Preparedness of neurosurgery graduates for neuroendovascular fellowship: a national survey of fellowship programs

OBJECT Endovascular interventions have become an essential part of a neurosurgeon’s practice. Whether endovascular procedures have been effectively integrated into residency curricula, however, remains uncertain. The purpose of this study was to assess the preparedness of US neurosurgery graduate trainees for neuroendovascular fellowship. METHODS A multidomain, global assessment survey was sent to all directors/faculty of neuroendovascular fellowship programs involved in training of US neurosurgery graduates. Surveyees were asked to assess trainees as they entered fellowship. RESULTS The response rate was 78% (25/32). Of respondent program directors, 38% reported that new fellows did not know the history and imaging of the patient and 50% were unable to formulate an appropriate treatment plan. As many as 79% of fellows were unfamiliar with endovascular devices and 75% were unfamiliar with angiographic equipment. Furthermore, 58% of fellows were unable to perform femoral access, 54% were unable to perform femoral closure, 79% were unable to catheterize a major vessel, 86% were unable to perform a 4-vessel angiogram, and 100% were unable to catheterize an aneurysm. Additionally, program directors reported that over 50% of fellows could not recognize neurovascular anatomy and 54% could not recognize/classify vascular abnormalities. There was an overall agreement that fellows demonstrated professionalism and interest in research and had good communication/clinical skills. CONCLUSIONS The results of this study suggest potential gaps in the training of neurosurgery residents with regard to endovascular neurosurgery. In an era of minimally invasive therapies, changes in residency curricula may be needed to keep pace with the ever-changing field of neurosurgery.

Download Full-text

Gender Distribution of Current Surgical Critical Care Fellows, Faculty, and Program Directors

The American Surgeon ◽

10.1177/00031348211011143 ◽

2021 ◽

pp. 000313482110111

Author(s):

Haley Ehrlich ◽

Jackie Nguyen ◽

Mason Sutherland ◽

Mark McKenney ◽

Adel Elkbuli

Keyword(s):

Critical Care ◽

Clinical Skills ◽

Program Directors ◽

Cross Sectional ◽

Gender Distribution ◽

Women Surgeons ◽

Effective Interventions ◽

Surgical Critical Care ◽

Fellowship Programs ◽

Surgical Field

As women surgeons continue to represent a minority within the surgical field while also holding lower ranked positions, gaining a sub-specialized set of clinical skills through surgical fellowships, like surgical critical care (SCC), is one approach to advance within the surgical field. A cross-sectional analysis was performed investigating the websites of all 106 US-based SCC fellowships. A total of 116 SCC fellows were included in this analysis, comprising 67 (59.3%) men and 46 (40.7%) women. There were 977 SCC fellowship faculty were evaluated, comprising 619 (67.9%) men and 292 (32.1%) women. Additionally, 103 SCC fellowship program directors were analyzed, consisting of 77 (74.8%) men and 26 (25.2%) women. There is a significantly lower proportion of women fellows and faculty members (P < .001) compared to men. SCC programs with female program directors on average have higher proportions of female fellows and faculty compared to programs with male program directors (52% and 36% vs 31% and 29%, respectively). There is a stable yet unbalanced gender distribution throughout all positions in SCC fellowship programs. Actively supporting women surgeons pursuing SCC fellowship and removing barriers to their advancement through effective interventions can disrupt the persistently low prevalence of women SCC fellows, faculty, and program directors.

Download Full-text

Improving Knowledge and Process for International Emergency Medicine Fellowship Applicants: A Call for a Uniform Application

Emergency Medicine International ◽

10.1155/2013/737391 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Gabrielle A. Jacquet ◽

Jamil D. Bayram ◽

William B. Ewen ◽

Bhakti Hansoti ◽

Steven Andescavage ◽

...

