Improving Resident Physician Participation in Reporting Patient Safety and Quality Concerns.

Background: Reporting medical errors, near misses, and adverse events is an important component of improving patient safety and resident learning. Studies have revealed that event reporting rates can be low for physicians, resident physicians, and fellows. The objective of this quality improvement project was to improve resident reporting of patient safety and quality events and engage residents in the analysis of events at a community-based teaching hospital in the United States. Methods: We developed a program to engage 122 residents from 6 Accreditation Council for Graduate Medical Education-accredited residency programs using a multifaceted approach that included instructing residents how to use the hospital's adverse event reporting system; requiring first-year residents to submit at least 1 report; reviewing all resident reports during a monthly multidisciplinary meeting; and ensuring that each resident who submitted a report received feedback on how the concern was being addressed. Results: The program resulted in a 41.8% (95% CI 31%-53%) absolute increase in the number of residents reporting a concern, and resident submissions led to several documented improvements in patient care. A survey was administered to the residents who submitted reports, and the majority (76.0% response rate) expressed satisfaction with both the reporting system and the feedback about how their submission was being addressed. The responding residents agreed that they were more likely to submit reports because of their experience with the program and that they felt the program would improve safety and the quality of care at the institution. Conclusion: This quality improvement project successfully increased resident event reporting and engaged residents in the review of submitted events. The program can serve as a model for other teaching hospitals.

Acceptability and feasibility of an evaluation table to assess the competency of general medicine interns during ambulatory rotations in Brest.

BACKGROUND: General practitioner interns need to acquire the expected clinical, communication, personal and professional competencies. Internship evaluations use qualitative evaluation tables to assess competency acquisition. However, there is no standardised evaluation table used in France. Some faculties use the exhaustive, precise, and manageable Exceler evaluation tool. We aim to evaluate opinions of General practice interns in Brest about the acceptability and feasibility of using the Exceler evaluation tool to monitor competency acquisition during internships. METHODS: This qualitative study used intern focus groups. Six-open ended questions with optional follow-up questions were asked. Cards from the Dixit® game were used to guide and facilitate discussion. Open, axial, then integrative analysis of the verbatim was performed. RESULTS: This is the first study to evaluate intern opinions about GP internship evaluations using focus groups. Participants felt that the quality of existing evaluations was insufficient, and it was difficult to monitor their progress. Adapting evaluations to individual profiles and backgrounds seemed necessary. Exceler appeared to be a possible solution due to its content validity, flexibility of use and accessibility. However, there were comments about possible modifications. CONCLUSIONS: Analysing opinions of tutors, supervisors and other practice centers could help identify potential barriers and reveal solutions to facilitate its implementation and use. TRIAL REGISTRATION: Not applicable.

[Challenges and options for advanced training in surgery : An interdisciplinary position paper against the background of the hospital structural reform in Germany]. / Herausforderungen und Chancen für die chirurgische Weiterbildung : Ein fachgesellschaftsübergreifendes Positionspapier vor dem Hintergrund der Krankenhausstrukturreform.

BACKGROUND: Even now the further training in surgery faces considerable challenges. The planned hospital structural reform will result in new bureaucratic and organizational hurdles, which could lead to a considerable loss of quality in advanced surgical training across all disciplines. OBJECTIVE: The aim of this position paper is to describe the current and future challenges for advanced surgical training and to identify possible approaches and opportunities for the further development against the background of the planned hospital structural reform. MATERIAL AND METHODS: For the development of this position paper a committee of representatives of the Young Forums of the German surgical societies identified and critically discussed current problems and challenges of the present residency training system and formulated a list of demands for a sustainable residency training concept. RESULTS: The planned shift to outpatient treatment and centralization were identified as central challenges for surgical residency training. Surgical training must be considered consistently and from the outset in all political reform efforts. In addition to a transparent and cost-appropriate financing of residency training, we call for the involvement of all German surgical societies in the reform process. Furthermore, the social framework conditions for junior surgeons should be considered. CONCLUSION: The structural change in the hospital landscape in Germany, which is being forced by politicians, harbors the risk of a further loss of quality and experience in surgical treatment and training. At the same time, the planned hospital reform offers a unique opportunity to address existing problems and challenges in surgical training and to consider them as a starting point for structural changes which are fit for the future.

