Assessment of the Effects of the COVID-19 Pandemic on Orthopaedic Surgery Training Among Orthopaedic Residents in Southern Nigeria.

Background: Surgical training is hands-on, with residents requiring optimal exposure to patients for optimal training and adequate experience. Thus, despite the increased usage of virtual, non-physical resources for medical education during the pandemic, orthopaedic surgical training still suffered adversely. Objectives: To explore the overall impact of the COVID-19 pandemic on Orthopaedic surgery training, teaching and practice amongst residents in southern Nigeria. Materials and Methods: This was a cross-sectional prospective study involving 54 senior orthopaedic surgery residents in southern Nigeria. Data were collected using a semi-structured online-based questionnaire created on the Google Forms and sent via online platforms (e.g., WhatsApp and Telegram). Descriptive and inferential analysis was done using Statistical Package for Social Sciences (SPSS). Consent was also obtained from all respondents. Results: A total of 54 orthopaedic surgery residents responded to our questionnaire. About 71.7% of the residents surveyed reported reduced exposure to surgical cases in general, and 70.3% reported reduced operative teaching exposure. About 68.5% of the respondents reported reduced opportunities for surgical skills acquisition training. More than half of respondents (63%) reported no changes in morbidity/mortality of orthopaedic cases witnessed and performed. The majority of the respondents agreed to a slight decrease in the availability of implants and courses (40.7%) whereas 44.4% affirmed an increase in the cost of training. Overall, 70.4% believed that the impact of COVID-19 on orthopaedic surgical training has been slightly negative. The average rating for experience on alternative learning methods - virtual video conferences, pre-recorded lectures, in-person small group meetings and surgical simulation activities was 2.26 on a scale of 1-4 (decreasing order of satisfaction). Conclusion: The COVID-19 pandemic caused significant changes in orthopaedic surgery training, with low cases exposure and reduction in operative teaching being the most significant changes and the resultant increase in alternative forms of training and skill acquisition.

Characteristics Associated with Successful Residency Match in General Surgery.

Objective: To evaluate characteristics of matched and unmatched general surgery residency (GSR) applicants. Background: Given the recent change of the United States Medical Licensing Exam Step 1 grading to pass/fail, understanding the factors that influence GSR match success is integral to identifying potential interventions to improve match rates for diverse medical students. Methods: Retrospective review of GSR National Residency Matching Program (NRMP) applicant and Accreditation Council for Graduate Medical Education (ACGME) active resident data between 2011 and 2022. Data included application characteristics for United States ("US") and "independent" applicants, factors cited by program directors in the interview and ranking process, paths pursued if applicants went unmatched, and racial/ethnic representation. Results: A total of 9149 US and 3985 independent applicants applied to GSR between 2011 and 2021. Matched versus unmatched applicants had higher step 1 scores (US: 236 vs 218, P = 0.005; independent: 237 vs 228, P = 0.001), higher step 2 scores (US: 248 vs 232, P = 0.006; independent: 245 vs 234, P < 0.001), more likely to belong to alpha omega alpha (US: 17.1% vs 1.6%, P = 0.002) or to attend a top 40 National Institutes of Health-funded school (US: 31.0% vs 19.4%, P = 0.002) compared to unmatched applicants. Program directors heavily factored step 1 and step 2 scores, letters of recommendation, interactions with faculty and trainees, and interpersonal skills when interviewing and ranking applicants. The proportion of active general surgery residents versus applicants was lower for Asians (12.3% vs 20.9%, P < 0.001), Black/African American (5.0% vs 8.8%, P < 0.001), Hispanic/Latino (5.0% vs 9.4%, P = 0.001), and underrepresented in medicine students (10.3% vs 19.1%, P < 0.001). Conclusions: In the pass/fail step 1 era, factors including step 2 score and other subjective metrics may be more heavily weighted in the GSR match process.

Increasing Importance and Costs Associated With Publishing for Dermatology Residency Applicants.

