Cultural Influences Catalyzing Resident Scholarly Productivity.

BACKGROUND AND OBJECTIVES: Scholarly activity is a core requirement set by the Accreditation Council for Graduate Medical Education (ACGME). A previous study documented a significant 302% increase in scholarly activity at Eglin Family Medicine Residency after implementation of a standard set of interventions from 2016 to 2019. Few researchers have explained why such interventions to increase scholarly activity are effective. Prior work has suggested that many different interventions are helpful, but why? Our qualitative study took a multilevel approach to explain accompanying cultural factors and to determine how specific interventions led to the observed increases in quality and quantity of resident scholarship. METHODS: Taking a grounded theory qualitative approach, we interviewed a cross-section of high- and low-producing residents (12) and faculty (5) using a semistructured interview guide. Data analysis occurred concurrently with interviews. The team iterated the interview guide three times until core code saturation was achieved. Then axial coding occurred, and our team developed a grounded theory of scholarship cultural change. RESULTS: During the transformation period of 2016 to 2019, participants identified mentorship availability, interest/opportunity alignment, research mechanics demystification, leadership support affecting productivity, and scholarship begets scholarship as key factors that promulgated the culture change leading to increased scholarship productivity. No single factor led to increased scholarship. Collectively, they mutually reinforced one another. CONCLUSIONS: This explanatory inquiry developed into a multilevel model which suggests that the synergy of promoting elements drives increased scholarly productivity. Other residencies should consider fostering these combined elements instead of emphasizing only isolated individual elements to increase resident scholarship productivity.

Operation Blood Rain Phase 2: Evaluating the Effect of Airdrop on Fresh and Stored Whole Blood.

BACKGROUND: Transfusion of whole blood (WB) is a lifesaving treatment that prolongs life until definitive surgical intervention can be performed; however, collecting WB is a time-consuming and resource-intensive process. Furthermore, it may be difficult to collect sufficient WB at the point of injury to treat critically wounded patients or multiple hemorrhaging casualties. This study is a follow-up to the proof-of-concept study on the effect of airdrop on WB. In addition, this study confirms the statistical significance for the plausibility of using airdrop to deliver WB to combat medics treating casualties in the pre-hospital setting when Food and Drug Administration (FDA)-approved cold-stored blood products are not available. METHODS: Forty-eight units of WB were collected and loaded into a blood cooler that was dropped from a fixed-wing aircraft under a Standard Airdrop Training Bundle (SATB) parachute or 68-in pilot chute. Twenty-four of these units were dropped from a C-145 aircraft, and 24 were dropped from a C-130 aircraft. A control group of 15 units of WB was storedin a blood cooler that was not dropped. Baseline and post-intervention laboratory tests were measured in both airdroppedand control units, including complete blood count; prothrombin time/partial thromboplastin time (PT/PTT); pH, lactate,potassium, bilirubin, glucose, fibrinogen, and lactate dehydrogenase (LDH) levels; and peripheral blood smears. RESULTS: The blood cooler, cooling packs, and all 48 WB units did notsustain any major damage from the airdrop. There was noevidence of hemolysis. Except for the one slightly damagedbag that was not sampled, all airdropped blood met parameters for transfusion per the Joint Trauma System Whole BloodTransfusion Clinical Practice Guideline and the Associationfor the Advancement of Blood and Biotherapies (AABB) Circular of Information for the Use of Human Blood and BloodComponents. CONCLUSIONS: Airdrop of fresh or stored WB in ablood cooler with a chute is a viable way of delivering bloodproducts to combat medics treating hemorrhaging patientsin the pre-hospital setting. This study also demonstrated theportability of this technique for multiple aircraft. The techniques evaluated in this study have the potential for utilizationin other austere settings such as wilderness medicine or humanitarian disasters where an acute need for WB delivery by airdrop is the only option.

A Curriculum to Increase Resident Scholarly Activity.

BACKGROUND AND OBJECTIVES: Scholarly activity (SA) is an Accreditation Council of Graduate Medical Education (ACGME) requirement for family medicine residents. Engaging residents in scholarly activity can be challenging. Naval Hospital Jacksonville Family Medicine Residency (NHJ) pioneered a curriculum that led to a dramatic, sustained increase in resident SA. We sought to implement the curriculum in other family medicine residency programs. METHODS: The curriculum was implemented at two additional family medicine residencies. Three curricular interventions were identified: a 3-hour case report workshop, a written practical guide to scholarly activity, and a resident peer research leader. One program implemented all three elements. The other implemented the workshop and written guide, but did not identify a resident peer leader. SA was measured using the annual ACGME program director report and compared the intervention year to the previous 3 years of SA using a 2-sample test for equality of proportions with continuity correction. We used pre- and postintervention surveys to evaluate resident attitudes about SA. RESULTS: The program implementing all three interventions increased residents' conference presentation 302% (n=34, P<.001). The program that did not identify a resident peer leader had no significant change in SA as reported to the ACGME. CONCLUSIONS: The curriculum was implemented in two additional residencies with promising results. We recommend further implementation across multiple sites to determine the extent to which the results are generalizable.