Pediatric dentistry, prosthodontics, and oral and maxillofacial surgery residents' stress, career satisfaction, and gender-based discrimination/harassment.

OBJECTIVES: Dental residents experience high stress in their demanding programs and gender-based harassment/discrimination can contribute to their stress. The objectives were to compare stress, satisfaction, experienced sexual harassment and observed discrimination of women in dental graduate programs with high, medium, and low percentages of women and to explore relationships between these constructs of interest. METHODS: Note that, 112 pediatric dentistry (PD), 44 prosthodontics, and 56 oral and maxillofacial surgery (OMS) residents responded to a survey. RESULTS: PD residents had the lowest personal life-related stress (4-point scale with 4 = very stressful: PD = 2.99/P = 3.67/OMS = 3.56; p < 0.001), faculty-related stress (2.68/3.66/3.03; p < 0.001), lack of confidence-related stress (2.79/3.31/2.96; p < 0.01) and academic stress (2.65/3.24/3.02; p < 0.001), while prosthodontics residents had the highest stress levels. The average frequency of experiencing sexual harassment was highest for OMS residents and lowest for PD residents (5-point scale with 1 = never: 1.15/2.62/2.74; p < 0.001). PD residents observed least and OMS residents most frequently that female residents were treated less positively by other residents because of their gender (1.59/2.57/3.00; p < 0.001). Prosthodontics residents had the lowest job satisfaction score (5-point scale with 1 = lowest satisfaction: 4.12/3.14/4.20; p < 0.001). The more frequently male and female residents experienced sexual harassment, the higher their personal life-related stress, faculty-related stress, lack of confidence-related stress, and academic stress, and the lower their career satisfaction, specialty content satisfaction, and stress-related satisfaction. Women's frequencies of observed gender-based discrimination were associated with higher stress and lower satisfaction, while men's frequencies of these observations were not associated with stress, but associated with increased satisfaction. CONCLUSIONS: Dental residents' stress, career satisfaction, experienced sexual harassment, and observed discrimination of women residents differ depending on the dental specialty program. Both male and female residents report more stress and less satisfaction the more they experience sexual harassment. The more women observe discrimination of women, the more stressed and the less satisfied they are. For men, the frequencies of these observations are not associated with stress, but positively associated with increased satisfaction.

Prevalence and factors associated with anxiety, depression and burnout in gynecology and obstetrics residents during the COVID-19 pandemic.

Objective: To determine the prevalence of anxiety, depression and burnout in residents of Gynecology and Obstetrics during COVID-19 pandemic in Brazil and its associated factors. Methods: Cross-sectional study involving all regions of Brazil, through the application of a sociodemographic questionnaire, the Hospital Anxiety and Depression Scale (HAD) and the Maslach Burnout Inventory (MBI-HSS) instrument. Multivariate analysis was performed after adjusting the Poisson model. Results: Among the 719 participating medical residents, screening was positive for anxiety in 75.7% and for depression in 49.8% of cases. Burnout syndrome was evidenced in 41.3% of the physicians studied. Those with depression are more likely to have anxiety (OR 0.797; 95%CI 0.687 - 0.925) and burnout syndrome (OR 0.847 95%CI 0.74 - 0.97). Residents with anxiety (OR 0.805; 95%CI 0.699 - 0.928) and burnout (OR 0.841; 95%CI 0.734 - 0.963) are more likely to have depression. Conclusion: High prevalence of anxiety, depression and burnout were found in residents of Gynecology and Obstetrics in Brazil, in addition to important correlations between anxiety-depression and depression-burnout.

