Occupational medicine residency graduate survey: assessment of training programs and core competencies

OBJECTIVE: This study provides insight into Occupational Medicine (OM) residency graduates and how residency programs are meeting their education goals. METHODS: A survey of graduates from nine OM residency program was performed to evaluate the effectiveness of OM residency training in the United States and Canada. RESULTS: Eighty percent of the OM residency graduates were currently practicing OM. Three-quarters worked in clinical practice for a mean of 20 hr/wk. Other activities varied and included management, teaching and consulting. Ninety-five percent were satisfied with their OM residency training. The competencies acquired were mostly ranked highly as practice requisites, although preparation in clinical OM might be better emphasized in training. Recent OM residency graduates were more likely to be board-certified in OM than other American College of Occupational and Environmental Medicine physician members (73% vs 41%). CONCLUSIONS: OM residency graduates over the past 10 years were highly satisfied with OM residency training, with the training generally meeting practice needs.     

首届订单定向医学毕业生就业现状研究

目的:描述分析首届订单定向医学毕业生的就业现状,评价订单定向医学生培养项目实施效果,发现存在的问题并提供相关的政策建议。方法:对中西部4所医学院校的2015届305名订单定向医学毕业生和315名临床五年制医学毕业生进行随访调查。分析其履行合约、参加工作及住院医师规范化培训情况。结果:订单定向毕业生合约履行率99.3%。订单定向毕业生和临床五年制毕业生到乡镇卫生院工作的比例分别为90.7%、2.8%,月平均收入分别为2 011元、2 774元,参加住院医师规范化培训的比例分别是77.8%、43.3%。结论:4所医学院校首届订单定向医学毕业生履行合约及参加住院医师规范化培训情况良好,但工作编制和待遇落实较为滞后,订单定向和住院医师规范化培训之间的关系尚未明确。建议在订单定向医学生毕业前,医学院校尽早与地方卫生行政部门和人力资源与社会保障部门协调联系,及早落实医学生的就业工作。同时,在充分协商的基础上,尽快明确订单定向医学生参加住院医师规范化培训的程序和要求。     

Expected benefits of streamlining undergraduate medical education by early commitment to specific medical specialties

Undergraduate medical education is too long; it does not meet the needs for physicians’ workforce; and its content is inconsistent with the job characteristics of some of its graduates. In this paper we attempt to respond to these problems by streamlining medical education along the following three reforms. First, high school graduates would be eligible for undergraduate medical education programs of 4 years duration. Second, medical school applicants would be required to commit themselves to a medical specialty and choose one of four undergraduate paths: (1) “Interventions/consultations” path that would prepare its graduates for residencies in secondary and tertiary specialties, such as cardiology and surgery, (2) “continuous patient care” path for primary care specialties, such as family medicine and psychiatry, (3) “diagnostic laboratory medicine and biomedical research” path that would prepare for either laboratory-based careers, such as pathology, biochemistry and bacteriology, or research in e.g., immunology and molecular genetics, and (4) “epidemiology and public health” path that would include population-based research, preventive medicine and health care administration. Third, the content of each of these paths would focus on relevant learning outcomes, and medical school graduates would be eligible for residency training only in specialties included in their path. Hopefully, an early commitment to a medical specialty will reduce the duration of medical education, improve the regulation of physicians’ workforce and adapt the curricular content to the future job requirements from medical school graduates.     

Personal growth and its correlates during residency training

OBJECTIVES: To explore the characteristics of and factors associated with personal growth during residency training. METHODS: In 2003, 359 house officers on 7 internal medicine residency training programmes in the USA were surveyed about their training experiences and issues related to their personal growth. Factor analysis and internal reliability testing were used to develop a 'personal growth scale'. Logistic regression models were then used to identify independent associations between individual variables and 'high' versus 'low' personal growth scores. RESULTS: A total of 281 house officers (80%) responded. The personal growth scale had a Cronbach's alpha of 0.81. Factors that were independently associated with achieving high amounts of personal growth during residency training included: agreeing that reflection is important during residency training (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.1-7.4); being male (OR 2.6, 95% CI 1.4-4.5); being non-white (OR 2.2, 95% CI 1.3-3.9); having a strong desire to develop personally and professionally (OR 2.2, 95% CI 1.1-4.1), and feeling highly supported by one's programme director (OR 2.1, 95% CI 1.2-3.9). Independent predictors of scoring below the median on the personal growth scale included feeling emotionally isolated at work (OR 0.4, 95% CI 0.2-0.7) and noting that negative or disappointing experiences had been powerful (OR 0.4, 95% CI 0.2-0.9). CONCLUSIONS: Disparate amounts of personal growth occur among trainees during residency training. Residency programmes interested in promoting personal growth among their trainees may wish to focus on modifiable factors that are associated with personal growth, such as fostering supportive relationships and encouraging reflection.     

