Parenting and Childbearing in Neurosurgical Residency: Perspectives from the United States and Canada.

BACKGROUND: Despite growing interest in family planning alongside surgical training, significant barriers exist including time constraints, stigma, and lack of paid leave and formal policies. We currently lack a deep understanding of the challenges residents face and how practice cultures may prohibit successful policy enactment. OBJECTIVE: To investigate residents' perspectives surrounding parenting and childbearing during neurosurgical residency in the United States and Canada. METHODS: A cross-sectional, qualitative study methodology was used, including focus groups with neurosurgical residents. Purposive sampling was employed to capture a broad range of perspectives including stage of training, geographical location, and gender. Data collection and analysis occurred in parallel, using a thematic analysis approach. Data collection continued until no new themes relating to the research questions were identified. RESULTS: Notable challenges included lack of formal family leave policies, time constraints, insufficient clinical human resources, physical health concerns, lack of lactation accommodations, and lack of mentorship. A subset of barriers were uncovered that stem specifically from workplace cultures, including gender norms, difficulty in asking for help, concerns for inconveniencing others, and pressures to time parental leave during research blocks. Several positive changes were identified including growing awareness and female representation, and benefits of the dual surgeon-parent identity. CONCLUSION: While parenting during neurosurgery residency is becoming increasingly common, significant practical and cultural barriers persist including a marked absence of formal policies. Culture shifts are essential in ensuring opportunities for life outside of medicine for all residents, irrespective of family status.

Enhancing Formative Feedback in Orthopaedic Training: Development and Implementation of a Competency-Based Assessment Framework.

OBJECTIVE: The purpose of this study was to develop, implement, and evaluate the effectiveness of an assessment framework aimed at improving formative feedback practices in a Canadian orthopaedic postgraduate training program. METHODS: Tool development began in 2014 and took place in 4 phases, each building upon the previous and informing the next. The reliability, validity, and educational impact of the tools were assessed on an ongoing basis, and changes were made accordingly. RESULTS: One hundred eighty-two tools were completed and analyzed during the study period. Quantitative results suggested moderate to excellent agreement between raters (intraclass correlation coefficient = 0.54-0.93), and an ability of the tools to discriminate between learners at different stages of training (p's < 0.05). Qualitative data suggested that the tools improved both the quality and quantity of formative feedback given by assessors and had begun to foster a culture change around assessment in the program. CONCLUSIONS: The tool development, implementation, and evaluation processes detailed in this article can serve as a model for other training programs to consider as they move towards adopting competency-based approaches and refining current assessment practices.

'It's not the form; it's the process': a phenomenological study on the use of creative professional development workshops to improve teamwork and communication skills.

INTRODUCTION: Past research has demonstrated the positive effects of visual and performing arts on health professionals' observational acuity and associated diagnostic skills, well-being and professional identity. However, to date, the use of arts for the development of non-technical skills, such as teamwork and communication, has not been studied thoroughly. METHODS: In partnership with a community print and media arts organisation, Centre[3], we used a phenomenological approach to explore front-line mental health and social service workers' experiences with a creative professional development workshop based on the visual and performing arts. Through preworkshop and postworkshop interviews with participants and postworkshop interviews with their managers, we sought to examine how participants' perceptions of the workshop compared with their preworkshop expectations, specific impacts of the workshop with respect to participants' teamwork and communication skills and changes in their perceptions regarding the use of the arts in professional development. RESULTS: Our workshops were successful in enhancing teamwork skills among participants and showed promise in the development of communication skills, though observable changes in workplace communication could not be confirmed. The workshop facilitated teamwork and collegiality between colleagues, creating a more enjoyable and accepting work environment. The workshops also helped participants identify the strengths and weaknesses of their communication skills, made them more comfortable with different communication styles and provided them with strategies to enhance their communication skills. CONCLUSIONS: Participation in the arts can be beneficial for the development of interpersonal skills such as teamwork and communication among health professionals.

Simulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs?