Training Family Medicine Residents in Dermoscopy Using an e-Learning Course: Pilot Interventional Study.

BACKGROUND: Skin cancers are the most common group of cancers diagnosed worldwide. Aging and sun exposure increase their risk. The decline in the number of dermatologists is pushing the issue of dermatological screening back onto family doctors. Dermoscopy is an easy-to-use tool that increases the sensitivity of melanoma diagnosis by 60% to 90%, but its use is limited due to lack of training. The characteristics of "ideal" dermoscopy training have yet to be established. We created a Moodle (Moodle HQ)-based e-learning course to train family medicine residents in dermoscopy. OBJECTIVE: This study aimed to evaluate the evolution of dermoscopy knowledge among family doctors immediately and 1 and 3 months after e-learning training. METHODS: We conducted a prospective interventional study between April and November 2020 to evaluate an educational program intended for family medicine residents at the University of Montpellier-Nîmes, France. They were asked to complete an e-learning course consisting of 2 modules, with an assessment quiz repeated at 1 (M1) and 3 months (M3). The course was based on a 2-step algorithm, a method of dermoscopic analysis of pigmented skin lesions that is internationally accepted. The objectives of modules 1 and 2 were to differentiate melanocytic lesions from nonmelanocytic lesions and to precisely identify skin lesions by looking for dermoscopic morphological criteria specific to each lesion. Each module consisted of 15 questions with immediate feedback after each question. RESULTS: In total, 134 residents were included, and 66.4% (n=89) and 47% (n=63) of trainees fully participated in the evaluation of module 1 and module 2, respectively. This study showed a significant score improvement 3 months after the training course in 92.1% (n=82) of participants for module 1 and 87.3% (n=55) of participants for module 2 (P<.001). The majority of the participants expressed satisfaction (n=48, 90.6%) with the training course, and 96.3% (n=51) planned to use a dermatoscope in their future practice. Regarding final scores, the only variable that was statistically significant was the resident's initial scores (P=.003) for module 1. No measured variable was found to be associated with retention (midtraining or final evaluation) for module 2. Residents who had completed at least 1 dermatology rotation during medical school had significantly higher initial scores in module 1 at M0 (P=.03). Residents who reported having completed at least 1 dermatology rotation during their family medicine training had a statistically significant higher score at M1 for module 1 and M3 for module 2 (P=.01 and P=.001). CONCLUSIONS: The integration of an e-learning training course in dermoscopy into the curriculum of FM residents results in a significant improvement in their diagnosis skills and meets their expectations. Developing a program combining an e-learning course and face-to-face training for residents is likely to result in more frequent and effective dermoscopy use by family doctors.

Analysis of National Resident Matching Program for Radiology Fellowships: Factors Affecting Program Fill Rates.

PURPOSE: The National Resident Matching Program (NRMP) is used by an increasing number of diagnostic radiology (DR) residents applying to subspecialty fellowships. Data characterizing match outcomes on the basis of program characteristics are limited. The aim of this study was to determine if fellowship or residency size, location, or perceived reputation was related with a program filling its quota. METHODS: Using public NRMP data from 2004 to 2022, DR residency, breast imaging (BI), musculoskeletal imaging (MSK), interventional radiology (IR), and neuroradiology (NR) fellowship programs were characterized by geography, DR and fellowship quota, applicants per position (A/P), and reputation as determined by being an Aunt Minnie best DR program semifinalist, Doximity 2021-2022 top 25 program, or U.S. News & World Report top 20 hospital. The DR program's reputation was substituted for fellowships at the same institution. A program was considered filled if it met its quota. RESULTS: The 2022 A/P ratios were 1.02 for IR, 0.83 for BI, 0.75 for MSK, and 0.88 for NR. IR was excluded from additional analysis because its A/P was >1. The combined BI, MSK, and NR fellowships filled 78% of positions (529 of 679) and 56% of programs (132 of 234). Factors associated with higher program filling included Doximity top 25 program, Aunt Minnie semifinalist, and U.S. News & World Report top 20 hospital affiliation (P < .001 for all); DR residency quota greater than 9, and fellowship quota of three or more (P < .01). The Ohio Valley (Ohio, western Pennsylvania, West Virginia, and Kentucky) filled the lowest, at 39% of programs (P = .06). CONCLUSIONS: Larger fellowship programs with higher perceived reputations and larger underlying DR residency programs were significantly more likely to fill their NRMP quota.

