Rural practice and the personal and educational characteristics of medical students: Survey of 1269 graduates of the University of Manitoba

ObjectiveTo describe the relationships between rural practice and the personal and medical education characteristics of medical students and residents.DesignCross-sectional, mailed survey.SettingManitoba.ParticipantsOf 2578 physician graduates of the University of Manitoba from 1965 to 2000 who were surveyed, 1269 (49%) responded.ResultsOf 1269 respondents, 39% had practised in rural settings, including 58% of the 362 respondents who identified family practice as their primary career activity, and 32% of the 907 respondents whose primary activities were other than family practice. For all graduates, being male (P = .0289), having lived in a rural community (P < .0001), having attended a rural high school (P < .0001), and having rural educational experiences during medical school (P = .0068) or during postgraduate training (P < .0001) were significantly related to a greater likelihood of rural practice. In the final multivariate model, graduates of rural high schools, compared with those from urban public schools, were 1.57 times (95% CI 1.09 to 2.26) more likely to have practised in rural settings. Graduates who undertook part of their undergraduate training in rural settings were 1.34 times (95% CI 1.09 to 1.75) more likely to practise in rural locations. For both undergraduates and residents, the distance of their rural education experiences from Winnipeg and the likelihood of rural practice were directly related. For both FPs and non-FPs, being male and undertaking rural education during residency training were associated with a greater likelihood of rural practice, as was the distance of the training experience from the urban setting. For non-FPs a similar association was observed with undergraduate rural experiences.ConclusionThis large survey of graduates from a Canadian medical school demonstrated that attending a rural high school (P < .0001) and having rural educational exposure during medical school and residency training (P = .0068) were significantly associated with a physician practising in a rural location. That is, rural educational experiences on the continuum from high school through residency training appeared to be associated with rural practice.     

Internal Medicine Residents' Preparedness to Care for Reproductive-Age and Pregnant Women

Background: Research that addresses whether residents are prepared to deliver preconception care and manage medical conditions in pregnant and postpartum women has been scarce since the publication of women's health competency guidelines for internists in 1997.

Purpose: To investigate current attitudes, training, and perceived preparedness in these areas and to explore relationships between resident characteristics and preparedness.

Methods: A 62-item questionnaire was given to 105 internal medicine residents and recent graduates at two affiliated residency programs.

Results: Eighty-five surveys were returned. Most respondents reported that they had minimal training and were unprepared in these areas but felt that learning these topics is important. Perceived preparedness correlated strongly with relevant didactic and clinical training but was not associated with gender, residency track, or career plan.

Conclusions: In light of published competency guidelines, internal medicine training programs should consider adding or increasing curricular content to improve residents' perceived preparedness to deliver care to reproductive-age and pregnant women.     

Recent Trends in Primary Care Interest and Career Choices Among Medical Students at an Academic Medical Institution

Phenomenon: As an impending shortage of primary care physicians is expected, understanding career trajectories of medical students will be useful in supporting interest in primary care fields and careers. The authors sought to characterize recent trends in primary care interest and career trajectories among medical students at an academic medical institution that did not have a family medicine department. Approach: Match data for 2,477 graduates who matched into resident training programs between 1989 and 2014 were analyzed to determine the proportion entering primary care residency programs. An online search and confirmatory phone call methodology was used to determine primary care career trajectories for the 795 graduates who matched into primary care residency programs between 1989 to 2010. Subanalyses were performed to characterize primary care career entrance among graduates who matched into the three primary care residency programs: Family Medicine, Categorical and Primary Care Internal Medicine, and Categorical and Primary Care Pediatrics. Findings: Between 1989 and 2014, 911 (37%) of all matched graduates matched into primary care residency programs. Of the 795 graduates who matched into these programs between 1989 and 2010, less than half (245; 31%) entered primary care careers. Of the graduates who ultimately entered primary care careers, 82% matched into either internal medicine or pediatrics residency programs and 18% matched into family medicine programs. Although there have been fluctuations in primary care interest that seem to parallel health care trends over the 26-year period, the overall percentage of graduates entering primary care residency programs and careers has remained fairly stable. Between 2006 and 2010, entrance into both primary care residency programs and primary care careers steadily increased. Despite this, the overall percentage of matched graduates who entered primary care careers over the 22-year study period (12%) was less than the national average (16%–18%). Insights: In the 26-year period between 1989 and 2014, primary care career interest increased slightly among medical students at this academic medical institution, with fluctuations that seem to coincide with national health care trends. Year-to-year fluctuations appear to be driven by rising numbers of Categorical Pediatrics and Categorical Internal Medicine matchers pursuing careers in primary care. There may be a need for specialized curricula and strategies to promote and retain interest in primary care at academic medical institutions, especially at institutions without family medicine training programs.     

