Interdepartmental and intradepartmental program cooperation has increased. This modest seed money has resulted in demonstrable sustainable impacts on teaching and learning, and increased morale and scholarly recognition.

To match or not: factors influencing resident choice of graduate medical education program.

BACKGROUND: Little is known about the factors that influence applicants' decisions to select a graduate medical education training program. Programs may improve their recruitment by better understanding that process. METHODS: Following the Match for the years 2008 though 2010, an electronic survey was sent to 664 applicants to 15 Duke University graduate medical education programs. Those individuals were ranked high enough to match to Duke University but chose to match at another institution. We used quantitative and qualitative analyses to explore factors influencing candidates' decisions and to identify program and institutional improvements to better attract top candidates. RESULTS: Response rate was 63% (417/664). The quantitative analysis identified factors that were "very important" to applicants (current resident satisfaction, relationship between faculty and residents, collegiality of current residents, quantity and quality of faculty content/mentoring, faculty teaching expertise, diversity of patients and types of procedures, and location), and those that were "not important" to applicants (child care or education opportunities for children, salary, United States Medical Licensing Examination requirements, part-time training options, favorable environment for minorities or women). There were statistically significant differences among specialties. Qualitative analysis identified 3 themes as most influential in their choice: location, program relationships, and the interview experience. CONCLUSION: The collection of 3 years of data across specialties identified factors that are important to applicants' choice of a training program. Some factors can be addressed quickly and with little effort, such as the format of the interview day. Others require programs and institutions to revisit their mission, priorities, and training culture to improve relationships between residents and faculty. Programs may wish to be more tactical in selecting the residents and faculty who meet with applicants and be more focused in planning how the interview time is used.

Internal reviews benefit programs of the review team members and the program under review.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) mandates that sponsoring institutions conduct internal reviews. In 1998, the ACGME Institutional Review Committee gave Duke University Hospital a citation for an inadequate internal review (IR) process. Since then, we have instituted several iterative changes. We describe the evolution of Duke University Hospital's current internal review process. INTERVENTION: We implemented a new review team composition, template report, use of the program information form, and centralization of documentation to improve our internal review process. In 2007, a more formal evaluation of the outcome and impact of these changes was instituted. This included a yearly survey of all participants and review team members, a review of programs, and a tracking process for the decisions of our Graduate Medical Education Committee (GMEC) on the status of reviewed programs. RESULTS: Participants from both the program under review and the review team evaluated the process favorably. Review teams reported they learned from the best practices of the program being reviewed. Program directors from the reviewed programs reported the process improved their documentation. Both groups reported the process better prepared them for their next ACGME Review Committee site visit. The GMEC has recommended "probationary sponsorship" for fewer programs since the IR process changes have been implemented. The IR process was recognized as a best practice in Duke University Hospital's 2004 ACGME institutional review. CONCLUSION: We believe our IR process, review-team composition, template report, program information form, and centralized documentation now fully meets accreditation standards. Participants are reasonably satisfied and report value from the process. More programs are judged to be within substantial compliance by the GMEC.

Use of an institutional template for annual program evaluation and improvement: benefits for program participation and performance.

PURPOSE: The Accreditation Council for Graduate Medical Education (ACGME) expects programs to engage in ongoing, meaningful improvement, facilitated in part through an annual process of program assessment and improvement. The Duke University Hospital Office of Graduate Medical Education (OGME) used an institutional practice-based learning and improvement strategy to improve the annual evaluation and improvement of its programs. METHODS: The OGME implemented several strategies including the development and dissemination of a template for the report, program director and coordinator development, a reminder and tracking system, incorporation of the document into internal reviews, and use of incentives to promote program adherence. RESULTS: In the first year of implementation (summer 2005), 27 programs (37%) submitted documentation of their annual program evaluation and improvement to the OGME; this increased to 100% of programs by 2009. A growing number of programs elected to use the template in lieu of written minutes. The number of citations related to required program review and improvement decreased from 12 in a single academic year to 3 over the last 5 years. CONCLUSION: Duke University Hospital's institutional initiative to incorporate practice-based learning and improvement resulted in increased documentation, greater use of a standardized template, fewer ACGME-related citations, and enhanced consistency in preparing for ACGME site visits.

Efficacy and efficiency of webcast orientations versus live resident orientations: results of a 2-year survey.

BACKGROUND: Beginning a graduate medical education training program is associated with a steep learning curve for incoming residents. OBJECTIVE: To compare the efficacy and efficiency of live versus webcast formats for Institutional Orientation. METHODS: This 2-year non-blinded study, with a nonrandomized cohort, compares outcomes for trainees oriented Summer 2005 in a ''live-lecture'' format with trainees oriented Summer 2006 using a webcast format. Outcomes include posttest success, the time required, presentation quality and utility, and cost. RESULTS: In 2005, 249 trainees attended the live orientation. Of the 211 who completed the posttest; 132 (63%) passed it within 3 attempts. Of the 241 trainees in 2006, 236 completed the posttest. Of these, 215 (91%) passed it within 3 attempts. Compared to the live-lecture cohort, the webcast cohort rated the posttest as more difficult. Despite performing better, significantly fewer trainees in the webcast cohort rated the posttest as "appropriate" (χ(2) =  5 28.57, df 5 1, P , .001). There were no significant differences between the 2 groups on their perceptions of quality and utility of the presentations. While the first year cost of the webcast exceeded that of live lectures, the amortized cost was nearly identical to the live-lecture costs. DISCUSSION: As corroborated by resident comments, the web-based approach was more effective because it provided trainees flexibility regarding when to study, options on how to view the material, and opportunities to review it if needed for mastery. We plan to continue using the webcast strategy, revising the content as needed.