Psychological Safety in Medical Education, Another Challenge to Tackle?

Psychological safety is the feeling that one can take interpersonal risks without fear of negative consequences including retaliation, intimidation, or rejection. The literature base on psychological safety in medical education is increasing. Despite increasing recognition in the medical literature, many medical practitioners and educators are uncertain about the background and effects of psychological safety on medical education.

Educating Our Future Medical Leaders: An Innovative Longitudinal Course Across Surgical and Medical Specialties in Graduate Education.

Problem: Increasing healthcare system complexity, multidisciplinary care delivery, and the need to deliver high-quality, cost-effective care drive a critical need for leadership development. Currently, few examples of multidisciplinary leadership development exist in the medical education literature. The Accreditation Council for Graduate Medical Education (ACGME) has identified leadership domains as essential milestones in residency education, encompassing areas such as interpersonal communication, quality improvement, and systems-based practice.

Virtual Brunches to Enhance Recruitment of Residents and Fellows Who Self-Identify as Underrepresented in Medicine.

Background: Our institution, along with many others, struggles to recruit residents and fellows who identify as underrepresented in medicine (UIM). There have been various program-level interventions implemented across the nation; however, little is known about graduate medical education (GME)-wide recruiting events for UIM trainees.

Objective: We describe the development, implementation, and evaluation of a GME-wide recruitment program, Virtual UIM Recruitment Diversity Brunches (VURDBs), to meet this need.

Do Lower Costs for Applicants Come at the Expense of Program Perception? A Cross-Sectional Survey Study of Virtual Residency Interviews.

Background: Travel costs and application fees make in-person residency interviews expensive, compounding existing financial burdens on medical students. We hypothesized virtual interviews (VI) would be associated with decreased costs for applicants compared to in-person interviews (IPI) but at the expense of gathering information with which to assess the program.

Objective: To survey senior medical students and postgraduate year (PGY)-1 residents regarding their financial burden and program perception during virtual versus in-person interviews.

Residency and Fellowship Program Leaders' Perceptions of Virtual Recruitment and Interviewing.

Background: Virtual recruitment is a new and more cost-effective alternative to traditional in-person recruitment in academic medicine. However, little is known about the perceived repercussions of the switch across a variety of training settings.

Objective: To describe the perceptions of graduate medical education program leaders about virtual matching and preferred format for future recruitment within an integrated health care delivery system sponsoring residency and fellowship programs at both university- and community-based primary teaching sites.

How Successful Are Residents and Fellows at Quality Improvement?

Background: Nationally, there is an expectation that residents and fellows participate in quality improvement (QI), preferably interprofessionally. Hospitals and educators invest time and resources in projects, but little is known about success rates or what fosters success.

Purpose: To understand what proportion of trainee QI projects were successful and whether there were predictors of success.

Encouraging Resident Adverse Event Reporting: A Qualitative Study of Suggestions from the Front Lines.

Introduction: Little is known about what motivates residents to report adverse events. The goals of the qualitative study were to: (1) better understand facilitators to residents' event reporting and (2) identify effective interventions that encourage residents to report.

Methods: The authors conducted focus groups of upper-level residents from 4 training programs (2 internal medicine, a pediatric, and a combined medicine-pediatric) who rotated at 3 institutions within a large healthcare system in 2016.

A Qualitative Analysis of Resident Adverse Event Reporting: What's Holding Us Back.

This study utilized focus groups of residents, who report adverse events at differing rates depending on their hospital site, to better understand barriers to residents' reporting and identify modifiable aspects of an institution's culture that could encourage resident event reporting. Focus groups included residents who rotated at 3 hospitals and represented 4 training programs. Focus groups were audio recorded and analyzed using qualitative methods.

Resident Case Volume Correlates with Clinical Performance: Finding the Sweet Spot.

Rationale And Objectives: To determine whether the total number of studies interpreted during radiology residency correlates with clinical performance as measured by objective criteria.

Materials And Methods: We performed a retrospective cohort study of three graduating classes of radiology residents from a single residency program between the years 2015-2017. The total number of studies interpreted by each resident during residency was tracked.

Do Residency Selection Factors Predict Radiology Resident Performance?

