The conceptualisation of educational supervision in a National Psychiatry Residency Training Program

Introduction: Development of expertise and counselling skills in psychiatry can be mastered only with effective supervision and mentoring. The conceptualisations of educational supervision amongst supervisors and residents were explored in this study to understand how supervisory roles may have been affected by the adoption of competency-based psychiatry residency training. Methods: A qualitative research approach with thematic analysis was adopted. Individual in-depth interviews using a semi-structured interview guide with a purposive sample of six supervisors and six newly graduated residents were conducted. Transcripts of the interview were analysed and coded using the Atlas Ti software. Results: Four major themes emerged from analysis of the transcripts: (1) Meaning and definition of supervision; (2) Expectations and responsibilities of the educational supervisor; (3) Elusiveness of mentoring elements in educational supervision and (4) Personal and professional development of residents in supervision. Supervisors and residents perceived educational supervision narrowly to be transactional with acquisition of knowledge and skills, but residents yearned for more relational interactions. Conclusion: This study showed that the roles and functions of supervisors in educational supervision were unclear. It also highlighted the lack of a mentoring orientation in supervision in the psychiatry residency training program. An emphasis on assessment of competencies might have contributed to tension in the supervisory relationship and lack of a mentoring role, with concerns on residents’ personal and professional identity development in their psychiatry training.

Medical Students’ Attitude Towards Robotic Surgery: A Cross-Sectional Survey

Introduction The robotic surgery and procedures are increasing worldwide. It is unknown whether medical students are well prepared for their future exposure to such technology. Objectives This study aimed to explore the knowledge and attitude of medical students from Saudi Arabia (SA) towards the robotic surgery. Methods We performed a cross-sectional survey of medical students at different colleges of medicine in SA. A web-based self-administered questionnaire using google forms was completed over a 2-month period starting on June 2021. Comparison between those with and without background about robotic surgery was performed. Results A total of 239 medical students from both governmental (46%) and private colleges (54%) responded to the questionnaire. 51.9% were interested in the surgical field and 37.7% considered themselves tech-savvy persons. Only (22.6%) had previous background about robotic surgery mainly from internet. Many (63.2%) showed positive attitude towards robotic surgery and expected that using robots will improve surgical outcomes. 48.5% of the students expected that patients in SA will not accept the robotic surgeries. Some (51.1%) concerned that robots could replace the surgeons and could make them less professional. Many believed that SA should invest and expand the robotic surgeries (69.1%). Students with background in robotic surgery had significantly younger median age (p < 0.030), earlier academic years (p < 0.001), higher GPA (p < 0.025), and more tech-savvy personality (p < 0.000) compared to those without background. Conclusion Most medical students are unaware of robotic surgery, but they have positive attitude with some concerns. Young students who consider themselves tech-savvy persons are in a better position, but they access their knowledge from internet rather than from their medical education. Medical curricula and residency training program should take these findings into consideration for preparing the future surgeons in SA.

Novel use of a sequential standardized oral board exam to assess PGY1 resident progression

Purpose A standardized oral board exam was created to longitudinally assess postgraduate year 1 (PGY1) pharmacy residents in key domains. Summary We provide a descriptive review of a novel oral board exam administered quarterly to our PGY1 pharmacy residents. Preceptors from our core rotations (internal medicine/infectious diseases, adult critical care, oncology, pediatrics, and administration/health policy and outcomes) developed questions based on situations commonly encountered by PGY1 residents to assess residents’ communication; the content of their response, assessment, and plan; and coachability. Over the 4-year history of this assessment, scoring has matured to consider whether a resident has or has not met or has exceeded expectations for a PGY1 resident at a given stage in their training. Our comprehensive feedback and action planning approach included residents’ self-assessment, feedback from the exam committee, development and implementation of a customized training plan for execution, and dissemination to our preceptors. Systematically assessing our PGY1 residents with this innovative method provided a process for tracking their performance and served as a baseline for those who completed additional training at our institution. Conclusion A standardized quarterly oral board exam was developed to identify residents’ strengths and areas for improvement at established periods during the PGY1 residency training program. This standardized assessment, paired with individualized action plans and open communication with key stakeholders, stimulated development in residents’ performance, communication, and interpersonal skills. We aim to expand this system’s application to identify predictors of success for candidates we interview for our postgraduate training programs.