Keyword(s):

Emergency Medicine ◽

Program Directors ◽

Application Process ◽

Convenience Sample ◽

Application System ◽

International Emergency Medicine ◽

Application Service ◽

Fellowship Programs ◽

Recent Graduates ◽

Universal Application

Background. There are currently 34 International Emergency Medicine (IEM) fellowship programs. Applicants and programs are increasing in number and diversity. Without a standardized application, applicants have a difficulty approaching programs in an informed and an organized method; a streamlined application system is necessary.Objectives. To measure fellows’ knowledge of their programs’ curricula prior to starting fellowship and to determine what percent of fellows and program directors would support a universal application system.Methods. A focus group of program directors, recent, and current fellows convened to determine the most important features of an IEM fellowship application process. A survey was administered electronically to a convenience sample of 78 participants from 34 programs. Respondents included fellowship directors, fellows, and recent graduates.Results. Most fellows (70%) did not know their program’s curriculum prior to starting fellowship. The majority of program directors and fellows support a uniform application service (81% and 67%, resp.) and deadline (85% for both). A minority of program directors (35%) and fellows (30%) support a formal match.Conclusions. Program directors and fellows support a uniform application service and deadline, but not a formalized match. Forums for disseminating IEM fellowship information and for administering a uniform application service and deadline are currently in development to improve the process.

Download Full-text

DECLINE OF CLINICAL ART AND TECNOLOGICAL MEDICINE BOOM

Anales de la Real Academia Nacional de Farmacia ◽

10.53519/analesranf.2021.87.02.02 ◽

2021 ◽

pp. 123-133

Author(s):

José Antonio Rodríguez Montes

Keyword(s):

Physical Examination ◽

Medical History ◽

Medical Practice ◽

New Technologies ◽

Clinical Skills ◽

Treatment Plan ◽

Correct Diagnosis ◽

Bedside Teaching ◽

The Past

Currently there is a consensus that the clinical art have been greatly deteriorating during the past 50 years. This problem has raised worldwide attention through as increase in publications, courses, symposia and congress. The erosion of bedside teaching and the consequent decline of clinical skills, notably wrongfull and inadequate use of new technologies. At as result, it becomes difficult if not impossible obtain an appropiate collection of the synptoms sufferick for the sick. Together with the medical history, the physical examination is mandatory for the correct diagnosis and developing the treatment plan. In this paper, the decline of clinical art is exposed and how this ancient heritage of medical practice can be recovered.

Download Full-text

Communication skills and tips for Part 3 MRCOG Examination

Tasks for Part 3 MRCOG Clinical Assessment ◽

10.1093/oso/9780198757122.003.0006 ◽

2017 ◽

Keyword(s):

Decision Making ◽

Communication Skills ◽

Clinical Assessment ◽

Clinical Skills ◽

Real Life ◽

Information Gathering ◽

Shared Decision ◽

Good Communication ◽

Information Giving ◽

Treatment Information

Good communication skills form a fundamental principle of the patient- centred clinical consultation. The new Part 3 of the MRCOG, assesses candidates based on their ability to apply the core clinical skills in the context of real- life scenarios. It assesses five core skills domains, with three relating to communication skills; i) Communicating with patients and their families, ii) Communicating with colleagues and iii) Information gathering. Communication skills in the Part 3 clinical assessment can be assessed in many forms: … ● Exploring patient symptoms or concerns (information gathering) ● Explaining a diagnosis, investigation or treatment (information giving) ● Involving the patient in a decision (shared decision making) ● Health promoting activities ● Obtaining informed consent for a procedure ● Breaking bad news ● Communicating with relatives ● Communicating with other members of the health care team … In order to provide patient- centred care, doctors must treat their patients as partners, involving them in the decision making regarding their care and instilling in them a sense of responsibility for their own health. When the patient feels that they are part of the team it increases their satisfaction with care, increases treatment adherence and improves clinical outcomes. It is these skills that are assessed in clinical assessment tasks involving communication. Clinical assessment candidates are often assessed in two communication domains; Process and Content. In order to do well in the information gathering stations, you must be aware of the differential diagnoses that may arise with various presentations and how to explore each one independently and as a collection. When it comes to information giving or shared decision marking, candidates need to be familiar with the most recent Royal College of Obstetrics and Gynaecology guidelines and know how to interpret their meaning to the patient and their families. The Calgary- Cambridge Model is one of the most recognized communication theories in medical education (Kurtz, 1996). This theory can be adapted to fit into most clinical scenarios. Using the Calgary- Cambridge Model, you should be able to obtain the majority of the points related to process.

