Nonclinical Time for Family Medicine Residency Faculty: National Survey Results

Introduction: Recent changes to the Accreditation Council for Graduate Medical Education (ACGME) requirements eliminated minimum standards for protected nonclinical time for core faculty. Faculty perform many nonclinical tasks to maintain family medicine residencies. The objective of this study is to describe the landscape of nonclinical time for family medicine residency faculty. Methods: Program directors at ACGME-accredited family medicine residencies were electronically surveyed in August 2019 to describe nonclinical time of their faculty. Survey information requested included program demographics, the amount of nonclinical time allocated, and the estimated amount of nonclinical time spent per year completing their faculty duties. Results: A total 156 of 635 program directors (24.6%) returned the survey and 58 (9.1%) completed the entire survey for analysis inclusion. An average of 3,394 hours per year, per program were estimated to be spent on nonclinical activities. The greatest amount of time was spent on program administration (39%) and the least amount of time on curriculum development (5%). There was variation in the use of nonphysician faculty to complete these tasks. Allocated faculty time was comparable to estimated time spent performing nonclinical tasks. On average, a 24-resident program devoted 1.9 full-time equivalent faculty salary support to complete nonclinical activities. Conclusions: Family medicine residency faculty spend significant time completing nonclinical tasks required to meet ACGME requirements and need the protected time to complete these necessary tasks. Direct data on the use of faculty nonclinical time is needed to more accurately define its use.

Distance Education in the Clinical Laboratory Sciences: Part of the Solution to the Professional Labor Shortage

The purpose of this paper is introducing research conducted about issues related to influences and barriers to the potential use of distance education for mitigating the clinical laboratory sciences labor shortage. Diagnostic careers such as those in the clinical laboratory sciences remain a mystery to many people because they do not have the same prominence or visibility associated with therapeutic careers. Clinical laboratory science courses often have both didactic and laboratory components. Coursework with laboratory components require additional faculty time for preparation. When health care education is offered in traditional university or college settings not affiliated with a teaching hospital or clinical setting, laboratory costs are higher due to purchasing supplies, reagents and media. Issues are further explored in a brief series of papers addressing them. Using DE for delivering diagnostic clinical educational is a potential viable solution for addressing national diagnostic labor shortages.

Endoscopy Training in Small Animal Internal Medicine: A Survey of Residency Training Programs in North America

Competency in multiple endoscopic techniques is a major goal of small animal internal medicine (SAIM) residency programs. Training relies predominantly on mentored supervision of procedures performed on patients. Supplementation of this apprenticeship model with classroom sessions and hands-on laboratories can be advantageous to trainees and patients. Few veterinary resources describe supplemental training options, and no single source exists for mentors to consult for program development. The purpose of this study was to describe the supplemental training opportunities currently available to SAIM residents at academic hospitals in the US and Canada and to compare their timing during the residency, resident and faculty time commitment, and perceived helpfulness. Data were collected by an electronic survey distributed to one faculty member per institution. The response rate was 80% (24/30). Most programs (22/24; 92%) offered some form of supplemental training, including classroom sessions (9/24), and hands-on laboratories using physical models (7/24), virtual reality simulators (2/24), and cadaver (2/24) and anesthetized (2/24) dogs. Fifteen programs provided residents with the opportunity to attend external endoscopy workshops. Only three programs required any training prior to residents performing procedures on patients. There was considerable variability in training between programs, precluding statistical comparisons. The survey identified topics for classroom sessions and several inexpensive physical models, rated very or extremely helpful, that would be suitable for programs with limited budgets. A human-based virtual reality simulator was also rated highly by two programs. Comprehensive, external workshops evoked numerous positive comments with perceived value ranging from somewhat to extremely helpful.

Entrustable Professional Activities: An Analysis of Faculty Time, Trainee Perspectives and Actionability