BACKGROUND: Although simulation-based training is becoming widespread in surgical education and research supports its use, one major limitation is cost. Until now, little has been published on the costs of simulation in residency training. At the University of Toronto, a novel competency-based curriculum in orthopaedic surgery has been implemented for training selected residents, which makes extensive use of simulation. Despite the benefits of this intensive approach to simulation, there is a need to consider its financial implications and demands on faculty time. QUESTIONS/PURPOSES: This study presents a cost and faculty work-hours analysis of implementing simulation as a teaching and evaluation tool in the University of Toronto's novel competency-based curriculum program compared with the historic costs of using simulation in the residency training program. METHODS: All invoices for simulation training were reviewed to determine the financial costs before and after implementation of the competency-based curriculum. Invoice items included costs for cadavers, artificial models, skills laboratory labor, associated materials, and standardized patients. Costs related to the surgical skills laboratory rental fees and orthopaedic implants were waived as a result of special arrangements with the skills laboratory and implant vendors. Although faculty time was not reimbursed, faculty hours dedicated to simulation were also evaluated. The academic year of 2008 to 2009 was chosen to represent an academic year that preceded the introduction of the competency-based curriculum. During this year, 12 residents used simulation for teaching. The academic year of 2010 to 2011 was chosen to represent an academic year when the competency-based curriculum training program was functioning parallel but separate from the regular stream of training. In this year, six residents used simulation for teaching and assessment. The academic year of 2012 to 2013 was chosen to represent an academic year when simulation was used equally among the competency-based curriculum and regular stream residents for teaching (60 residents) and among 14 competency-based curriculum residents and 21 regular stream residents for assessment. RESULTS: The total costs of using simulation to teach and assess all residents in the competency-based curriculum and regular stream programs (academic year 2012-2013) (CDN 155,750, USD 158,050) were approximately 15 times higher than the cost of using simulation to teach residents before the implementation of the competency-based curriculum (academic year 2008-2009) (CDN 10,090, USD 11,140). The number of hours spent teaching and assessing trainees increased from 96 to 317 hours during this period, representing a threefold increase. CONCLUSIONS: Although the financial costs and time demands on faculty in running the simulation program in the new competency-based curriculum at the University of Toronto have been substantial, augmented learner and trainer satisfaction has been accompanied by direct evidence of improved and more efficient learning outcomes. CLINICAL RELEVANCE: The higher costs and demands on faculty time associated with implementing simulation for teaching and assessment must be considered when it is used to enhance surgical training.

Examining the barriers to meaningful assessment and feedback in medical training.

BACKGROUND: Recent reports from both accreditation bodies in North America highlight problems with current assessment practices in postgraduate medical training. Previous work has shown that educators might be reluctant to report poor performance or fail underperforming trainees. This study explores the barriers perceived by medical educators to providing more meaningful assessment and feedback to trainees. METHODS: Semistructured interviews were conducted with 22 physician educators. Interviews were audiotaped and transcribed verbatim. Three researchers analyzed the transcripts using a grounded theory approach. RESULTS: Participants expressed a reluctance to provide poor assessments or feedback to trainees. Fifty-five percent of the participants reported passing trainees who could have benefited from additional training. Our data revealed a number of barriers which may account for these findings. Implementing more frequent formative assessments could help educators more effectively evaluate trainees and provide feedback, although a shift in the culture of medicine may be required. CONCLUSION: It is imperative that the barriers to effective assessment and feedback identified in this study be addressed to improve postgraduate medical training and enhance patient care.

Student-led learning: a new teaching paradigm for surgical skills.

BACKGROUND: Competency-based education and simulation are being used more frequently in surgical skills curricula. We explored a novel student-led learning paradigm, which allows trainees to become more active participants in the learning process while maintaining expert guidance and supervision. METHODS: Twelve first-year orthopedic residents were randomized to either a student-led (SL) or a traditional instructor-led group during an intensive, month-long, laboratory-based technical skills training course. A rigorous qualitative-description approach was used for analysis. RESULTS: Four prominent themes emerged: instructional style, feedback, peer and instructor collaboration, and self-efficacy. Compared with the instructor-led group, there was more peer assistance, feedback, collaboration, and hands-on and active learning observed in the SL group. CONCLUSIONS: The flexible and socially rich nature of the SL learning environment may aid in development of both technical and nontechnical skills early in residency and ultimately privilege later clinical learning.