Association of performance in medical residency selection with a psychiatric diagnosis, and depressive and anxiety symptoms.

OBJECTIVE: Few studies have focused on medical students and residents' mental health impact on medical residency selection (MRS) performance. The authors evaluated the association of performance in MRS with depressive and anxiety symptoms and with a reported psychiatric diagnosis (rPD). METHODS: The authors enrolled candidates after the second round of MRS examinations at a Brazilian Medical School. Performance was assessed by final grade. Depressive and anxiety symptoms were assessed by the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) and the State-Trait Anxiety Inventory (STAI). The authors performed mediation analysis and multiple linear regression analysis to investigate the impact of rPD, state and trait anxiety, and depressive symptom severity on performance. RESULTS: 515 of the 643 MRS candidates (80.1%) participated in the study. Higher age, attending a preparatory course for MRS, rPD, and the number of MRS applications that year were associated with poorer performance. In mediation analysis, trait anxiety was associated with a direct effect on performance and an indirect effect mediated by rPD. CONCLUSION: The data suggest that psychiatric diagnosis is associated with poorer performance on MRS, regardless of current symptoms of anxiety and depression. Additionally, increased levels of trait anxiety may negatively impact performance, directly and indirectly.

Structured Textbook Review and Individualized Learning Plans Successfully Remediate Underperforming Residents and Improve General Surgery Program Performance on the ABSITE.

Background: We endeavored to create an evidence-based curriculum to improve general surgery resident fund of knowledge. Global and resident-specific interventions were employed to this end. These interventions were monitored via multiple choice question results on a weekly basis and American Board of Surgery In-Training Examination (ABSITE) performance. Methods: This study was performed in a prospective manner over a 2-year period. A structured textbook review with testing was implemented for all residents. A focused textbook question-writing assignment and a Surgical Council on Resident Education (SCORE)-based individualized learning plan (ILP) were implemented for residents scoring below the 35th percentile on the ABSITE. Results: Curriculum implementation resulted in a statistically significant reduction in the number of residents scoring below the 35th percentile, from 50% to 30.8% (P = .023). One hundred percent of residents initially scoring below the 35th percentile were successfully remediated over the study period. Average overall program ABSITE percentile scores increased from 38.5% to 51.4% over a 2-year period. Conclusion: Structured textbook review and testing combined with a question-writing assignment and a SCORE-focused ILP successfully remediated residents scoring below the 35th percentile and improved general surgery residency ABSITE performance.

Variation in Transcript Reports Among Residency Applicants: An Anesthesia Program's Perspective.

Background: With recent changes made to move USMLE Step 1 and COMLEX Level 1 scores to Pass/Fail, it becomes necessary to find other metrics to evaluate residency candidates. One conserved metric included in all residency applications is medical school transcripts. This study aims to highlight the highly varied transcript reporting in a new era of holistic applicant review. Methods: Medical school transcripts were extracted from the Electronic Residency Application Service applications to our anesthesiology residency program for the 2021-2022 application cycle. All personally identifiable information was removed. Results were categorized and tallied by 2 independent reviewers. Overall, we assessed transcript information from 156 allopathic and osteopathic medical schools. Transcript data were separated into 9 different categories. Results: The most common grading system for allopathic medical schools was Pass/Fail. The most common grading system for osteopathic medical schools was Pass/Fail and Letter Grades. There were several medical schools that had unique grading systems and many of those did not provide a grading key for interpretation. Less than half of the allopathic and osteopathic schools offered Honors or High Pass in their grading systems, often with little information provided as to how these grades were earned. Conclusion: The information provided on medical school transcripts is extremely variable. Although many schools reported grades as Pass/Fail, there was no majority or consistent presentation among the transcripts. Much of the information provided on transcripts required interpretation by its reviewer and made the process of holistic applicant review more difficult.