Teaching an integrated approach to complementary, alternative, and mainstream therapies for children: a curriculum evaluation.

BACKGROUND: Increasing numbers of patients seek information about complementary and alternative medicine (CAM) from their primary physicians. We sought to evaluate our 4-year old curriculum integrating mainstream and CAM care for common outpatient pediatric problems within a family medicine residency. DESIGN: Cross-sectional survey. METHODS: Subjects included current (1998) third-year residents and recent graduates from our program and nearby University of Washington-affiliated family medicine residency programs. The survey included items on training experiences, knowledge, attitudes and behavior regarding CAM. RESULTS: Among the 18 respondents from our program and 21 from comparison programs, the average age was 32 years and one-third were male. Over 80% of respondents felt that residencies should provide training in CAM. Substantial numbers of respondents from all programs recommended CAM therapies to patients in the past year. All respondents had recommended special diets and nutritional supplements; more than 50% recommended herbal remedies, acupuncture, meditation or progressive relaxation, massage or home remedies. Respondents from all groups had similar attitudes and knowledge about integrative medicine; those from the intervention program were more likely than comparison respondents to agree that their residency training had prepared them to answer patients' questions about CAM (50% vs. 19%, p = 0.04). CONCLUSIONS: Primary care residents increasingly seek training to answer patients' questions and are already recommending a variety of CAM therapies. Primary care residencies need to develop and evaluate responsible, evidence-based curricula integrating mainstream and CAM therapies.     

Residents as teachers: Survey of Canadian family medicine residents

Objective

To examine Canadian family medicine residents’ perspectives surrounding teaching opportunities and mentorship in teaching.

Design

A 16-question online survey.

Setting

Canadian family medicine residency programs.

Participants

Between May and June 2011, all first- and second-year family medicine residents registered in 1 of the 17 Canadian residency programs as of September 2010 were invited to participate. A total of 568 of 2266 residents responded.

Main outcome measures

Demographic characteristics, teaching opportunities during residency, and resident perceptions about teaching.

Results

A total of 77.7% of family medicine residents indicated that they were either interested or highly interested in teaching as part of their future careers, and 78.9% of family medicine residents had had opportunities to teach in various settings. However, only 60.1% of respondents were aware of programs within residency intended to support residents as teachers, and 33.0% of residents had been observed during teaching encounters.

Conclusion

It appears that most Canadian family medicine residents have the opportunity to teach during their residency training. Many are interested in integrating teaching as part of their future career goals. Family medicine residencies should strongly consider programs to support and further develop resident teaching skills.     

Collaboration between family physicians and nurse clinicians: Opinions of graduates in family medicine

Objective

To determine whether graduating family physicians are exposed to collaboration between family physicians and nurse clinicians during their training, as well as their opinions about shared care between doctors and nurse clinicians in the delivery of patient care.

Design

Anonymous online survey.

Setting

Two French-Canadian university family medicine residency programs.

Participants

The 2010 and 2011 graduating family physicians (N = 343) from the University of Montreal and Laval University in Quebec.

Main outcome measures

The extent to which nurse clinicians in graduating family physicians’ training milieu were involved in preventive and curative patient care activities, and graduates’ opinions about nurse clinicians sharing care with physicians.

Results

Of 343 graduates, 186 (54.2%) participated in the survey. Although as residents in family medicine their exposure to shared care with nurse clinicians was somewhat limited, respondents indicated that they were generally quite open to the idea of sharing care with nurse clinicians. More than 70% of respondents agreed or strongly agreed that nurse clinicians could adjust, according to protocols of clinical guidelines, the treatment of patients with diabetes, hypertension, and asthma, as well as regulate medication for pain control in terminally ill patients. By contrast, respondents were less favourable to nurse clinicians adjusting the treatment of patients with depression. More than 80% of respondents agreed or strongly agreed that nurse clinicians could initiate treatment via a medical directive for routine hormonal contraception, acne, uncomplicated cystitis, and sexually transmitted infections. Respondents’ opinions on nurse clinicians initiating treatment for pharyngitis and otitis were more divided.