Perception of the Educational Environment of Post-graduate Residents in Teaching Hospitals across Pakistan

Aim: To evaluate the perception of educational environment of post-graduate residents in teaching hospitals of Pakistan. Methodology: This cross-sectional descriptive study was conducted in four tertiary care hospitals in Pakistan from January 2020 to November 2020.The Post-graduate Hospital Education Environment Measure (PHEEM) inventory (40 items on a 0-4 Likert scale) was distributed among 195 post-graduate residents of multiple specialties by convenience non-probability sampling technique. Response was recorded into three subscales which included perception of teaching, role of autonomy and social support. The total score of these three domains had a combined maximum and minimum of 160 and 0, respectively. Results: Cumulative mean score obtained in our study showed a total score of 23.69 ± 16.247 / 56 for the theme: Perception of Role of autonomy, 24.17 ± 16.928 / 60 for Perception of Teaching and 19.35 ± 13.224 / 44 for Perception of Social Support. Conclusion: There are no drastic flaws in the post-graduate medical education residency-training program currently running in Pakistan. However, there is need for further improvement in teaching attitude of instructors and the need to eradicate discriminatory behavior felt by the post-graduate residents in certain circumstances. Keywords: Perception, Educational environment, Postgraduate Residents, Pakistan

Critical Comparison Of The Quality And Content Of Integrated Vascular Surgery, Thoracic Surgery, And Interventional Radiology Residency Training Program Websites (Preprint)

BACKGROUND With the move to virtual interviewing, residency websites are an important recruitment resource, introducing applicants to programs across the country and allowing for comparison. Recruitment is highly competitive from a common potential pool between vascular surgery, thoracic surgery and interventional radiology with the ratio of applicants to positions being highest in interventional radiology, followed by thoracic surgery and lastly vascular surgery, as reported by the National Resident Matching Program. OBJECTIVE To evaluate the accessibility and availability of online content for those integrated residency programs. METHODS A list of accredited vascular surgery, thoracic surgery, and interventional radiology residencies was obtained from the ACGME. Program websites were evaluated by trained independent reviewers (n=2) for content items pertaining to program recruitment and education (scored absent or present). Statistical analysis was performed in R software RESULTS Of ACGME accredited programs, 56 of 61 (92%) vascular surgery, 27 of 27 (100%) thoracic surgery, and 74 of 85 (87%) interventional radiology programs had functional websites (P=0.122). Vascular surgery websites contained a median of 26 content items (IQR: 20, 32), thoracic surgery websites contained a median of 27 content items (IQR: 21, 32), and interventional radiology websites contained a median of 23 content items (IQR: 18, 27). Two content items considered highly influential to applicant program decision are procedural experience and faculty mentorship, were reported at 32% and 11% for vascular surgery, 19% and 11% for thoracic surgery, and 50% and 15% for interventional radiology (P=0.008 and P=0.751, respectively). Key deficits were work hours, debt management and curriculum for interventional radiology; resident profiles, sample contracts, and research interests in vascular surgery; operative experiences, program director contact and message for thoracic surgery. Interventional radiology deficits were work hours and thoracic surgery deficits were procedural experience. Both IR and CT websites lacked information in evaluation criteria and faculty mentorship. CONCLUSIONS This study has uncovered key differences in availability of online content for residencies recruiting from the same pool of applicants. Thoracic surgery has the most information, followed by vascular surgery, with interventional radiology reporting the least content. In the era of virtual interviewing from the same potential pool of applicants, programs should review and revise their web presence with the aim to increase the availability of online content in order to attract valuable candidates. CLINICALTRIAL n/a

Satisfaction of the Clinical Teachers on Standardized Residency Training Program (SRTP) in China