Experiences with a combined residency in internal and preventive medicine

BACKGROUND: The importance of integrating preventive medicine training into other residency programs was reinforced recently by the residency review committee for preventive medicine. Griffin Hospital in Derby CT has offered a 4-year integrated internal medicine and preventive medicine residency program since 1997. This article reports the outcomes of that program. METHODS: Data were collected from surveys of program graduates and the American Boards of Internal and Preventive Medicine in 2005-2007, and analyzed in 2007-2008. Graduates rated the program in regard to job preparation, the ease of transition to employment, the value of skills learned, the perceived quality of board preparation, and the quality of the program overall. Graduates rated themselves on core competencies set by the Accreditation Committee for Graduate Medical Education. RESULTS: Since 1997, the program has enrolled 22 residents. Residents and graduates contribute significantly toward quality of care at the hospital. Graduates take and pass at high rates the boards for both for internal and preventive medicine: 100% took internal medicine boards, 90% of them passed; 63% took preventive medicine boards, 100% of them passed). The program has recruited residents mainly through the match. Graduates rated most elements of the program highly. They felt well-prepared for their postgraduation jobs; most respondents reported routinely using preventive medicine skills learned during residency. Graduates either have gone into academic medicine (31%); public health (14%); clinical fellowships (18%); or primary care (9%); or they combine elements of clinical medicine and public health (28%). CONCLUSIONS: Integrating preventive medicine training into clinical residency programs may be an efficient, viable, and cost-effective way of creating more medical specialists with population-medicine skills.     

Importance of nutritional issues among family physicians

Physicians spend three or more years after medical school in residency training. Nutrition education in medical schools is often absent or inadequate, but residency offers an excellent opportunity for appropriate training. A mail survey of all graduates of a family medicine residency was used to ascertain their nutrition interests and practices, obtaining an 86% response rate (142 responses). Almost all of these physicians counseled patients about nutrition and made referrals for patients with nutritional problems. About 63%, primarily those in metropolitan areas, referred patients to registered dietitians in private practice. These physicians believed that most nutrition issues were important in medical practice, especially nutrition in diabetes management, weight control and cardiovascular disease. Life cycle nutrition issues as a group were ranked as being more important than chronic disease or prevention issues. Physicians who were women, younger (40 years of age), or non-white ranked nutritional issues as more important to the practice of medicine. Nutrition education of physicians during residency should be encouraged, especially as it pertains to chronic disease and prevention.     

A comparison of practice outcomes of graduates from traditional and non-traditional medical schools in Australia

AIM: The primary aim of the study was to compare the practice outcomes of doctors who graduated from a non-traditional, problem-based medical school (University of Newcastle) with those of graduates from a traditional programme (University of Sydney), matched randomly on the background characteristics of graduation year, age, gender, and rural primary and secondary school education. Our secondary aim was to differentiate admission from curricular influences by comparing the outcomes of Newcastle and Sydney graduates who entered medical school under similar admission criteria ('traditional academic' entry). DESIGN: Nested case-control analysis in a retrospective cohort study. METHODS: A validated mail-out survey was distributed to all Newcastle and Sydney graduates registered to practise in the state of New South Wales, Australia. OUTCOME MEASURES: Current main occupation (clinician or other), clinical career choice (family medicine and psychiatry or other specialties), practice location (urban or rural) and employment sector (public or private). RESULTS: A total of 513 Newcastle respondents (68% of the original, eligible Newcastle sample) were each matched randomly with a Sydney respondent according to the four background characteristics. Medical school background was not related to main occupation; over 90% of all graduates were employed in clinician positions. A greater proportion of Newcastle than Sydney graduates were either training or qualified in family medicine or psychiatry rather than in other specialties. The school of graduation was not related to practice environment; fewer than 20% of all graduates were working in rural locations and around 25% were employed in the public sector. There were no differences in outcome between Newcastle and Sydney graduates who had entered medical school under similar academic criteria. CONCLUSION: Our study suggests that initial selection procedures of medical school candidates with particular background characteristics and attributes may influence practice outcomes. Further research is required to confirm these findings.     