The financial costs associated with publishing in academic journals have steadily risen in recent years, reflected by higher publishing fees and the emergence of open access (OA) publishing models. Research remains an essential part of academia and has special significance for residency applicants. Due to recent changes in some objective measures used to rank residency applicants, such as abandoning numerical United States Medical Licensing Examination (USMLE) Step 1 scores and transitioning pre-clinical grades to Pass/Fail, other objective measures have gained significance: in particular, the quality and quantity of research activities including manuscripts, abstracts, and presentations have become more important in residency applications. This has led to a significant increase in the reported number of research experiences and publications to more competitive specialties, including dermatology. Our study analyzes the current financial landscape of publishing in the field of dermatology and the financial burden placed on applicants as well as programs to meet the expected number of research experiences in order to successfully match into a dermatology residency. Through a comprehensive examination of 85 dermatology-based academic journals, we assess the costs and differences of publishing in OA and hybrid OA journals while also exploring potential avenues for mitigating the financial burden of publishing. Our findings indicate that while cost-effective options exist, the financial burden of article processing charges remains substantial.

Sending a Signal: Evaluating the Impact of Program and Geographic Preference Signaling on the Internal Medicine Residency Match.

Background For over a decade, the number of residency applications has surged, a trend known as "application inflation." COVID-19 further intensified this trend, leading the Association of American Medical Colleges (AAMC) to address the issue by introducing a supplemental application in the 2021-2022 cycle, allowing programs to identify applicants with a connection to their program or geographic region. For the 2022-2023 cycle, the number of program signals increased from five to seven. The impact of the supplemental application and the increase in signals on the likelihood of an applicant matching with a program has yet to be evaluated. Methods This retrospective cohort study evaluated the impact of program signaling and geographic preference on the matching likelihood in our internal medicine residency program. Data from MyERAS® and the Supplemental Application for 640 applicants who applied to our large, urban, university-based program in the Southeastern United States during the 2020-2021 and 2022-2023 application cycles were included. Using univariate and multivariate analysis, we examined the correlation between program signal, geographic preference, and final match location. Results Applicants who sent a program signal had nearly three-fold higher odds of matching with our program. Geographic preference was numerically but not statistically associated with higher odds of matching. Both signaling a preference for matching with a program in an urban environment and couples matching correlated with decreased odds of matching with our program. Geography was an important predictor of match location as residing in our AAMC geographic region, our four-state area, and our specific state had increased odds of matching with our program. Conclusions Signaling our program was associated with increased odds of matching with our program. Geographic preferences were less predictive of a match with our program; however, they did predict the likelihood of a match at a program within that region. Future studies are needed to ensure external validity.

Creation of an Automated and Comprehensive Resident Progress System for Residents and to Save Hours of Faculty Time: Mixed Methods Study.

BACKGROUND: It is vital for residents to have a longitudinal view of their educational progression, and it is crucial for the medical education team to have a clear way to track resident progress over time. Current tools for aggregating resident data are difficult to use and do not provide a comprehensive way to evaluate and display resident educational advancement. OBJECTIVE: This study aims to describe the creation and assessment of a system designed to improve the longitudinal presentation, quality, and synthesis of educational progress for trainees. We created a new system for residency progress management with 3 goals in mind, that are (1) a long-term and centralized location for residency education data, (2) a clear and intuitive interface that is easy to access for both the residents and faculty involved in medical education, and (3) automated data input, transformation, and analysis. We present evaluations regarding whether residents find the system useful, and whether faculty like the system and perceive that it helps them save time with administrative duties. METHODS: The system was created using a suite of Google Workspace tools including Forms, Sheets, Gmail, and a collection of Apps Scripts triggered at various times and events. To assess whether the system had an effect on the residents, we surveyed and asked them to self-report on how often they accessed the system and interviewed them as to whether they found it useful. To understand what the faculty thought of the system, we conducted a 14-person focus group and asked the faculty to self-report their time spent preparing for residency progress meetings before and after the system debut. RESULTS: The system went live in February 2022 as a quality improvement project, evolving through multiple iterations of feedback. The authors found that the system was accessed differently by different postgraduate years (PGY), with the most usage reported in the PGY1 class (weekly), and the least amount of usage in the PGY3 class (once or twice). However, all of the residents reported finding the system useful, specifically for aggregating all of their evaluations in the same place. Faculty members felt that the system enabled a more high-quality biannual clinical competency committee meeting and they reported a combined time savings of 8 hours in preparation for each clinical competency committee as a result of reviewing resident data through the system. CONCLUSIONS: Our study reports on the creation of an automated, instantaneous, and comprehensive resident progress management system. The system has been shown to be well-liked by both residents and faculty. Younger PGY classes reported more frequent system usage than older PGY classes. Faculty reported that it helped facilitate more meaningful discussion of training progression and reduced the administrative burden by 8 hours per biannual session.