Background: Standardized Residency Training Program (SRTP) is a significant initiative to deepen health systems and medical education in developed countries like China. Despite prompting the SRTP nationwide and implementing it with various improvements, Chinese continuous medical education is still in its infancy. Compared with the residents, little is known about clinical teachers under SRTP in China; but clinical teachers effectively determine the training quality as a critical disseminator of knowledge, skills, and values in medical practice. Thus, the study aims to analyze critical factors affecting their cognitive job satisfaction and provide continuous improvements for SRTP.Methods: From December 1, 2018, to May 31, 2019, we conducted a self-design questionnaire from 13 SRTPs (including both training bases and professional bases) in Shaoxing city to evaluate participants' satisfaction. Altogether, 574 clinical teachers responded to the survey with generally high overall satisfaction. We adopted Chi-square Test and Fisher's Exact Test to evaluate the single impact factors affecting the satisfaction of clinical teachers. The multiple factors analysis applied the Logistic Regression model.Results: The male clinical teachers had significant differences in satisfaction of teaching content (OR: 0.675, [95%CI: 0.477~0.953]), conflicts between study and work (OR: 0.542, [95%CI: 0.371~0.791]), the attention of leaders (OR: 0.403, [95%CI: 0.252~0.645]) and subsidies of teachers (OR: 0.527, [95%CI: 0.347~0.805]). Compared with internal medicine, clinical teachers from Surgery (OR: 2.396, [95%CI: 1.365-4.206]) and other departments (OR: 2.409, [95%CI: 1.406-4.129]) were more satisfied when considered residents have high motivation on training. Besides, compared with attending physician, deputy chief physician (OR: 0.493, [95%CI: 0.310- 0.783]) and chief physician (OR: 0.683, [95%CI: 0.471-0.991]) more disagreed that residents' wage is good enough.Conclusion: Clinical teachers widely recognize the SRTP. However, teachers' satisfaction varied due to different genders, working clinical departments, and professional titles. The study also discussed possible reasons and strategy implications behind these findings, which combined unique Chinese society characteristics. Further, we believe the analysis and interpretations remind us of the applications of Western medical education methods, and theories also should consider the unique socio-cultural challenges.

130 Adaptation of IHI Joy-in-Work framework to reduce burnout among postgraduate trainees

Primary Subject area Physician Wellness Background Physician burnout is a psychological phenomenon with serious and pervasive consequences on physicians’ mental health, patient safety, and quality of care. Burnout is multifactorial, originating from systemic issues, organizational culture and individual coping skills. Burnout is more common in residency training. Residents experience burnout more intensely due to lack of autonomy, self-efficacy and exposure to mistreatment. Residents are also frontline workers and the future healthcare givers. Organization-led interventions mostly focus on building resilience and mindfulness without addressing systems-level issues. In our study, we attempted to shift the paradigm to address system-level concerns first. We aimed to adapt Joy-in-Work: a quality improvement framework developed by the Institute for Healthcare Improvement (IHI). This program allows residents to identify system problems that are meaningful to them and empower them to work as a team, taking back their autonomy and self-efficacy. Objectives To demonstrate that Joy-in-Work can be adapted effectively into a residency training program to reduce burnout and improve psychological safety among residents. Design/Methods The four steps of Joy-in-Work were implemented for residents in a level 3 neonatal intensive care unit. Residents engaged in “what matters” conversations through survey and group meetings, and identified impediments to Joy-in-Work. By applying QI methodology, residents identified priority interventions to eliminate impediments. Finally, the effectiveness of interventions was evaluated. Primary outcomes included prevalence of burnout and psychological safety; secondary outcomes assessed control over workload, and organizational culture. An IHI 12-item questionnaire was administered at baseline and after the interventions. To assess sustainability, a survey was also conducted one year after the implementation. We assessed adherence to interventions, nurse practitioners’ satisfaction and residents’ workload indicators. Results Through the implementation of Joy-in-Work, residents identified autonomy and work life integration as priorities. Stakeholders developed two interventions: change call schedule according to residents’ preferences and earlier afternoon handover time. Burnout was 77.8%, 50% and 75% for three survey periods respectively. Psychological safety increased consistently from 16.7% to 37.5% to 43.8%. Lack of control over workload dropped sharply from 72.2% to 12.5%, with a rebound to 56.3%. Most secondary outcomes demonstrated a similar pattern of positive change initially with reversion to baseline. Conclusion We demonstrated that Joy-in-Work is successfully adaptable into a residency setting. Implementation through residents’ engagement and empowerment can decrease burnout and improve psychological safety significantly. The process itself was likely the key driver for achieving positive outcomes rather than the actual interventions. Sustainability remains a key issue that requires systems support.