Kimberly D. Schenarts

Is your residency program ready for Generation Y

Current residency applicants are members of Generation Y and are significantly different from previous generations of trainees as well as the faculty who attract, recruit, and manage them. Generation Y has been affected by globalization, diversification, terrorism, and international crisis. They are products of the self-esteem movement in child rearing, education, and extracurricular activities where they were all declared winners. Childrens activities no longer had winners and losers or first, second, and third place; every child received a participation trophy. Even though they were raised to be a team player, their parents always told them they are special. Technology is ingrained into their daily lives, and they expect its use to be effective and efficient. Generation Y-ers desire to impact the world and give back to their communities and demand immediate access to leadership. This generation poses a challenge to residency programs that will need to attract, recruit, and manage them effectively. This article will provide an overview of Generation Y, contrast Generation Y with Generation X, and discuss how to use generation-specific strategies to attract, recruit, and manage a Generation Y resident.

Educational Impact of the Electronic Medical Record

INTRODUCTION The electronic medical record (EMR) is commonly thought to improve the safety and quality of care; however, there is scant information on the impact the EMR has on graduate medical education (GME). METHODS A review of English language literature was performed using MEDLINE and OVID databases using or combining the terms, EMR, GME, electronic health record, education, medical student, resident, clinical decisions support systems, quality, and safety. RESULTS The EMR has a negative effect on teacher and learner interactions, clinical reasoning, and has an inconsistent impact on resident workflow. Data on the impact of the EMR on patient safety, quality of care, and medical finances are mixed. DISCUSSION Based on the literature to date, the EMR has not had as dramatic an effect on patient outcomes is commonly believed. While the overall impact of the EMR on education seems to be negative, there are actions that can be taken to mitigate this impact.

Workplace bullying of general surgery residents by nurses

OBJECTIVE Workplace bullying is at the forefront of social behavior research, garnering significant media attention. Most of the medical research has addressed bullying of nurses by physicians and demonstrates that patient care and outcomes may suffer. The intent of this study was to determine if general surgery residents are bullied by nurses. DESIGN A survey instrument previously validated (Negative Acts Questionnaire-Revised) to evaluate for workplace bullying was modified to reflect the resident-nurse relationship. After institutional review board approval, the piloted online survey was sent to general surgery program directors to forward to general surgery residents. Demographic data are presented as percentages, and for negative acts, percentages of daily, weekly, and monthly frequencies are combined. SETTING Allopathic general surgery residencies in the United States. PARTICIPANTS General surgery residents. RESULTS The response rate was 22.1% (n = 452). Most respondents were men (55%) and had a mean age of 29 years (standard deviation = 7). Although 27.0% of the respondents were interns, the remaining classes were equally represented (12%-18% of responses/class). The respondents were primarily from medium-sized residency programs (45%), in the Midwest (28%), training in university programs (72%), and rotating primarily in a combined private and county hospital that serves both insured and indigent patients (59%). The residents had experienced each of the 22 negative acts (11.5%-82.5%). Work-related bullying occurs more than person-related bullying and physical intimidation. Ignoring of recommendations or orders by nurses occurs on a daily, weekly, or monthly basis for 30.2% of residents (work-related bullying). The most frequent person-related bullying act is ignoring the resident when they approach or reacting in a hostile manner (18.0%), followed by ignoring or excluding the resident (17.1%). CONCLUSIONS Workplace bullying of general surgery residents by nurses is prominent. Future research is needed to determine the toll on the residents well-being and patient outcomes.

Using Elements from an Acute Abdominal Pain Objective Structured Clinical Examination (OSCE) Leads to More Standardized Grading in the Surgical Clerkship for Third-Year Medical Students