Quiet.

Description According to theatrical superstition, saying "Macbeth" in the theater when you aren't actively performing or rehearsing foreshadows impending doom. In a similar way, in the hospital, its own production of sorts where medical staff is under pressure to perform, it's the "Q" word. We all dread the "Q" word and are vexed with anyone who dares say it. Yet sometimes wandering the hospital during night float, I often feel a profound sense of "Quiet." The word is typically associated with a lack of it, but I find there is a certain peace with being alone with one's thoughts. Residency can be an isolating endeavor, and this particular type of quiet reflection doesn't come around often in a busy hospital. When it does, I think about the other people in this shared space that we work in who may also be feeling the same way, which is bizarrely comforting. However, I probably wouldn't say so out loud, especially under a full moon.

Transformation of Mandatory Physiotherapy Internship into A Structured Competency-Based Program: A Pilot Study.

Introduction: Health professions education is challenging in terms of developing ways to construct and assess the amalgamation of knowledge, skills and attitudes that result in novice graduates to be self-aware and confident to practice without supervision. Currently, the Physiotherapy internship program in India does not have a comprehensive competency-based framework. With the current batch of interns facing the wrath of the COVID-19 pandemic during their undergraduate training, it is a matter of concern to ensure they have developed the required competencies to handle patients independently. Methods: This is a single-group interventional study using convenience sampling. A competency framework inclusive of a comprehensive assessment and training module was developed and introduced to 27 physiotherapy interns. Every intern underwent 10 training sessions along with 8 competency assessments during 6 months of internship training. A pre-post indigenous questionnaire was used to assess their self-perceived competency along with feedback questionnaire taken at the end of the module. Results: Implementation of the competency framework revealed a statistically significant difference in the self-perceived competency (pre=84.36±10.98, post=98.55±8.74, p≤0.000). Having uniformity in assessment techniques among the faculty, being exposed to challenging cases during assessment, having training module at the beginning of the internship were some of the suggestions given by the participants. Conclusion: Competency based education offers to be an effective technique in health professional program. Incorporating a competency-based training would help the learners to understand their strengths and weaknesses that would go a long way to develop competent health-care professionals. Developing such framework in curriculum will emphasize standardization of learning outcomes, thereby resulting in quality education, further enhancing patient care, and improving the health outcomes worldwide.

Fostering Diversity in Urology: Addressing Ethnic Disparities in Applicant and Resident Recruitment.

INTRODUCTION: In this retrospective database review, the objective was to investigate the ethnic composition of urology applicants and residents in recent years and assess whether any advancements have been made in enhancing the recruitment of candidates from historically underrepresented groups in medicine. METHODS: A retrospective database review was conducted on self-reported data on the ethnicity of urology applicants from academic year 2016 to 2017 (AY2016) to AY2021 and urology residents from AY2011 to AY2021. Applicant data were collected from the Association of American Medical Colleges, and resident data were collected from the Accreditation Council for Graduate Medical Education. The ethnic proportions of applicants and residents within cohorts were analyzed using χ2 tests, and differences between cohorts were analyzed using Z tests. RESULTS: There was a statistically significant decrease in the proportion of White applicants from 61.4% to 50.5% from AY2016 to AY2021 and a statistically significant increase in the proportion of applicants of multiple race/ethnicity from 4.7% to 12.0% from AY2016 to AY2021. There were disproportionately more Hispanic/Latino residents than applicants and disproportionately fewer residents of multiple race/ethnicity than applicants in the 2 cycles analyzed. There were disproportionately fewer Black residents than applicants only in the comparison of AY2016 to AY2020 applicants to AY2020 residents. CONCLUSIONS: There continues to be a lack of ethnic representation among applicants and residents in urology from underrepresented groups in medicine, despite some measurable improvement over the years. This deficit highlights the important need for new and ongoing efforts to diversify the field.