Obstetrics and Gynecology Residency Geographic Match Location Patterns: Comparison of Pre and Post Virtual Interviews.

OBJECTIVE: To evaluate the impact of virtual interviews on geographic trends for applicants and programs in the obstetrics and gynecology (OBGYN) resident match. DESIGN: Cross-sectional study of a random 50% sample of all OBGYN residency programs listed by the Accreditation Council for Graduate Medical Education (ACGME) for the 2023 to 2024 academic year. Data collected from each program included geographic location, number of residents per year, and total number of residents. Residents were categorized into 4 mutually exclusive geographic match categories: matched into the same institution, matched into same state (but different institution), matched into the same US Census region but a different state/institution, or matched into a different US Census region. RESULTS: A total of 148 of 295 (50.2%) residency programs were included (known total number of residents = 2,928 from four US census regions and Puerto Rico). Most programs were considered small (≤16 residents; n = 52, 35.1%). In general, 43.9% (1148 of 2617) residents matched in a different region from their medical school training. For the primary outcome, no differences in the geographic placement in the previrtual (2020) and virtual application cycles (2021-2023) were observed (p = 0.51). When analyzed by program size or program region, there was no difference in the geographic placement in the previrtual and virtual application cycles. CONCLUSIONS: This study suggests that the virtual interview process did not demonstrate an impact on geographical placement of OBGYN residents, regardless of the size of the residency program or the program's geographic region.

General Surgery Residency Applicant Perspectives on Alternative Residency Interview Models with Implementation of an Optional Second Look Day.

OBJECTIVE: In response to Covid-19, the Association of American Medical Colleges (AAMC) recommended for residency interviews to take place virtually. Benefits of virtual interviews include substantial cost saving and scheduling flexibility. However, it is more difficult to understand program culture and there is concern that more emphasis will be placed on board examination scores and class rank. Programs are split in their decision to keep virtual interviews in the future. This study aims to provide more clarification on students' perspectives and explore the role of an optional second look day to bridge the gap left by the lack of in-person interaction. DESIGN: This cross-sectional study surveyed applicants at our general surgery residency program during the 2022 to 2023 cycle. An optional second look day event was held after submission of the program's rank list. The first survey was sent to all applicants who interviewed with the residency program and asked to pick an interview style that they favored (in person vs virtual) and then asked to rate factors that impacted their decision. It also asked if an optional second look day event was made available, what factors would applicants consider to be important in their decision to attend. The second survey was sent to applicants who attended second look day and asked applicants to state importance of factors that led to their decision to attend. RESULTS: About 50/110 completed the first survey. Applicants preferred virtual over in-person interviews (52% vs 28%). Those who chose virtual selected factors of time commitment and financial burden to be very important compared to those who chose in-person. Applicants who preferred in-person interviews placed most importance on avoiding technical issues and having personal interactions such as: with attending surgeons, with residents, assessment of program culture, visiting facilities, and visiting the town. Applicants were asked to pick important factors if they were to attend an optional second look day after their virtual interview. The following factors were chosen as very important: time commitment, financial burden, interaction with program leadership, interaction with attending surgeons, interaction with residents, visiting facilities, and visiting the town. We then held a second look event after the submission of our rank list. 34/110 attended and 17 complete the survey. Cost and time commitment were not as important to this group who actually attended; they chose in-person interactions with leadership and residents and assessing the program culture to be most important. CONCLUSION: This study aimed to determine the best interview method based on student perceptions. We also piloted an optional second look day to determine whether or not it fills the gaps left by the suspension of in-person interviews. We recommend continuing with virtual interviews as this is what applicants prefer. It alleviates the financial burden of travel and allows for better time management. However, the significance of in-person interactions cannot be ignored. We propose that second look days should be incorporated after submission of the program's rank list to allow applicants the opportunity for in-person interactions, exploration of the town, and enhance their overall interviewing experience.

Evolving Regional Anesthesiology and Acute Pain Medicine fellowship application process: a program director survey.