Download Full-text

Prosthodontics

Oxford Assess and Progress: Clinical Dentistry ◽

10.1093/oso/9780198825173.003.0017 ◽

2019 ◽

Author(s):

Nicholas Longridge ◽

Pete Clarke ◽

Raheel Aftab ◽

Tariq Ali

Keyword(s):

Treatment Planning ◽

Clinical Skills ◽

Treatment Plan ◽

Work Load ◽

Daily Basis ◽

Digital Dentistry ◽

Production Methods ◽

Black And White ◽

Reading Key ◽

The Individual

Prosthodontics comprises most of the routine restorative treatments that practitioners perform on a daily basis. Much restorative work re¬sults from the impact of caries and periodontal disease. However, the prevalence of toothwear is dramatically increasing and can be expected to form a more prominent feature of the modern practitioner’s work¬load. There is a considerable theory base in prosthodontics, covering all aspects of fixed and removable treatments, both conventional and contemporary. Although the individual management of teeth can be tricky, a challenge many new practitioners struggle with is treatment planning on a patient level. Treatment planning is rarely black and white, with considerable variations in opinion among clinicians, even for more simple cases. The staging of treatment planning is fairly consistent across the profession (e.g. relief of pain first, then investigatory phase, etc.), but in complex cases, a second opinion may be warranted. Not only is treatment plan¬ning a difficult skill, but so is the execution. It takes practice to become adept at the variety of clinical skills in prosthodontics and the staging of treatment, but this makes for a rewarding and fascinating discipline. Modern dentistry has a much greater focus on minimal invasive treat-ment, relying on dentine bonding and adhesive dentistry to limit the need for aggressive preparations of teeth and protect the vitality of the pulp. Moreover, the progression in digital dentistry is exponential, with newer production methods and clinical techniques becoming increasingly accurate and ever more accessible. As such, the modern practitioner needs to have a good understanding of both conventional concepts and modern alternatives in order to be able to apply the material and tech¬nique of choice to achieve an optimal outcome. The questions in the chapter aim to cover a wide range of topics, testing conventional concepts in both fixed and removable prostho¬dontics, whilst touching on contemporary materials and production methods. It is hoped that the reader will be challenged and the more difficult questions will promote wider reading. Key topics include: ● Diagnosis and treatment planning ● Occlusion ● Toothwear ● Complete dentures ● Removable dentures (including denture design principles) ● Direct restorations ● Crown and bridge ● Implant restorations ● Laboratory processes ● Digital dentistry.

Download Full-text

Maintaining High-Quality Multidisciplinary Pain Medicine Fellowship Programs: Part I: Innovations in Pain Fellows’ Education, Research, Applicant Selection Process, Wellness, and ACGME Implementation During the COVID-19 Pandemic

Pain Medicine ◽

10.1093/pm/pnaa168 ◽

2020 ◽

Vol 21 (8) ◽

pp. 1708-1717 ◽

Cited By ~ 1

Author(s):

Lynn Kohan ◽

Susan Moeschler ◽

Boris Spektor ◽

Rene Przkora ◽

Christopher Sobey ◽

...