Publication Fate of Research Works Achieved During Master's Degree in Surgical Science in a French Survey.

The aim of this study was to assess the publication fate of research projects performed during the research year by students enrolled in a Master's degree (MSc) of surgical science and to identify factors associated with subsequent publication. An anonymous online survey of 35 questions was sent to students enrolled in MSc of surgical science between 2013 and 2020. The questionnaire included student's characteristics, topic, and supervision of the research projects developed during the research year and dissemination of the research work. Data regarding publication was collected using PubMed database. Factors associated with publication were identified by univariate analysis. Among 361 students, 26% completed the survey. Among respondents, the publication rate of research projects was 53.7%. The median time interval between the end of the research year and the date of publication was 2 (1-3) years. The student was listed as a first author in 70.6% of publications. Factors associated with publication of the research work completed during the research year were student's previous publications (P = 0.041) and presentation of the research work in academic conferences (P = 0.005). The most mentioned cause for non-publication was the absence of completion of the research work. Among respondents, the publication rate of research works performed during the MSc was high, which emphasizes the quality of the work carried out by the students and their involvement. Significant efforts must be undertaken to encourage the enrollment of residents in scientific research. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01973-y.

Thinking Outside the Box: The Interventional Surgeon.

Advances in treatment of structural heart disease have been disruptive to cardiovascular surgery, and there have been discussions about how to incorporate these technologies into the surgeons' therapeutic arsenal. Transcatheter procedures, complex redo interventions, and endovascular aortic approaches are already practiced by cardiovascular surgeons in Brazil. The expansion of these techniques, coupled with recent changes in the country's medical residency program in cardiovascular surgery, has led to an urgent need to acquire catheter-based skills. In this article, we discuss these aspects in the light of the reality of cardiovascular surgery training in Brazil.

Manejo de la vía aérea ante un caso de paro respiratorio en un escenario clínico simulado. Experiencia en una residencia de pediatría / Airway management during a respiratory arrest in a clinical simulation scenario. Experience at a pediatric residency program

Introducción. La insuficiencia respiratoria es la causa más común de paro cardíaco en pediatría; su reconocimiento y el manejo adecuado son cruciales. La simulación se utiliza para mejorar las habilidades médicas. El objetivo del trabajo fue determinar la proporción de residentes de pediatría que reconocieron un paro respiratorio (PR) pediátrico en un centro de simulación. Métodos. Se realizó un estudio observacional con 77 médicos residentes. Se utilizó un caso simulado de un paciente con dificultad respiratoria que progresa a PR. Resultados. De los 77 participantes, 48 reconocieron el paro respiratorio (62,3 %). El tiempo medio para reconocer el PR fue de 34,43 segundos. Conclusión. El 62,3 % de los participantes logró reconocer el paro respiratorio. Entre aquellos que lo identificaron, el tiempo promedio fue de 34,43 segundos. Se observaron graves deficiencias en algunas de las intervenciones esperadas.

Introduction. Respiratory failure is the most common cause of cardiac arrest in pediatrics. Recognizing and managing it adequately is critical. Simulation is used to improve medical skills. The objective of this study was to establish the proportion of pediatric residents who recognized a respiratory arrest in a child at a simulation center. Methods. This was an observational study in 77 residents. A simulation of a patient with respiratory distress that progressed to respiratory arrest was used. Results. Among the 77 participants, 48 recognized respiratory arrest (62.3%). The mean time to recognize respiratory arrest was 34.43 seconds. Conclusion. Respiratory arrest was recognized by 62.3% of participants. Among those who did so, the average time was 34.43 seconds. Severe failures were noted in some of the expected interventions.