Conclusion

Graduating family physicians are quite open to collaborating with nurse clinicians. Although they have observed some collaboration between physicians and nurses, there are areas of shared clinical activities in which they would benefit from further exposure and training.     

Choosing family medicine residency programs: What factors influence residents’ decisions?

Objective

To describe key determinants for residents’ selection of a new community-based, interprofessional site for their family medicine training, and to evaluate residents’ satisfaction with their programs.

Design

Combined qualitative and quantitative methods using in-depth interviews and a survey.

Setting

McMaster University, including the new site of the Centre for Family Medicine in Kitchener-Waterloo, Ont, and a long-established site in Hamilton, Ont.

Participants

Eleven first-year and second-year family medicine residents from the Kitchener-Waterloo site participated in in-depth interviews. Forty-four first-year and second-year family medicine residents completed the survey, 22 in Kitchener-Waterloo and 22 in Hamilton.

Methods

Kitchener-Waterloo residents participated in in-depth interviews during their residency programs in 2008 to 2009 using a semistructured format to explore their choice of site and the effect of an interprofessional environment on their education. Common themes were established using qualitative analysis techniques; based on these themes, a survey was developed and distributed to residents from both sites to further explore factors influencing site selection, satisfaction, and effects of interprofessional education.

Main findings

Residents identified several reasons for selecting a new community-based, interprofessional family medicine residency program. Reasons included preference for the location and opportunities to learn in an interprofessional teaching environment. A less hierarchical structure and greater opportunities for one-on-one teaching also influenced their choices. Perception of poor communication from the well established site was identified as a challenge. Residents at both sites indicated similarly high levels of program satisfaction.

Conclusion

Residents selected the new community-based family medicine site for reasons of geographic location and the potential for clinical learning experiences and interprofessional education. High program satisfaction was achieved at both the new and well established sites. Family medicine residency programs developing community-based networks might consider and encourage the positive influence of interprofessional care and education. Good communication between distributed sites remains a challenge.     

Knowledge of CanMEDS–Family Medicine roles: Survey of Canadian family medicine residents

Objective

This study evaluates the self-perceived awareness of the new CanMEDS–Family Medicine (CanMEDS-FM) roles by family medicine residents.

Design

A 22-question online survey.

Setting

Canadian family medicine residency programs.

Participants

All residents enrolled in a Canadian family medicine residency as of September 2010 received the survey between May and June 2011. A total of 568 residents participated.

Main outcome measures

Survey respondents indicated their awareness of, their exposure to, and the perceived importance of the CanMEDS-FM roles.

Results

The survey response rate was 25.1%. In total, 88.9% (463 of 521) of family medicine residents were aware of the CanMEDS-FM roles; there was no statistically significant difference in awareness between first- and second-year residents. Family medicine expert and communicator were most frequently chosen as the most important CanMEDS-FM roles, while manager and scholar were selected the least often. Overall, 76.4% of family medicine residents thought that their core family medicine teaching was guided by CanMEDS-FM, while 41.8% thought the same about off-service rotations.

Conclusion

It appears that most family medicine residents are aware of the CanMEDS-FM roles. While core family medicine training and evaluation seem to be grounded in CanMEDS-FM, residency program directors should endeavour to ensure that the same principles apply during off-service rotations.     

Family medicine residents’ practice intentions: Theory of planned behaviour evaluation

ObjectiveTo assess residents’ practice intentions since the introduction of the College of Family Physicians of Canada’s Triple C curriculum, which focuses on graduating family physicians who will provide comprehensive care within traditional and newer models of family practice.DesignA survey based on Ajzen’s theory of planned behaviour was administered on 2 occasions.SettingMcMaster University in Hamilton, Ont.ParticipantsResidents (n = 135) who were enrolled in the Department of Family Medicine Postgraduate Residency Program at McMaster University in July 2012 and July 2013; 54 of the 60 first-year residents who completed the survey in 2012 completed it again in 2013.ResultsThe responses indicate that the factors modeled by the theory of planned behaviour survey account for 60% of the variance in the residents’ intentions to adopt a comprehensive scope of practice upon graduation, that there is room for curricular improvement with respect to encouraging residents to practise comprehensive care, and that targeting subjective norms about comprehensive practice might have the greatest influence on improving resident intentions.ConclusionThe theory of planned behaviour presents an effective approach to assessing curricular effects on resident practice intentions while also providing meaningful information for guiding further program evaluation efforts in the Department of Family Medicine at McMaster University.     