BACKGROUND AND OBJECTIVES: Most Regional Anesthesiology and Acute Pain Medicine (RAAPM) fellowship programs transitioned to virtual interviews in 2020 because of the COVID-19 pandemic. Then, the RAAPM fellowship match started in 2023 in order to make the application process more equitable. In this study, we surveyed RAAPM fellowship program directors (PDs) to determine how such major events of the early 2020s shaped the fellowship application process. METHODS: A 16-question survey was distributed to US RAAPM program directors. The survey aimed to assess whether PDs prefer the fellowship match over the previous rolling application format and to gauge PDs' confidence in using virtual interviews to evaluate applicants. RESULTS: 56 (71%) RAAPM program directors completed the survey. 79% of respondents participated in the inaugural match. 59% of PDs preferred the fellowship match over the rolling application format. The interview was rated the most important selection criterion. Of the 93% of PDs who switched to virtual interviews during the pandemic, only 4 PDs (7%) resumed in-person interviews in some capacity. Majority of PDs believed that virtual interviews were not inferior to in-person interviews for assessing applicants; 48% of respondents preferred virtual interviews over in-person interviews. CONCLUSIONS: Most RAAPM programs continued to conduct virtual interviews exclusively. Majority of program directors preferred the fellowship match. PDs ranked the interview as the most important selection factor. Most PDs thought virtual interviews were not inferior to in-person interviews, but they remained divided on which format they prefer.

Fellow perceptions of robotic surgery preparedness for fellowship.

INTRODUCTION: Many surgical fellowship programs incorporate robotic surgery, yet not all residency programs offer robotic training for residents. Given the variability of pre-fellowship robotic exposure, the goal of this study was to explore whether standardized robotic skills assessment would be useful to fellows at the start of their training. METHODS: In partnership with the Fellowship Council, we surveyed current fellows of accredited Thoracic, Colorectal, HPB, and Advanced GI/MIS/Bariatrics/Foregut Fellowship programs. Main outcome measurements included amount of robotic exposure during residency, fellows' robotic skills at the start of fellowship, and fellows' attitudes towards a standardized skills assessment. RESULTS: In total, 78 fellows completed the survey. Mean percentage of cases performed robotically during fellowship was 38.1% (SD ± 32.25%). From our respondents, 46% had no robotic curriculum during residency and 86.9% felt a standardized robotic curriculum during residency would have been beneficial. When asked if they started fellowship with adequate robotic skills to operate autonomously, 31% strongly agreed, but 24.4% strongly disagreed. The majority of fellows reported their fellowship program did not conduct an assessment of their robotic skills (71.5%), or provide a specific robotic curriculum (75.6%). On the other hand, 73.3% felt a formal proficiency assessment at the start of fellowship would be helpful for individualized support and training. CONCLUSIONS: Given the significant variability in resident exposure to robotic surgery, a standardized robotic curriculum during residency would likely be beneficial. Additionally, a robotic skills assessment at the start of fellowship could help provide a tailored training experience for fellows interested in this skillset.

Medication Errors as a Marker of Resident Competency.

Introduction Educators continue to evaluate ways to assess resident performance in conjunction with the Accreditation Council for Graduate Medical Education (ACGME) general surgery milestones. We investigated whether the rate of medication errors could reflect general surgery resident competency. We hypothesized that the identification of increased medication errors made by general surgery residents could be a potential screening tool to identify residents who are academically at risk prior to their formal biannual milestone evaluation by the clinical competency committee. Methods This is a retrospective cohort study comparing rates of medication ordering errors against ACGME core competency scores over four years in a general surgery residency program at an academic, university-affiliated, level 1 trauma center in the Northeastern United States. Results We identified 95 general surgery residents who inputted 1,164,663 medication orders during the four years studied. There were 1,214 (0.1%) errors identified. Of those, 1,146 (94.4%) were level 3 errors, and 68 (5.6%) were level 4 errors. This represents an error rate of 1.04 errors per 1,000 medication orders. There was a statistically significant decrease in the error rate as the post-graduate year (PGY) level increased (p=0.005). However, there was no correlation between the error rate and individual ACGME milestone competency scores by PGY level. Conclusions We explored whether medication errors may be an early measurement of worsening resident performance as demonstrated by a decrease in ACGME core competency scores. However, the rate of errors did not correlate consistently with these measures. This may underscore that medication errors measure an aspect of resident performance that we do not capture with our current assessments.

Integrating psychiatry into basic clinical skills: A three-year nationwide quantitative assessment of postgraduate training programs.