Efecto de la "ley de residentes" sobre el bienestar laboral en cirugía: resultados de un estudio nacional de métodos mixtos en Colombia / Effect of the "residents' law" on occupational well-being in surgery: Results of a national mixed methods study in Colombia

Introducción. El efecto de las políticas para el mejoramiento del bienestar de los residentes, en términos de desgaste profesional y compromiso laboral, es controversial y su resultado tras la implementación de la "ley de residentes" (1917/2018) en Colombia es desconocido. Este estudio explora el efecto de esta ley en médicos residentes de cirugía colombianos. Métodos. Estudio de métodos mixtos secuencial explicativo. Inicialmente, se invitó a todos los residentes de cirugía del país a autodiligenciar los cuestionarios UWES-17 y MBI-HSS para evaluar el compromiso laboral (vigor, dedicación y absorción) y desgaste profesional (agotamiento emocional, despersonalización y baja realización personal) antes (2019) y después (2022) de la implementación de la ley. Se probaron diferentes hipótesis mediante modelos de ecuaciones estructurales. Los resultados fueron explorados con cirujanos mediante grupos focales. La información cualitativa fue analizada manualmente y por inteligencia artificial, y reportada en temas principales. Resultados. Participaron en el estudio 400 residentes. La tasa de desgaste profesional fue de 24,8 % antes y 15,8 % después (p=0,032). El análisis de ecuaciones estructurales confirmó que el agotamiento emocional sobre el desgaste profesional fue menor en 2022 (p=0,022). No se identificaron cambios significativos en el compromiso laboral. La principal explicación fue atribuida a los beneficios económicos de la ley. Conclusión. La tasa de desgaste profesional en médicos residentes de cirugía colombianos se redujo significativamente tras la implementación de la "ley de residentes". Estos hallazgos tienen implicaciones para la practica y el mejoramiento de la calidad de la educación.

Introduction. The effect of policies to improve residents' well-being, in terms of professional burnout and work commitment is controversial, and its result after the implementation of the "residents' law" (1917/2018) in Colombia is unknown. This study explores the effect of this law on Colombian surgical residents. Methods. Explanatory sequential mixed methods study. Initially, all surgical residents in the country were invited to self-complete the UWES-17 and MBI-HSS questionnaires to evaluate work commitment (vigor, dedication, and absorption) and professional burnout (emotional exhaustion, depersonalization, and low personal accomplishment) before (2019) and after (2022) the implementation of the law. Different hypotheses were tested using structural equation models. The results were explored with surgeons through focus groups. Qualitative information was analyzed manually and by artificial intelligence, and reported into main themes. Results. 400 residents participated in the study. Burnout rates were 24.8% before and 15.8% after (p=0.032). The structural equations analysis confirmed that emotional exhaustion over professional burnout was lower in 2022 (p=0.022). No significant changes in work commitment were identified. The main explanation was attributed to the economic benefits of the law. Conclusion. The burnout rate in Colombian surgical residents was significantly reduced after the implementation of the "residents' law". These findings have implications for practice and improving the quality of education

Training Cerebrovascular and Neuroendovascular Surgery Residents: A Systematic Literature Review and Recommendations.

Background: The rapid evolution of neuroendovascular intervention has resulted in the inclusion of endovascular techniques as a core competency in neurosurgical residency training. Methods: We conducted a literature review of studies involving the training of neurosurgical residents in cerebrovascular and endovascular neurosurgery. We reviewed the evolution of cerebrovascular neurosurgery and the effects of these changes on residency, and we propose interventions to supplement contemporary training. Results: A total of 48 studies were included for full review. Studies evaluated trainee education and competency (29.2%, 14/48), neuroendovascular training models (20.8%, 10/48), and open cerebrovascular training models (52.1%, 25/48), with some overlap. We used a qualitative analysis of reviewed reports to generate a series of suggested training supplements to optimize cerebrovascular education. Conclusion: Cerebrovascular neurosurgery is at a crossroads where trainees must develop disparate skill sets with inverse trends in volume. Continued longitudinal exposure to both endovascular and open cerebrovascular surgical fields should be mandated in general resident education, and blended learning tactics using adjunct simulation systems and models should be incorporated with didactics to both optimize learning and alleviate restraints placed by decreased volume and autonomy.