The Development of a National Emergency Medical Services Curriculum Framework for Physicians in Canada

Background. As the role of emergency medical services (EMS) continues to expand, EMS physicians andmedical directors require special skills andtraining to keep pace with the rapidly evolving subspecialty of EMS. In Canada, subspecialty training in EMS is still relatively new, anda standard national curriculum for physician EMS training does not exist. Objective. To develop a national EMS curriculum for emergency medicine (EM) residents andfellows andan abbreviated curriculum for non-EM trainees andcommunity physicians. Methods. The authors obtained EMS curricula andopportunities from Canadian EM andEMS training programs anda sample of U.S. programs to determine existing curricula, anddeveloped a framework for a national EMS curriculum using an expert working group of EMS medical directors andEMS leaders in Canada. Results. Canadian EM residency training programs included an EMS rotation, but their content anddepth of training were not uniform. The expert working group proposed a comprehensive set of training objectives, grouped into 16 categories, stratified by level of training. Conclusion. The proposed framework andobjectives are suitable for training medical students, family medicine trainees, community physicians, EM residents, andEMS fellows in Canada. The authors hope this article will serve as a guideline for residency andfellowship directors to develop their EMS training programs in a consistent manner, promote formal training for physicians involved in EMS, andhelp define the specific knowledge andexpertise required of physicians who provide EMS medical direction in Canada.     

Pharmacists teaching in family medicine residency programs: National survey

Objective

To determine the percentage of family medicine residency programs that have pharmacists directly involved in teaching residents, the types and extent of teaching provided by pharmacists in family medicine residency programs, and the primary source of funding for the pharmacists.

Design

Web-based survey.

Setting

One hundred fifty-eight resident training sites within the 17 family medicine residency programs in Canada.

Participants

One hundred residency program directors who were responsible for overseeing the training sites within the residency programs were contacted to determine the percentage of training sites in which pharmacists were directly involved in teaching. Pharmacists who were identified by the residency directors were invited to participate in the Web-based survey.

Main outcome measures

The percentage of training sites for family medicine residency that have pharmacists directly involved in teaching residents. The types and the extent of teaching performed by the pharmacists who teach in the residency programs. The primary source of funding that supports the pharmacists’ salaries.

Results

More than a quarter (25.3%) of family medicine residency training sites include direct involvement of pharmacist teachers. Pharmacist teachers reported that they spend a substantial amount of their time teaching residents using a range of teaching modalities and topics, but have no formal pharmacotherapy curriculums. Nearly a quarter (22.6%) of the pharmacists reported that their salaries were primarily funded by the residency programs.

Conclusion

Pharmacists have a role in training family medicine residents. This is a good opportunity for family medicine residents to learn about issues related to pharmacotherapy; however, the role of pharmacists as educators might be optimized if standardized teaching methods, curriculums, and evaluation plans were in place.     

A Longitudinal Study of Emergency Medicine Residents' Malpractice Fear and Defensive Medicine

Objectives: To determine the baseline level and evolution of defensive medicine and malpractice concern (MC) of emergency medicine (EM) residents.
Methods: Using a validated instrument consisting of case scenarios and Likert-type scale questions, the authors performed a prospective, longitudinal (June 2001 to June 2005) study of EM residents at five 4-year California residency programs.
Results: All 51 EM interns of these residencies were evaluated; four residents left their programs and one took medical leave, resulting in 46 graduating residents evaluated. MC did not affect the residency choice of interns. Although perceived likelihood of serious disease increased in case scenarios over time, defensive medicine decreased in 27% of cases and increased in 20%. On a scale with 1 representing extremely influential and 5 representing not at all influential, the mean (±SD) influence of MC on interns' and graduates' case evaluation and management was 2.5 (±1.1) and 2.7 (±1.0), respectively. Comparing interns and graduates, there was no significant difference in the percentages of respondents who declared MC (mean difference in proportions, 3.3%; 95% CI =−8.4% to 15%) or refused procedures because of MC (11.5%; 95% CI =−1.3% to 24.3%). More interns, however, declared substantial loss of enjoyment of medicine than graduates (48%; 95% CI = 30.3% to 65.5%).
Conclusions: Physicians enter four-year EM residencies in California with moderate MC and defensive medicine, which do not change significantly over time and do not markedly impact their decisions to perform emergency department procedures. Malpractice fear markedly decreases interns' enjoyment of medicine, but this effect decreases by residency completion.     