Aim: The aim of this study was to develop quantitative outcome indicators for psychiatric training programs integrated into the General Medicine In-Training Examination (GM-ITE) and to investigate which characteristics correlate with high scores in psychiatry. Methods: A nationwide cross-sectional study was conducted over 3 fiscal years (2021-2023). An anonymous online questionnaire was distributed to postgraduate year 1 and 2 residents who completed the GM-ITE. The primary outcome was GM-ITE score, with a particular focus on psychiatry. Multiple-choice questions for the psychiatry field were created by board-certified psychiatrists with various subspecialties, then reviewed and piloted. Multiple regression analysis examined correlations between GM-ITE score and various resident and facility characteristics. Results: A total of 18,226 residents participated over the 3 years, of whom 5%-6% aspired to specialize in psychiatry. Quantitative scores were effective in the psychiatry field across all 3 years. Psychiatry aspirants had lower scores in internal medicine, emergency, and total scores but higher scores in psychiatry. Residents from university hospitals had lower psychiatry scores, while the number of psychiatry beds and supervising psychiatrists did not correlate with higher psychiatry scores. These findings indicate the need for psychiatric training programs distinct from general internal medicine and emergency training. Conclusion: Based on these quantitative psychiatry scores, this study highlights the necessity of improving physical assessment skills during residency for psychiatry aspirants, who score higher in psychiatry. Future research should identify effective training programs and facility practices that lead to higher psychiatry scores among residents, and thereby better integrate psychiatry into basic clinical skills.

Reliability of a workplace-based assessment for the United States general surgical trainees' intraoperative performance using multivariate generalizability theory: a psychometric study

PURPOSE: The System for Improving and Measuring Procedure Learning (SIMPL), a smartphone-based operative assessment application, was developed to assess the intraoperative performance of surgical residents. This study aims to examine the reliability of the SIMPL assessment and determine the optimal number of procedures for a reliable assessment. METHODS: In this retrospective observational study, we analyzed data collected between 2015 and 2023 from 4,616 residents across 94 General Surgery Residency programs in the United States that utilized the SIMPL smartphone application. We employed multivariate generalizability theory and initially conducted generalizability studies to estimate the variance components associated with procedures. We then performed decision studies to estimate the reliability coefficient and the minimum number of procedures required for a reproducible assessment. RESULTS: We estimated that the reliability of the assessment of surgical trainees' intraoperative autonomy and performance using SIMPL exceeded 0.70. Additionally, the optimal number of procedures required for a reproducible assessment was 10, 17, 15, and 17 for postgraduate year (PGY) 2, PGY 3, PGY 4, and PGY 5, respectively. Notably, the study highlighted that the assessment of residents in their senior years necessitated a larger number of procedures compared to those in their junior years. CONCLUSION: The study demonstrated that the SIMPL assessment is reliably effective for evaluating the intraoperative performance of surgical trainees. Adjusting the number of procedures based on the trainees' training stage enhances the assessment process's accuracy and effectiveness.

Burnout is not associated with trainee performance on the Vascular Surgery In-Training Exam.

OBJECTIVE: The Vascular Surgery In-Training Examination (VSITE) is a yearly exam evaluating vascular trainees' knowledge base. Although multiple studies have evaluated variables associated with exam outcomes, few have incorporated training program-specific metrics. The purpose of this study is to evaluate the impact of the learning environment and burnout on VSITE performance. METHODS: Data was collected from a confidential, voluntary survey administered after the 2020 to 2022 VSITE as part of the SECOND Trial. VSITE scores were calculated as percent correct then standardized per the American Board of Surgery. Generalized estimating equations with robust standard errors and an independent correlation structure were used to evaluate trainee and program factors associated with exam outcomes. Analyses were further stratified by integrated and independent training paradigms. RESULTS: A total of 1385 trainee responses with burnout data were collected over 3 years (408 in 2020, 459 in 2021, 498 in 2022). On average, 46% of responses reported at least weekly burnout symptoms. On unadjusted analysis, burnout symptoms correlated with a 14 point drop in VSITE score (95% confidence interval [CI], -24 to -4; P = .006). However, burnout was no longer significant after adjusted analysis. Instead, higher postgraduate year level, being in a relationship, identifying as male gender with or without kids, identifying as non-Hispanic white, larger programs, and having a sense of belonging within a program were associated with higher VSITE scores. CONCLUSIONS: Despite high rates of burnout, trainees generally demonstrate resilience in gaining the medical knowledge necessary to pass the VSITE. Performance on standardized exams is associated with trainee and program characteristics, including availability of support systems and program belongingness.