The Development of the Canadian Physiotherapy Assessment of Clinical Performance (ACP) 2.0 - Alignment with the 2017 Competency Profile.

Purpose: Clinical education and assessment of students' performance during clinical placements are key components of Canadian entry-to-practice physiotherapy curriculum and important in developing entry-level physiotherapy practitioners. The Canadian Physiotherapy Assessment of Clinical Performance (ACP) is the measure currently used to assess physiotherapy student performance on clinical placements in most of the entry-to-practice physiotherapy programmes across Canada. The release of the 2017 Competency Profile by the National Physiotherapy Advisory Group resulted in a revision of the existing ACP. The purpose of this study is to report the process used to develop a revised version of the ACP based on the 2017 Competency Profile, henceforth called the ACP 2.0. Method: Using a multistage process, we sought input from Canadian clinical education academics, an expert consultant panel, as well as physiotherapists across Canada using a questionnaire, meetings, and an online survey, respectively. Results: Twelve of 15 clinical education academics responded to a questionnaire. The expert consultant panel (n = 12) met three times. There were 144 physiotherapists who initiated the national, online, survey and met the inclusion criteria; 84 completed the survey. In the ACP 2.0, rating scales and comments boxes were grouped, and additional text was added to 12 items for further clarification. The ACP 2.0 came to have 18 items and 9 comment boxes in addition to summative comments, in contrast to the original ACP's 21 items and 9 comment boxes. Conclusions: In November 2020, Canadian clinical education academics reviewed the proposed draft ACP 2.0 and unanimously accepted it for implementation in Canadian physiotherapy university programmes.

Objectif: l'enseignement clinique et l'évaluation du rendement des étudiants pendant les stages cliniques sont des éléments clés du programme canadien d'entrée en pratique de la physiothérapie et sont importants pour former des praticiens de la physiothérapie prêts à entrer en pratique. L'évaluation du rendement clinique de la physiothérapie au Canada (ÉPC) est la mesure actuellement en usage pour évaluer le rendement des étudiants en physiothérapie lors de leur stage clinique dans la plupart des programmes d'entrée en pratique de la physiothérapie au Canada. La publication du Profil des compétences par le Groupe consultatif national en physiothérapie en 2017 a donné lieu à une révision de l'ÉPC. La présente étude vise à rendre compte du processus utilisé pour mettre au point une version révisée de l'ÉPC d'après le Profil des compétences de 2017, désormais appelée l'ÉPC 2.0. Méthodologie: au moyen d'un processus échelonné, les chercheurs ont demandé l'apport d'universitaires canadiens en enseignement clinique, d'un groupe d'experts consultants et de physiothérapeutes des diverses régions du Canada dans le cadre d'un questionnaire, de réunions et d'un sondage en ligne, respectivement. Résultats: au total, 12 des 15 universitaires en enseignement clinique ont répondu à un questionnaire. Le groupe d'experts consultants (n = 12) s'est réuni trois fois. Enfin, 144 physiothérapeutes qui respectaient les critères d'inclusion ont entrepris le sondage national en ligne, et 84 l'ont terminé. Dans l'ÉPC 2.0, les échelles d'évaluation et les encadrés de commentaires ont été regroupés et du texte a été ajouté à 12 des points afin de les clarifier. L'ÉPC 2.0 comporte finalement 18 points et neuf encadrés de commentaires en plus des commentaires sommatifs, par rapport aux 21 points et aux neuf encadrés de commentaires de l'ÉPC original. Conclusions: en novembre 2020, les universitaires en enseignement clinique canadiens ont révisé le projet d'ÉPC 2.0 et en ont adopté la mise en œuvre à l'unanimité au sein des programmes universitaires de physiothérapie du Canada.