BACKGROUND There is poor reliability in the Likert-based assessments of patient interaction and general knowledge base for medical students in the surgical clerkship. The Objective Structured Clinical Examination (OSCE) can be used to assess these competencies. OBJECTIVE We hypothesize that using OSCE performance to replace the current Likert-based patient interaction and general knowledge base assessments will not affect the pass/fail rate for third-year medical students in the surgical clerkship. METHODS In this retrospective study, third-year medical student clerkship data from a three-station acute abdominal pain OSCE were collected from the 2009-2010 academic year. New patient interaction and general knowledge base assessments were derived from the performance data and substituted for original assessments to generate new clerkship scores and ordinal grades. Two-sided nonparametric statistics were used for comparative analyses, using an α = 0.05. RESULTS Seventy third-year medical students (50.0% female) were evaluated. A sign test showed a difference in the original (4.45/5) and the new (4.20/5) median patient interaction scores (p < 0.01). A sign test did not show a difference in the original (4.00/5) and the new (4.11/5) median general knowledge base scores (p = 0.28). Nine clerkship grades changed between these different grading schemes (p = 0.045), with an overall agreement of 87.1% and a kappa statistic of 0.81. There were no differences in the pass/fail rate (p > 0.99). CONCLUSIONS We conclude that there are no differences in pass/fail rate, but there is a more standardized distribution of patient interaction assessments and utilization of the full spectrum of possible passing grades. We recommend that the current patient interaction assessment for third-year medical students in the surgical clerkship be replaced with that found through trained standardized patients in this three-station acute abdominal pain OSCE.

It was the night before the interview: Perceptions of resident applicants about the preinterview reception

OBJECTIVE Hosting a reception for prospective interns the evening before the interview has become a well-established expectation. It is thought that these initial impressions significantly influence the ranking process. Despite these well-held beliefs, there has been a paucity of studies exploring the preinterview reception. DESIGN A survey tool was created and piloted to ensure validity. The survey was then administered to a fourth-year class of allopathic medical students immediately after interviews but before Match Day. SETTING A university, teaching hospital. PARTICIPANTS Fourth-year allopathic medical students. RESULTS The response rate was 100% (n = 69). Ninety-six percent of programs hosted an event. Although these events were minimally stressful (86%), the same percent felt that not attending would limit their knowledge of the program, and 66% felt that it would negatively affect their application. Forty percent believe this event to be extremely important to residency programs in selecting interns. Ninety-five percent are attended by residents only, and approximately half were at a casual restaurant. Most applicants (97%) never paid for their own meal, and 69% felt that if they did, it would leave a negative impression of the program. CONCLUSIONS Candidates believe the preinterview reception is important in the selection process, that failing to attend would negatively affect their application, and provides insight about the program. Alcohol is often provided but rarely has a negative effect. Applicants prefer an informal setting with unfettered interactions with the residents.

What Do Surgical Nurses Know About Surgical Residents

OBJECTIVE A fundamental premise of establishing collaborative relationships between residents and nurses is a basic understanding of the attributes of each group. The intent of this study was to determine what surgical nurses know about surgical residents. DESIGN A piloted survey tool was administered to a cross-section of nurses working in 3 surgical intensive care units, a surgical intermediate unit, and 2 general surgical floors. Surgical residents completed the same survey tool. The percentage of residents giving the most frequent response was compared with the percentage of nurses giving the same response. SETTING A university, teaching hospital. PARTICIPANTS One hundred twenty-four of 129 surgical nurses and 24 of 25 surgical residents who completed the survey tool. RESULTS The response rate for nurses on the 2 survey days was 94%, or 54% of all surgical nurses employed by the hospital, and 96% for residents. The nurses surveyed were equally distributed between the units. Ninety-nine percent of nurses did not have a surgical resident as a significant other, 55% of nurses had greater than 5 years experience, and 95% were licensed registered nurses. Seventy-eight percent of nurses correctly indicated that a medical doctorate is the highest degree required to start residency (p = 0.01), but only 57% accurately identified the length of surgical residency (p = 0.02). Nurses perceived residents devoted less time to patient care (p < 0.01) and more time to studying (p < 0.01). Forty percent of nurses do not think interns are legally physicians (p < 0.01) or hold a medical license (p < 0.01). Forty percent of nurses are aware of the 80-hour work week restriction (p < 0.01). Eighteen percent of nurses have the perception that residents are not allowed to perform bedside procedures without an attending physician present (p = 0.03), while 56% have the perception that residents are not allowed to perform any part of an operation without an attending physician (p < 0.01). There is a misperception among 32% of nurses that residents pay tuition for residency (p < 0.01), while only 52% accurately identified the range of a residents salary (p = 0.01) and 11% the amount of resident debt (p < 0.01). CONCLUSIONS Despite the importance of the collaborative relationship in surgical patient care, surgical nurses have a limited understanding of surgical residents. Educating nurses about the education, roles, and responsibilities of surgical residents might improve collaborative relationships and ultimately patient care.