Continuing medical education: interests of former and current residents of a physical medicine and rehabilitation residency program

To plan targeted, relevant continuing medical educational activities, a study was undertaken to assess demographic data, practice patterns, and current continuing medical educational needs of former graduates of the physical medicine and rehabilitation program. A survey was sent to the 168 physicians who had completed a physical medicine and rehabilitation residency program from 1961 to 1995 and to the 34 then current residents in the program. Questions were asked regarding gender, year of completion of residency, certification, fellowships, current employment situation, size of practice community, work time distribution, and busiest areas of clinical practice. In addition, from a list of 47 topics plus "other," the respondents indicated in which topics they had a current strong interest in continuing their education. They also responded to questions about their most important considerations when deliberating about attending an educational activity, the amount of notice required regarding an upcoming course, and the preferred duration of educational activities. The response rate of former residents was 56% and of then current residents was 100%. Topics of interest to greater than half of the respondents, in descending order, were musculoskeletal/soft tissue disorders, therapeutic injections/nerve blocks, industrial medicine, back and neck pain rehabilitation, and sports-related disorders. There were significant differences on some topics based on gender, year of residency completion, academic affiliation, private practice, and ratings of residency training in that topic. The most important consideration when deciding whether to attend an educational activity was, by far, interest in topic, followed by provision of continuing medical educational credits. There are among physiatrists several differences in educational interests that challenge continuing medical education planners to determine efficient, effective ways to deliver continuing medical education to meet these needs within the financial and time constraints imposed by today's clinical practice.     

Shifting into third gear: Current options and controversies in third-year postgraduate family medicine programs in Canada

Objective

To summarize current options for postgraduate third-year programs in family medicine in Canada and compile current controversies about the expanding number of programs available and the trend toward subspecialization in family medicine.

Design

A literature search was conducted by the Regina Qu’Appelle Health Region Library research staff for Canadian family medicine fellowships and residency programs using MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature from the beginning of 2005 to September 1, 2011. All available websites for programs offering third-year options were reviewed.

Setting

Canadian family medicine residency programs.

Methods

A list of current third-year residency programs was generated from the Canadian Post-MD Education Registry. In addition, the current Canadian Resident Matching Service website was reviewed, along with every program-specific website, for current third-year programs offered.

Main findings

More than 30 different options for third-year residency programs are available, including a number of community-influenced and resident-directed enhanced-skills programs. In 2010 to 2011 there were 237 postgraduate third-year family medicine residents compared with 128 in 2010 to 2011, an increase of 109 positions.

Conclusion

Controversies over the benefits to the patient population, the practice patterns of third-year residency graduates, and the influence of a subspecialty trend against a stated goal of comprehensive family medicine continue to exist, while the number of available third-year residency options continues to expand.     

Residency research requirements and the CanMEDS-FM scholar role: Perspectives of residents and recent graduates

Objective

To explore the perspectives of family medicine residents and recent family medicine graduates on the research requirements and other CanMEDS scholar competencies in family practice residency training.

Design

Semistructured focus groups and individual interviews.

Setting

Family practice residency program at the University of British Columbia in Vancouver.

Participants

Convenience sample of 6 second-year family medicine residents and 6 family physicians who had graduated from the University of British Columbia family practice residency program within the previous 5 years.

Methods

Two focus groups with residents and individual interviews with each of the 6 recently graduated physicians. All interviews were audiotaped, transcribed, and analyzed for thematic content.

Main findings

Three themes emerged that captured key issues around research requirements in family practice training: 1) relating the scholar role to family practice, 2) realizing that scholarship is more than simply the creation or discovery of new knowledge, and 3) addressing barriers to integrating research into a clinical career.