Keyword(s):

Selection Process ◽

Well Being ◽

Program Directors ◽

Learning Opportunities ◽

Board Members ◽

State Governments ◽

Innovative Solutions ◽

Control And Prevention ◽

Fellowship Programs ◽

The Impact

Abstract Background Pain fellowship programs are facing unique challenges during the COVID-19 pandemic. Restrictions from state governments and the Centers for Disease Control and Prevention have resulted in a rapidly changing and evolving learning environment for todays’ fellows. Innovative solutions must be sought to guarantee that proper education is maintained and to ensure the well-being of our trainees. Methods We assembled a panel of pain program directors who serve as officers/board members of the Association of Pain Program Directors to provide guidance and formulate recommendations to pain fellowship directors nationally. This guidance is based on reviewing current changes to the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Anesthesiology policies and best available evidence and expert opinion on the use of remote educational activities, research endeavors, and trainee wellness. Conclusions The country is in the midst of an unprecedented pandemic. The impact on pain management fellowships has been severe and will likely last for months, resulting in extraordinary challenges to the administration of pain fellowship programs and the education of our fellows. Understanding revisions to ACGME policies, using technology to promote remote learning opportunities, and providing trainees with opportunities to alleviate their anxiety and encourage mental health are beneficial strategies to implement. Together, we can implement innovative solutions to help overcome these challenges.

Download Full-text

Nephrology Fellows’ and Program Directors’ Perceptions of Hospital Rounds in the United States

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.10190819 ◽

2020 ◽

Vol 15 (4) ◽

pp. 474-483

Author(s):

Suzanne M. Boyle ◽

Keshab Subedi ◽

Kurtis A. Pivert ◽

Meera Nair Harhay ◽

Jaime Baynes-Fields ◽

...

Keyword(s):

United States ◽

Patient Care ◽

Training Programs ◽

Clinical Skills ◽

Care Delivery ◽

Clinical Skill ◽

Program Directors ◽

The United States ◽

Early Morning ◽

Attending Rounds

Background and objectivesHospital rounds are a traditional vehicle for patient-care delivery and experiential learning for trainees. We aimed to characterize practices and perceptions of rounds in United States nephrology training programs.Design, setting, participants, & measurementsWe conducted a national survey of United States nephrology fellows and program directors. Fellows received the survey after completing the 2019 National Board of Medical Examiners Nephrology In-Training Exam. Program directors received the survey at the American Society of Nephrology’s 2019 Nephrology Training Program Directors’ Retreat. Surveys assessed the structure and perceptions of rounds, focusing on workload, workflow, value for patient care, and fellows’ clinical skill-building. Directors were queried about their expectations for fellow prerounds and efficiency of rounds. Responses were quantified by proportions.ResultsFellow and program director response rates were 73% (n=621) and 70% (n=55). Most fellows (74%) report a patient census of >15, arrive at the hospital before 7:00 am (59%), and complete progress notes after 5:00 pm (46%). Among several rounding activities, fellows most valued bedside discussions for building their clinical skills (34%), but only 30% examine all patients with the attending at the bedside. Most directors (71%) expect fellows to both examine patients and collect data before attending-rounds. A majority (78%) of directors commonly complete their documentation after 5:00 pm, and for 36%, after 8:00 pm. Like fellows, directors most value bedside discussion for development of fellows’ clinical skills (44%). Lack of preparedness for the rigors of nephrology fellowship was the most-cited barrier to efficient rounds (31%).ConclusionsHospital rounds in United States nephrology training programs are characterized by high patient volumes, early-morning starts, and late-evening clinical documentation. Fellows use a variety of prerounding styles and examine patients at the beside with their attendings at different frequencies.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_17_CJN.10190819.mp3

Download Full-text

Direct Versus Indirect Supervision of Fellows Covering Football Events: A Survey of Fellows and Program Directors

Journal of Graduate Medical Education ◽

10.4300/jgme-d-10-00038.1 ◽

2010 ◽

Vol 2 (3) ◽

pp. 442-448 ◽

Cited By ~ 2

Author(s):

Charles A. Lascano ◽

Mark L. Stovak ◽

A. T. Harvey

Keyword(s):