Practices, Attitudes, and Knowledge Regarding Recombinant Zoster Vaccine Among Family Medicine Residents in Riyadh, Saudi Arabia.

Background The aim of the research is to determine the existing knowledge, perceived practices, and attitudes toward the recombinant Zoster vaccine among family medicine residents (FMR) included in the medical profession. The present study aims to narrow down the identified gap in knowledge and develop vaccinations that will assist the targeted deme to eradicate zoster and the aftermaths that accompany it. Methods This research utilizes a descriptive cross-sectional survey design to assess the knowledge, practices, and attitudes of FMR toward the zoster vaccine in Riyadh, Saudi Arabia. By quantifying data at a specific point in time, this design allows for a detailed examination of the current status across various levels of residency programs. Participants from different institutions are interviewed simultaneously, enabling a thorough study of the targeted population group. The study includes 154 FMR from three different levels (R1, R2, R3) enrolled in residency programs at various institutions in Riyadh, Saudi Arabia. These participants were selected from a group of individuals invited to share their prior knowledge, habits, and beliefs regarding the recombinant Zoster vaccine. The study offers detailed statistical insights into demographics, vaccination attitudes, and knowledge among healthcare professionals. Key findings highlight diverse recommendations for different adult groups, the prevalence of vaccine availability, and the main sources of immunization information. Results The study found diverse recommendations for vaccination among different adult groups, with mean recommendations ranging from 2.50 to 2.94. Nearly all respondents (96.8%) reported having the vaccine available at their place of practice. However, knowledge gaps were evident, particularly concerning vaccination timing and specific requirements, highlighting the need for targeted education and clearer guidelines in vaccination practices among healthcare providers. Conclusion The study highlights the nuanced vaccination recommendations among healthcare professionals, particularly for different adult populations, and the availability of varicella-zoster virus (VZV) vaccines. The reliance on diverse information sources underscores the need for targeted educational efforts to ensure accurate and consistent immunization practices across healthcare settings. Addressing uncertainties and promoting informed decision-making can enhance vaccination uptake and patient care outcomes in clinical practice.

Current state of the pain medicine match: perspective and an eye to the future.

The National Resident Matching Program (NRMP) for pain medicine fellowships marked its 10th anniversary in 2023, coinciding with growing discussions within the Association of Pain Program Directors (APPD) regarding the program's future in the context of a recent decline of applicants into pain medicine. This letter explores the rationale behind reassessing the NRMP's utility for pain medicine, examining historical and current trends, and considering the implications of withdrawing from the match. Despite a recent decline in applicants and an increase in unfilled positions, the APPD advocates for continued participation in the match. The match ensures equitable and stable recruitment, preventing the chaotic pre-match environment of competitive, early offers. Data from similar specialties highlight the pitfalls of non-match systems, such as increased applicant pressure and reduced program visibility. The APPD supports maintaining the NRMP match while implementing reforms like preference signaling to address evolving challenges. The APPD aims to preserve the match's benefits and ensure a stable future for pain medicine fellowship recruitment.

Development of a bleeding arteriovenous fistula task trainer.

BACKGROUND: As end-stage renal disease becomes more prevalent in the United States, the number of Americans with arteriovenous (AV) fistulas continues to increase. One of the most feared complications of AV fistulas is life-threatening hemorrhage, as patients can exsanguinate within minutes. OBJECTIVES: As frontline healthcare workers, emergency medicine (EM) providers need to be able to provide rapid and effective treatment for this rare presentation. We developed a task trainer model to simulate AV fistula hemorrhage to prepare and train EM residents. METHODS: This task trainer model was constructed with readily available materials and takes about 30 minutes to make. Twenty-one EM residents participated in the training session. The session consisted of a brief didactic on AV fistula hemorrhage control followed by hands on usage of the task-trainer model. The participants filled out an anonymous survey afterwards rating the model. RESULTS: Residents completed anonymous postcourse surveys rating the session on a five-point Likert scale. Both the overall teaching session and the task trainer were rated very highly. Compared to precourse ratings, residents reported statistically significant postcourse improvements in their level of confidence in managing AV fistula hemorrhage. CONCLUSIONS: To our knowledge, this is the first published task trainer model to simulate a bleeding AV fistula for EM residents. The model was well received by our trainees, is relatively inexpensive, and made from easily sourced materials. We believe this model can be used for trainees of all disciplines to prepare them for this potentially catastrophic patient presentation.

