Sample attrition analysis in a prospective cohort study of medical graduates in China

Background A major challenge of prospective cohort studies is attrition in follow-up surveys. This study investigated attrition in a prospective cohort comprised of medical graduates in China. We described status of attrition, identified participants with higher possibility of attrition, and examined if attrition affect the estimation of the key outcome measures. Methods The cohort study recruited 3,620 new medical graduates from four medical universities in central and western China between 2015 and 2019. Online follow-up surveys were conducted on an annual basis. Follow-up status was defined as complete (meaning that the participant completed all the follow-up surveys) and incomplete, while incomplete follow-up was further divided into ‘always-out’, ‘rejoin’ and ‘other’. Multivariable logistic and linear regressions were used to examine factors predicting attrition and the influence on the outcome measures of career development. Results 2364 (65.3%) participants completed all follow-up surveys. For those with incomplete follow-up, 520 (14.4%) were ‘always-out’, 276 (7.6%) rejoined in the 2020 survey. Willingness to participate in residency training (OR=0.80, 95%CI[0.66 - 0.98]) and willingness to provide sensitive information in the baseline survey predicted a lower rate of attrition (providing scores for university entrance exam OR=0.82, 95%CI[0.69 - 0.97]]; providing contact information (OR=0.46, 95%CI[0.32 - 0.66]); providing household income (OR=0.60, 95%CI[0.43 - 0.84]). Participants with compulsory rural service (OR=1.52, 95%CI[1.05 - 2.19]) and those providing university entrance scores (OR=1.64, 95%CI[1.15-2.33)) were more likely to rejoin in the follow-up survey. These factors associated with follow-up status did not have significant impact on key outcome measures of career development. Conclusions Graduates who were unwilling to participate in residency training or not providing sensitive information should be targeted early in the cohort study to reduce attrition. More information about the study should be provided to those graduates early to facilitate their understanding of the meaning in participation. On the contrary, medical graduates with compulsory rural service and those who provided university entrance scores were more likely to rejoin in the cohort. The research team should invest more effort in contacting those graduates and returned them to the cohort.

Urology Residency Training During the Pandemic: A Review of the Current Literature

Background Since COVID–19 was declared a pandemic on March 11, 2020, health care systems worldwide have been under significant strain. Although urology is not on the frontline of care for patients with COVID-19, every practicing urologist has been affected by the global outbreak. The objective of this review is to evaluate the impact of COVID–19 pandemic on urology residency training programs. Methods We reviewed the current evidence on urology residency training during the COVID-19 pandemic. Relevant databases (MEDLINE, Scopus, Cochrane Library) were searched for articles published to June 2021 that included residents’ or directors’ opinions on their residency training programs during the COVID-19 crisis. Results The literature search identified 72 articles. Fifteen studies including more than 2500 residents were eligible for inclusion in the analysis. During the pandemic, learning activities carried out by urology residents have been extensively affected. Worldwide, operation volume has decreased, especially for procedures in which residents were directly involved. Similarly, there has been a decline in most academic activities, and many studies have reported the negative impact on residents’ mental well-being and lifestyle. On the other hand, the lockdown provided an opportunity to review the current training system and to increase the implementation of tools such as telemedicine and smart-learning surgical skill training programs. Conclusion The COVID-19 pandemic has resulted in significant changes in urology residency programs worldwide, which have had a negative impact on surgical training and academic activities. Residents’ well-being and mental health have also been put at risk. However, this unprecedented situation has also generated new online learning modalities and technological innovations in the field of training in urology.

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.