The Role of Gender and Distance Mentoring in the Surgical Education Research Fellowship

OBJECTIVE The nature of the mentor-mentee relationship is important in the pursuit of successful research projects. The purpose of this study is to evaluate the mentor-mentee relationships in the Surgical Education Research Fellowship (SERF) based on gender and geographical distances regarding program completion. We hypothesize that there are no differences for SERF program completion rates based on gender pairs and distances between pairs. METHODS This was a retrospective study from 2006 to 2011. Mentor-mentee rosters were retrospectively reviewed for program completion, demographics, and PubMeD indexing. Time zone differences and geographic distances between pairs were found with online applications. Chi-square tests were used for categorical variables and nonparametric statistics were carried out using α = 0.05. RESULTS Of the 82 individuals accepted into the SERF program, 43 (52%) completed the SERF program during the study period. There were no differences in program completion rates based on fellow gender and gender pairing (all p > 0.05). Different-gender pairs that completed the program (n = 17) were indexed more frequently on PubMed than same-gender pairs that completed the program (n = 24) (41% vs 12%, p = 0.04). There were no differences in program completion based on time zone differences (p = 0.20). The median distance between pairs completing the program (n = 35) was greater than that for pairs not completing the program (n = 36) (1741 km [IQR: 895-3117 km] vs 991 km [IQR: 676-2601 km]; p = 0.03). CONCLUSION Completion of the SERF program was independent of mentor-mentee gender pairs and time zone differences. There was greater geographical distance separating mentor-mentee pairs that completed the SERF program compared with pairs that did not complete the program. Distance mentoring is a successful and crucial element of the SERF program.

The sum is greater than its parts: clinical evaluations and grade inflation in the surgery clerkship

BACKGROUND This study examines grading component distributions to determine whether alterations in clinical grade determination reduce skew and improve predictive capability of the clinical evaluation. METHODS Rotation evaluations, examination scores, and final grades were collected for third-year medical students over a 2-year period. Conditional logistic regression and ordinary least squares regression models were run using SAS 9.3. RESULTS Conditional logistic regression demonstrated significant association between global clinical score and final grade and between average clinical evaluation score and final grade. Inclusion of shelf score into either model demonstrated increase in overall final grade. CONCLUSIONS Regressions using global and average clinical evaluation score indicate that average score is a better fit for a norm-based grading system. Arguably, the Shelf measures clinical knowledge more objectively than clinical evaluation, but both were significant. Clinical evaluation is prone to inflation because of its subjective nature; conceivably, inflation leads to the decreased correlation with shelf score.

Resident Wellness and Social Support: Development and Cognitive Validation of a Resident Social Capital Assessment Tool

OBJECTIVE The purpose of this study is to develop and generate validity evidence for an instrument to measure social capital in residents. DESIGN Mixed-methods, phased approach utilizing a modified Delphi technique, focus groups, and cognitive interviews. SETTING Four residency training institutions in Washington state between February 2016 and March 2017. PARTICIPANTS General surgery, anesthesia, and internal medicine residents ranging from PGY-1 to PGY-6. RESULTS The initial resident-focused instrument underwent revision via Delphi process with 6 experts; 100% expert consensus was achieved after 4 cycles. Three focus groups were conducted with 19 total residents. Focus groups identified 6 of 11 instrument items with mean quality ratings ≤4.0 on a 1-5 scale. The composite instrument rating of the draft version was 4.1 ± 0.5. After refining the instrument, cognitive interviews with the final version were completed with 22 residents. All items in the final version had quality ratings >4.0; the composite instrument rating was 4.8 ± 0.1. CONCLUSIONS Social capital may be an important factor in resident wellness as residents rely upon each other and external social support to withstand fatigue, burnout, and other negative sequelae of rigorous training. This instrument for assessment of social capital in residents may provide an avenue for data collection and potentially, identification of residents at-risk for wellness degradation.