Conclusion

Creation of new medical knowledge is just one aspect of the CanMEDS scholar role, and more attention should be paid to the other competencies, including teaching, enhancing professional activities through ongoing learning, critical appraisal of information, and learning how to better contribute to the dissemination, application, and translation of knowledge. Research is valued as important, but opinions still vary as to whether a formal research study should be required in residency. Completion of residency research projects is viewed as somewhat rewarding, but with an equivocal effect on future research intentions.     

Residents’ perceptions of patient management and the value placed on family medicine: Quebec perspective

Objective

To document the perceptions that family medicine residents have of patient management.

Design

Bilingual, quantitative questionnaire consisting of 10 questions.

Setting

Quebec.

Participants

All (n = 747) family medicine residents in Quebec.

Main outcome measures

The questionnaire was designed to capture residents’ perceptions of patient management, their plans to incorporate patient management into their practice, and how they thought this aspect of family medicine practice should be promoted.

Results

In all, 289 residents (38.7%) completed the questionnaire. Of these, 201 reported that they planned to accept patients during their first 5 years of practice. The most common inhibiting factors were the difficulty of taking time off, complex cases, and the responsibilities that come with continuity of care. Neither Quebec’s regional medical staffing plans nor its specific medical activities emerged as important inhibiting factors. Respondents indicated that raising the profile of family medicine could be achieved by promoting it to medical students, changing the institutional culture, and increasing the visibility of family medicine residents and supervisors on the teams working in training settings.

Conclusion

Quebec residents plan to include patient management in their practices. However, solutions must be found for the heavy burden of responsibility that comes with an office practice and for continuing to make patient management appealing to young family physicians.The cornerstone of family medicine is patient management. And yet, in spite of the efforts that have been made to make the inclusion of patient management in one’s medical practice attractive, it is a different story in the field. In a study of physicians in general practice conducted by the Fédération des médecins omnipraticiens du Québec in 2006 and 2007,¹ 64% of young physicians had chosen to work primarily in secondary care settings. In addition, although 60% of family physicians practised primary care, more than 64% had been in practice for longer than 20 years, compared with 14% who had practised for less than 10 years.¹ Data collected in 2010 show that family physicians with 15 years of practice or less work in hospitals 70% of the time.² The shortage of Quebec physicians delivering patient management is alarming: 1 in 5 Quebec residents does not have a family physician.³ Secondary medical care is just as important to the proper functioning of Quebec’s health care system as primary care is. Reconciling these 2 aspects of the system, which are so closely linked when family medicine is promoted, is essential to the survival of this specialty, which affects both the delivery of patient care in the physician’s office and the practice of general medicine in a hospital setting.Because most young physicians decide during their residency whether they will provide patient management, we believe that it is important to know what students currently doing their residency plan to practise, and to ask them how patient management could be portrayed as a stimulating and enriching way to practise family medicine. We also believe that it is important to highlight factors that, according to residents, could help to promote family medicine, with patient management as a central focus. To begin evaluating these complex, yet important, aspects, we asked the 2011 and 2012 cohorts of family medicine residents about their plans regarding patient management and their perceptions of the value placed on family medicine.     

Apheresis education in Canadian residency programs: A needs assessment

Indications for therapeutic and donor apheresis continue to increase and expand into new domains of therapy. The level and amount of apheresis education in residency programs remains heterogeneous, which may translate into varying degrees of clinical confidence in providing care. The purpose of this study was to assess Canadian clinicians' perceptions of their apheresis training in order to help demonstrate a need for a concrete apheresis education in residency curricula. A 22-question survey was distributed to Canadian graduates who recently completed training (2013–2017) in the following specialties: hematology, nephrology, transfusion medicine, and hematologic pathology. Questions regarding clinician perception of their training were asked using a Likert scale. Fifty-seven survey responses (32% response rate) were obtained from recent graduates from hematology (29/57, 51%), nephrology (21/57, 37%), hematologic pathology (4/57, 7%) and transfusion medicine (3/57, 5%). Although most respondents (68%) received some form of apheresis exposure during residency, only 23% reported a formal apheresis rotation. Only 40% felt that the amount of time devoted to apheresis education was sufficient, and only four respondents (7%) felt confident providing independent apheresis care at the end of training. Overall, these findings suggest that a common, dedicated apheresis curriculum in these training programs could possibly increase knowledge and competence of trainees, and provide a more solid foundation in apheresis for future practice.