Rationale And Objectives: The purpose of our study is to determine what information in medical student residency applications predicts radiology residency success as defined by objective clinical performance data.

Materials And Methods: We performed a retrospective cohort study of residents who entered our institution's residency program through the National Resident Matching Program as postgraduate year 2 residents and completed the program over the past 2 years. Medical school grades, selection to Alpha Omega Alpha (AOA) Honor Society, United States Medical Licensing Examination (USMLE) scores, publication in peer-reviewed journals, and whether the applicant was from a peer institution were the variables examined.

Condition Help: A Patient- and Family-Initiated Rapid Response System.

Background: Rapid response teams (RRTs) help in delivering safe, timely care. Typically they are activated by clinicians using specific parameters. Allowing patients and families to activate RRTs is a novel intervention.

Making Residents Part of the Safety Culture: Improving Error Reporting and Reducing Harms.

Objectives: Reporting medical errors is a focus of the patient safety movement. As frontline physicians, residents are optimally positioned to recognize errors and flaws in systems of care. Previous work highlights the difficulty of engaging residents in identification and/or reduction of medical errors and in integrating these trainees into their institutions' cultures of safety.

Comparing Trainee and Staff Perceptions of Patient Safety Culture.

Purpose: The Accreditation Council for Graduate Medical Education implemented the Clinical Learning Environment Review (CLER) program to evaluate and improve the learning environment in teaching hospitals. Hospitals receive a report after a CLER visit with observations about patient safety, among other domains, the accuracy of which is unknown. Thus, the authors set out to identify complementary measures of trainees' patient safety experience.

JOURNAL CLUB: Incidence of Complications Following Fluoroscopically Guided Lumbar Punctures and Myelograms.

Objective: Headaches due to CSF leak are a well-described complication of dural puncture. It is uncertain how long patients should be observed after dural puncture to reduce the risk of headache. Most of the literature has focused on dural punctures performed without fluoroscopic guidance.

Evaluating the Clinical Learning Environment: Resident and Fellow Perceptions of Patient Safety Culture.

Background: The Accreditation Council for Graduate Medical Education has begun to evaluate teaching institutions' learning environments with Clinical Learning Environment Review visits, including trainee involvement in institutions' patient safety and quality improvement efforts.

Objective: We sought to address the dearth of metrics that assess trainee patient safety perceptions of the clinical environment.

Methods: Using the Hospital Survey on Patient Safety Culture (HSOPSC), we measured resident and fellow perceptions of patient safety culture in 50 graduate medical education programs at 10 hospitals within an integrated health system.

Implementation and evaluation of a multidisciplinary systems-focused internal medicine morbidity and mortality conference.

Background: Morbidity and mortality (M&M) conferences provide a forum for discussing adverse events and systems-based practice (SBP) issues; however, few models for implementing multidisciplinary, systems-focused M&M conferences exist.

Objective: To implement a new systems-focused M&M conference and evaluate success in focusing on adverse events and systems issues in a nonpunitive, multidisciplinary manner.

Methods: We implemented a new M&M conference into our large university-based internal medicine residency program.

Head CT scan overuse in frequently admitted medical patients.

Background: Patients frequently admitted to medical services undergo extensive computed tomography (CT) imaging. Some of this imaging may be unnecessary, and in particular, head CT scans may be over-used in this patient population. We describe the frequency of abnormal head CT scans in patients with multiple medical hospitalizations.

Hold-over admissions: are they educational for residents?

Purpose: Since implementation of resident duty-hour restrictions, many academic medical centers utilize night-float teams to admit patients during off hours. Patients are transferred to other resident physicians the subsequent morning as "hold-over admissions." Despite the increase of hold-over admissions, there are limited data on resident perceptions of their educational value.

Overcoming patient barriers to discussing physician hand hygiene: do patients prefer electronic reminders to other methods?

Background: Despite agreement that handwashing decreases hospital-acquired infections (HAIs), physician hand hygiene remains suboptimal. Interventions to empower patients to discuss handwashing have had variable success.

Objective: To understand patient perceived barriers to discussing physician hand hygiene and to determine whether patients prefer electronic alerts over printed information as an intervention to discuss physician handwashing.