A decision-tree model of career choice for veterinarians in clinical residency programs

OBJECTIVE To identify factors that individuals in clinical residency training programs consider when making a choice for or against a career in academic clinical medicine. SAMPLE 207 veterinarians in clinical residency programs. PROCEDURES An online survey was distributed to 1,053 veterinarians participating in clinical residency training programs overseen by organizations recognized by the AVMA American Board of Veterinary Specialties. Results were compiled and decision factors were analyzed by means of principal component analysis to identify latent factors from the set of survey items. These factors were then used to construct a decision tree to predict respondents’ choice of whether to enter academic medicine or private clinical practice. RESULTS 207 (20%) responses were analyzed. Ninety-three of 194 (48%) respondents reported a desire to pursue a career in academic medicine, and 101 (52%) reported a desire to pursue a career in private clinical practice. Principal component analysis identified 14 items clustered on research, clinical teaching, classroom teaching, and clinical practice. A decision tree was constructed that resulted in an overall accuracy of 82% in predicting a resident's career choice of academic medicine versus private clinical practice. The construct of professional benefits had a negative effect on desiring a career in academic medicine, whereas the construct of professional priorities and having had a positive residency training experience had a positive effect on desiring a career in academic medicine. CLINICAL RELEVANCE Understanding factors that attract and encourage residents who might have an aptitude and interest in academic medicine holds important implications for addressing the shortage of veterinarians entering academic medicine.

Family Medicine and Emergency Redeployment: Unrealized Potential

Background and Objectives: Discussions of scope of practice among family physicians has become a crucial topic amidst the COVID-19 pandemic, coupled with new attention to residency training requirements. Family medicine has seen a gradual narrowing of practice due to a host of issues, including physician choice, expanding scope of practice from physician assistants and nurses, an increased emphasis on patient volume, clinical revenue, and residency training competency requirements. We sought to demonstrate the flexibility of the family medicine workforce as shown through their scopes of practice, and argue that this is indication of their potential for redeployment during emergencies. Methods: This study computes scopes of practice for 78,416 family physicians who treat Medicare beneficiaries. We used Evaluation and Management (E/M) codes in Medicare’s 2017 Part-B public use file to calculate volumes of services done across six sites of service per physician. We aggregated counts and proportions of physicians and the E/M services they provided across sites of practice to characterize scope, and performed a separate analysis on rural physicians. Results: The study found most family physicians practicing at a single site, namely, the ambulatory clinic. However, family physicians in rural areas, where need is greater, exhibit broader scope. This suggests that a significant number of family physicians have capacity for COVID-19 deployment into other settings, such as emergency rooms or hospitals. Conclusions: Family physicians are a potential resource for emergency redeployment, however the current breadth of scope for most family physicians is not aligned with current residency training requirements and raises questions about the future of family medicine scope of practice.

Person-centred care in psychiatry: a clinical and philosophically informed approach

SUMMARY After many years of mental healthcare reform there is still a lot of unease among patients about healthcare workers’ lack of attention to their daily needs and to the tensions and ambiguities that accompany their attempts to integrate their condition into their lives. Person-centred care is often presented as a solution, but the term refers to many differing approaches and needs further specification depending on the problem it aims to resolve. This article presents and discusses a clinical and philosophically informed approach that flexibly focuses on the person- and context-bound aspects of the patient's condition and on the co-regulatory role of the clinician in the patient's attempt to regulate their condition. This approach is a way of thinking, rather than yet another model. It will be shown how this approach can be integrated in the core curriculum of specialty (residency) training in psychiatry.

Position Statement on Religion and Spirituality in Psychiatry: Seven Recommendations

Background: in December 2015 the Executive Committee of the World Psychiatric Association approved a Position Statement on religion, spirituality in psychiatry. Since then, the World Psychiatric Association Section of Religion, Spirituality and Psychiatry has committed to publicizing the Position Statement worldwide. Aim: to bring this statement, especially the seven recommendations, to the attention of the international psychiatric community, in particular the Russian psychiatric community. Method: a narrative review and the seven recommendations in the Position Statement are explained, thus demonstrating its importance. Conclusion: religion and spirituality in psychiatry are part of daily psychiatric practice, scientific research, residency training and continuous medical education, and the political and public realm. With the publication of the Position Statement, the Executive Committee of the World Psychiatric Association has made a major accomplishment that benefits psychiatry around the world.