Military Medical Student Specialty Preferences During the DHA Transition: A Retrospective Analysis.

BACKGROUND: The Military Health System is a unique subsector within the nation's Graduate Medical Education (GME), with a different incentive structure for specialty selection for military medical students compared with their civilian counterparts. Changes by the Defense Health Agency (DHA) in 2017 emphasized a shift in military GME to training "operational" medical specialties. This study sought to gain insight into military medical students' reactions to the 2017 DHA transition by examining whether students continued to select "operational" specialties at similar rates as well as whether students remained satisfied with attending medical school. METHODS: We performed a retrospective analysis of Uniformed Services University (USU) post-match students from 2015 to 2020 using anonymized data from the Association of American Medical Colleges (AAMC) Graduation Questionnaire, separated into pre-DHA (2015-2017) and post-DHA (2018-2020) transition groups. RESULTS: Regarding both intent to practice an operational specialty and satisfaction with choosing medical school, there was no statistically significant difference between the preand post-DHA transition groups. CONCLUSIONS: Whether preor post-DHA transition, USU medical students demonstrated similar preferences for operational specialties as well as similar levels of satisfaction with medical school attendance, suggesting that this transition may not significantly influence medical students' career preferences nor blunt their desire to enter military medicine.

Novel Approach to Residents Training in Breast Surgery Using Human Donors.

INTRODUCTION: Given the high incidence rate of breast cancer and shortage of fellowship trained specialists, general surgeons are frequently responsible for these patients. Residents have less operative exposure to breast surgery due to duty hour restrictions and decreased resident autonomy. We created a curriculum using human donors designed to teach junior residents to perform breast lumpectomy and sentinel lymph node biopsies. METHODS: All eighteen junior surgery residents were invited. We chose fresh human donors to represent tissue planes more accurately. We inserted Savi Scout reflectors (Merit Oncology, Inc) in each breast for tumor localization. An olive pit plus 1 mL of methylene blue was inserted in the axilla for SLN identification. In session 1, attendings discussed proper technique and residents performed the procedures and received feedback. In session 2 after 2 mo, residents performed the same operation without any guidance. They were graded on technique during both sessions and filled out a postsession survey to gauge confidence. RESULTS: Seven PGY1 and six PGY2 residents participated. Half of the respondents strongly felt this session improved their understanding of lumpectomies, sentinel lymph node biopsies, and axillary anatomy. Most felt strongly that their skills improved and these skills were transferable to the operating room. In attending evaluations, PGY1 residents significantly improved in all aspects of the procedures; PGY2 residents showed nonstatistical significant improvement. CONCLUSIONS: Residents find these sessions helpful in learning anatomy, improving confidence and efficiency, and facilitating skill acquisition that is transferable to the operating room. We believe this approach should be considered in general surgery training programs.

National Survey of Otolaryngology Program Directors Regarding Recruitment Methods for Underrepresented in Medicine Residents.

OBJECTIVE: To characterize Otolaryngology residency program strategies for recruiting underrepresented minorities in medicine (URiM) residents and their perceived effectiveness, and explore perceived barriers to recruitment. DESIGN: We conducted a survey of Otolaryngology program directors (PDs) at the 122 accredited programs within the United States, utilizing a validated and previously published survey utilized within the OB-GYN literature. We solicited information regarding recruitment of underrepresented minorities in medicine (URiM) applicants, effectiveness of strategies, and perceived barriers in recruitment. SETTING: A national survey of U.S. accredited residency programs in Otolaryngology in 2022-2023. RESULTS: A total of 42 (34%) PDs responded. 55% of programs reported an increase in URiM residents, of which 18(43%) described an intentional change. Almost all PDs reported placing at least "some" significance in the recruitment of URiM residents (95%). Statistically significant differences were seen in recruitment methods between programs that saw an increase in URiM resident recruitment an those that did not. Additionally, Program Directors believed that increased face-face interaction with applicants were the most effective forms of recruitment. PDs found the biggest challenge to recruitment was a lack of diverse applicants (6.3/10) and faculty (5.8/10). This perception did not change when adjusted for programs that saw an increase in URiM trainee recruitment. CONCLUSIONS: This study demonstrates the URiM resident recruitment practices and perceived effectiveness of these strategies within otolaryngology programs nationally. The results and analysis may provide programs who are looking to diversify their workforce with some effective and meaningful strategies to start the process.