The Royal College of Physicians and Surgeons of Canada introduced Competence by Design (CBD) as an educational model along with Entrustable Professional Activities (EPAs) as markers of achievement that could be directly observed on a frequent basis. In 2017, the University of Calgary Internal Medicine (IM) program piloted CBD. The purpose of this study was to (1) assess whether written feedback from EPAs were actionable, valuable, and disruptive to workflow and (2) assess the time required to complete an EPA. MethodsSeven Foundations of Discipline EPAs were used with 31 PGY-1 Calgary IM residents. The study used quantitative and qualitative data. Following a discussion on an EPA and completion of both the quantitative and written feedback, residents were asked to comment on the value of the encounter and the degree of disruption to workflow. Assessors provided time to complete an EPA. Data were anonymized. Trainee comments were coded for value and disruption, and assessor’s written feedback was coded for actionability. ResultsOne hundred and five EPA encounters were submitted. The majority of the comments provided to trainees were not actionable (94.3%, n = 99/105). While most residents did not comment on value (73.3%, n = 77/105) or disruption (44.8%, n = 47/105) of the encounter, those that did generally found the encounters valuable (25.7%, n = 27/105) and nondisruptive (35.2%, n = 37/105). A minority found the process nonvaluable (1%, n = 1/105) and disruptive (20%, n = 21/105). The mean time to complete an EPA form and provide feedback was 8.6 min. ConclusionMost written feedback was not actionable, suggesting a potential role for faculty development to guide assessors and help them coach trainees on EPAs. RÉSUMÉLe Collège royal des médecins et chirurgiens du Canada a introduit la compétence par conception (CPC) comme modèle d’enseignement, ainsi que les activités professionnelles confiables (APC) comme marqueurs de réussite qui pourraient être observés directement et souvent. En 2017, le programme de médecine interne (MI) de l’Université de Calgary a testé la CPC. L’objectif de cette étude était : 1) d’évaluer si la rétroaction écrite des APC était exploitable, utile et perturbatrice pour le déroulement du travail; 2) d’évaluer le temps nécessaire pour mener à bien une APC. MéthodesSept APC d’acquisition des fondements de la discipline ont été utilisées chez 31 résidents de première année en MI de l’Université de Calgary. L’étude a utilisé des données quantitatives et qualitatives. Après avoir discuté d’une APC et terminé la rétroaction quantitative et écrite, les résidents ont été invités à faire des commentaires sur l’utilité de la rencontre et le degré de perturbation du déroulement du travail. Les évaluateurs ont accordé du temps pour compléter une APC. Les données ont été anonymisées. Les commentaires des stagiaires ont été codés en fonction de l’utilité et du degré de perturbation, et la rétroaction écrite des évaluateurs a été codée en fonction de l’exploitabilité. RésultatsAu total, 105 rencontres d’APC ont été soumises. La majorité des commentaires fournis aux stagiaires n’étaient pas exploitables (94,3 %, n = 99/105). Bien que la plupart des résidents n’aient pas fait de commentaires sur l’utilité (73,3 %, n = 77/105) ou la perturbation (44,8 %, n = 47/105) de la rencontre, ceux qui l’ont fait ont généralement trouvé les rencontres très utiles (25,7 %, n = 27/105) et non perturbatrices (35,2 %, n = 37/105). Une minorité a trouvé le processus inutile (1 %, n = 1/105) et perturbateur (20 %, n = 21/105). Le temps moyen pour remplir un formulaire d’APC et fournir une rétroaction était de 8,6 minutes. ConclusionLa plupart des rétroactions écrites n’étaient pas exploitables, ce qui suggère un rôle que pourrait jouer le perfectionnement du corps professoral afin de guider les évaluateurs et de les aider à encadrer les stagiaires qui effectuent les APC.

Barriers to Scholarship Integration in Professional Athletic Training Programs and Resources Needed to Overcome Barriers: A Report from the Association for Athletic Training Education Research Network

Context Athletic training program administrators have identified that it is important to incorporate a scholarship component into professional education curricula. Objective Explore the barriers to implementing student scholarship in professional programs and identify resources necessary to overcome the barriers. Design Consensual qualitative research. Setting Individual teleconference interview. Patients or Other Participants A total of 17 program directors of professional programs was interviewed. Programs reported an average of 3 ± 1 core faculty supporting 37 ± 21 students, with 3 ± 2 faculty involved in scholarship activities of their students. Data saturation guided the number of participants. Data Collection and Analysis Interviews occurred using a semistructured interview guide. All interviews were recorded and transcribed verbatim. Data were analyzed by a 3 person research team and coded into themes and categories based on a consensus process. Credibility was established by using multiple researchers, an external auditor, and member checks. Results Two major themes emerged from the data: (1) current challenges and shortcomings and (2) resources and strategies needed to achieve scholarship. Participants noted a lack of research or scholarship culture at their current institution and a lack of faculty time and expertise to implement and guide research throughout the curriculum as current challenges. Participants further identified that a lack of clear expectations for how much scholarship was necessary and lack of buy-in from faculty, students, and preceptors made it difficult to implement scholarly projects in the curriculum. Necessary resources to overcome barriers included institutional support in the form of faculty release, support, training, or all of the aforementioned. Participants identified that collaborative research opportunities as well as publicly available examples of completed student scholarly activity would further guide them in overcoming the curricular challenge of implementing scholarship. Conclusions Internal institutional support, external peer collaboration, and public examples of success are necessary to overcome barriers to scholarship integration in professional athletic training curricula.

Textbook Alternative Incentive Programs at U.S. Universities: A Review of the Literature

Objective – This article reviews current literature on incentive grant programs for textbook alternatives at universities and their libraries. Of particular interest in this review are common patterns and factors in the design, development, and implementation of these initiatives at the programmatic level, trends in the results of assessment of programs, and unique elements of certain institutions’ programs. Methods – The review was limited in scope to studies in scholarly and professional publications of textbook alternative incentive programs at universities within the United States of America, published within ten years prior to the investigation. A comprehensive literature search was conducted and then subjected to analysis for trends and patterns. Results – Studies of these types of programs have reported substantial total cost savings to affected students compared to the relatively small financial investments that are required to establish them. The majority of incentive programs were led by university libraries, although the most successful efforts appear to have been broadly collaborative in nature. Programs are well-regarded by students and faculty, with benefits to pedagogy and access to materials beyond the cost savings to students. The field of replacing textbooks with alternatives is still evolving, however, and the required investment of faculty time and effort is still a barrier, while inconsistent approaches to impact measurement make it difficult to compare programs or establish best practices. Conclusion – Overall, the literature shows evidence of significant benefits from incentive programs at a relatively low cost. Furthermore, these programs are opportunities to establish cross-campus partnerships and collaborations, and collaboration seems to be effective at helping to reduce barriers and increase impact. Further research is needed on similar programs at community colleges and at higher education institutions internationally.