Sports Medicine ◽

Online Survey ◽

Program Directors ◽

Direct Supervision ◽

Supervision Practice ◽

Fellowship Programs ◽

Supervision Practices ◽

Injury Outcomes ◽

Indirect Supervision ◽

Serious Injuries

Abstract Background The Accreditation Council for Graduate Medical Education (ACGME) program requirements mandate “adequate supervision,” of residents, but there is little guidance for sports medicine fellowship directors regarding the transition from direct to indirect supervision of fellows covering football games. Objective We sought to gather evidence of current supervision practices in the context of injury outcomes. Methods Fellows and program directors of ACGME-accredited sports medicine fellowship programs were invited to complete an online survey regarding their experience and current supervision practice at football games. Criteria for transition to autonomy and desired changes in supervision practice were elicited. Player safety was quantified by noting the number of field-side emergencies, whether an attending was present, and whether better outcomes might have resulted from the presence of an attending. Results A total of 80 fellows and 50 program directors completed the online survey. Direct supervision was lacking in about 50% of high school games and 20% of college games. A resulting cost in terms of player safety was estimated to apply to 5% of serious injuries by fellows' report but less than 0.5% by directors' report. Written criteria for transitioning from direct supervision to autonomy were the exception rather than the rule. The majority of fellows and directors expressed satisfaction with the current level of supervision, but 20% of fellows would prefer more supervision through postgame review. Conclusions Football games covered by fellows are often not directly supervised. Absence of an attending affected the outcomes of 5% or less of serious injuries. Transition to autonomy does not usually require meeting written criteria. Fellows might benefit from additional off-site supervision.

Download Full-text

Pivotal Clinical Study to Evaluate the Safety and Effectiveness of the MANTA Vascular Closure Device During Percutaneous EVAR and TEVAR Procedures

Journal of Endovascular Therapy ◽

10.1177/1526602820912224 ◽

2020 ◽

Vol 27 (3) ◽

pp. 414-420 ◽

Cited By ~ 2

Author(s):

Zvonimir Krajcer ◽

David A. Wood ◽

Neil Strickman ◽

Nelson Bernardo ◽

Chris Metzger ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Major Complication ◽

Multicenter Trial ◽

Closure Device ◽

Study Cohort ◽

Complication Rates ◽

Vascular Closure Device ◽

Primary Analysis ◽

Femoral Access ◽

Endovascular Interventions

Purpose: To evaluate the safety and effectiveness of the MANTA percutaneous vascular closure device in patients undergoing percutaneous endovascular aneurysm repair (PEVAR) or thoracic endovascular aortic repair (TEVAR). Materials and Methods: The SAFE MANTA Study ( ClinicalTrials.gov identifier NCT02908880) was a prospective, single-arm, multicenter trial in patients undergoing endovascular interventions using large-bore sheaths (transcatheter aortic valve replacement, PEVAR, or TEVAR) at 20 sites in North America. Patient selection intended to test the MANTA device in populations without morbid obesity, severe calcification, or a severely scarred femoral access area. Of the 263 patients enrolled in the primary analysis cohort, 53 (20.2%) patients (mean age 74.9±8.9 years; 41 men) underwent PEVAR (n=51) or TEVAR (n=2) procedures and form the cohort for this subgroup analysis. Per protocol a single MANTA device was deployed in all PEVAR/TEVAR cases. Results: The mean time to hemostasis in the PEVAR/TEVAR cohort was 35±91 seconds, with a median time of 19 seconds vs 24 seconds in the overall SAFE MANTA population. The MANTA device met the definition for technical success in 52 (98%) of 53 PEVAR/TEVAR cases compared with 97.7% in the overall SAFE MANTA population. One (1.9%) major complication (access-site stenosis) occurred in this subgroup compared to 14 (5.3%) events in the SAFE population. In the PEVAR/TEVAR group, 1 pseudoaneurysm was noted prior to discharge, another at 30-day follow-up, and one at 60 days. One (1.9%) of the 3 minor pseudoaneurysms was treated with ultrasound-guided compression and the other 2 required no treatment. Conclusion: The MANTA device demonstrated a short time to hemostasis and low complication rates compared with published literature results of other percutaneous closure devices. Time to hemostasis and complication rates were comparable between the PEVAR/TEVAR patients and the full SAFE MANTA study cohort. The MANTA device provides reliable closure with a single percutaneous device for PEVAR/TEVAR procedures.

Download Full-text