Sociology Departments and Program Review: Chair Perspectives on Process and Outcomes

Sociology faculty are accountable to multiple stakeholders to demonstrate that our academic programs are effective and that students are learning. Despite the ubiquity of mandated program review practices, which often include the assessment of student learning, research is lacking on the extent to which these efforts lead to improvements in departmental outcomes and student experiences. Similarly, little research exists on how department leaders experience and evaluate the utility of these efforts. This article uses data from a national survey of sociology departments to document how program review and assessment are enacted in sociology departments and to explore chairs’ perspectives on program review processes and its outcomes. The article concludes with a series of recommendations for improving these processes so that faculty time is used well and the experiences of sociology students are enhanced.

Developing and Evaluating a Remote Quality Assurance System for Point-of-Care Ultrasound for an Internal Medicine Residency Global Health Track

Background: A quality assurance system is vital when using point-of-care ultrasound (POCUS) to ensure safe and effective ultrasound use. There are many barriers to implementing a quality assurance system including need for costly software, faculty time, and extra work to log images. Methods: With minimal funding or protected faculty time, we successfully developed an effective remote quality assurance system between residents rotating internationally and faculty in the US. Results: 270 total exams were logged using this system (41 per resident over a 7 week period). Over the course of the implementation period, a significant increase was seen in average image quality (p = 0.030) and percent agreement with reviewer (p = 0.021). No significant increase was seen for percent images with quality rating 5/5 (p = 0.068) or for studies per resident per week (p = 0.30). Discussion/Conclusions: A quality assurance system for remote review and feedback of POCUS exams was successfully developed with limited available funding, using consumer-level software and an educational collaboration. Residents used the system regularly and demonstrated improvement in reviewer-rated image acquisition and interpretation skills. A similar system can be applied for physicians in any geographic area looking to learn POCUS, in partnership with local or international POCUS mentors. We detail a step-by-step approach, challenges encountered, and lessons learned, to help guide others seeking to implement similar programs.

Starting New Accreditation Council for Graduate Medical Education (ACGME) Residency Programs in a Teaching Hospital

Starting a new ACGME approved residency program can positively impact patient care, medical education, hospital operations, and the community as whole. This requires a significant amount of commitment, time, and preparation. The initial application and accreditation process should start early and requires a thorough understanding on the ACGME requirements. Building a new residency program involves collaboration among various stakeholders, starting with the teaching hospital, ACGME, and the Center of Medicare and Medicaid services (CMS). It is prudent to also consider the operational and logistical issues such as budget, faculty and administrative staff hire, faculty time for administrative duties, and educational space for faculty and residents. It is vital to recognize how the institution’s strengths and weaknesses match up to these requirements. A robust educational and clinical curriculum in line with ACGME’s core competencies and useful educational collaboration among various programs is critical for effective program. Recruiting and developing the appropriate faculty members is another important aspect for a successful program. The final challenge is recruiting residents that will fit well into the new residency program. Lastly, we discuss the challenges and tips to mitigate the risks of disappointment in the process of starting and creating a flagship residency program.

Family Medicine Faculty Time Allocation and Burnout: A Residency Research Network of Texas Study

ABSTRACT Background Burnout among graduate medical education (GME) faculty is a well-documented phenomenon, but few studies have explored the relationship between faculty time allocation and burnout. Objective Our objectives were to (1) characterize time allocation of academic family physicians, (2) measure the difference between actual versus preferred time spent on various tasks, and (3) examine this difference in relation to burnout. Methods From January to March 2017, family medicine GME faculty across Texas completed anonymous online surveys for burnout (Maslach Burnout Inventory) and occupational stress (Primary Care Provider Stress Checklist). They also reported the percentage of time they actually versus prefer to allocate across 5 categories of tasks: direct patient care, nondirect clinical duties, teaching, administration, and research. Difference scores between actual and preferred time allocation were calculated and correlated with burnout and stress scores. Results Of the faculty physicians surveyed, 53% provided complete responses (103 of 195). On average they engaged in their preferred amount of time on direct patient care (30% of their time) and administrative duties (15%). Meanwhile, faculty preferred to increase time spent teaching (37% to 41%, P = .002) and conducting research (4% to 7%, P ≤ .001), while reducing time spent on nondirect clinical duties (14% to 7%, P < .001). Those with higher misalignment in their weekly schedules reported higher levels of professional burnout and occupational stress. Conclusions Many family medicine GME faculty spent 20% or more of their time in a manner incongruent with their preferences, which may place them at higher risk for burnout and occupational stress.