Measurement of how well a paediatric training programme prepares graduates for their chosen career paths

To provide a sound basis for modification of our paediatric residency education programme, we surveyed graduates from the past 16 years. The questionnaire was designed to determine the adequacy of training rotations in preparing graduates for their career paths. Questionnaires were mailed to 81 graduates; 73 (90%) replied. A modified version was completed by 27 of 29 current residents (93%). For most rotations, responses were normally distributed. However, 10 or more respondents identified exposure in one area as `excessive' and in 6 as `inadequate'. Current residents scored many rotations as `inadequate', likely indicative of their limited exposure to actual practice. Recommendations were consistent for subjects needing more instruction. All major issues raised by graduates had been identified by faculty, but the substantiation enabled changes to be made with widespread support. We recommend periodic survey of graduates to evaluate how well education is preparing residents for their ultimate career paths.     

订单定向医学生的工作意愿：基于四所医学院校的三年跟踪分析

目的：跟踪分析三届订单定向医学生与普通临床毕业生在毕业三年后的就业与规培情况，探讨首届定向生的实际履约情况、基层服务意愿与职业发展路径特点，并提出政策建议。方法：选取中西部四所医学院校，分别对2015—2017届订单定向生和普通五年制医学生在毕业当年建立队列，随后连续三年开展随访调查。结果：首届（2015届）订单定向毕业生到乡镇卫生院服务的履约率高于98%，2016届定向生表示“一定会履行合约”的学生占80.6%。2015、2016两届学生中有51.6%愿意在基层服务满3年以上，在完成服务期后，定向生平均愿意在基层继续服务4.8年。乡镇卫生院发放的月工资每提高1 000元，学生平均愿意在基层多服务1.3年。结论：已毕业定向生在规培结束后回乡镇卫生院履约的比例很高，多数已毕业定向生愿意履约完成服务期，收入是唯一可以提高其基层服务意愿的激励因素。     

Short-term effectiveness of an outcomes research training curriculum within a coordinated program

The fourth edition of the Commission on Accreditation for Dietetics Education Standards of Education mandated outcomes research training. Our objective was to determine the short-term effectiveness (<5 years) of the outcomes research training curriculum in the Coordinated Program in Dietetics (CP) at the University of Missouri-Columbia, which exceeds these minimum standards. Toward this end, a survey tool was administered to University of Missouri-Columbia CP graduates before the implementation of the fourth edition of Standards of Education and to University of Missouri-Columbia CP graduates with two semesters of outcomes research training; graduates of two other CPs from different universities from the same years were also surveyed. Graduates who went through CPs after implementation of the fourth edition of the Standards of Education showed notable improvement in attitudes, interest, and participation in most of the outcomes research skills queried, compared with those who completed their education under the earlier standards; knowledge was only slightly improved. Of these areas, only enhancements in attitudes and interest were consistently more pronounced in food and nutrition professionals trained using the University of Missouri-Columbia's outcomes research curriculum compared with other CP graduates. Both the Commission on Accreditation for Dietetics Education and program directors can use the findings described herein to further assess and develop the research competencies and/or to strengthen their programs.     

Career choices of general preventive medicine residency graduates: 1981-1986

To identify career choices made by recent graduates of general preventive medicine residency programs, all funded residency programs in general preventive medicine (excluding federal and military programs) were surveyed. Eighty-two percent of programs responded and reported on the career choices of 241 graduates who graduated from 1981 to 1986. In order of preference, the categories of career choice were: program activities (36.5%), teaching (19.1%), clinical services (17.0%), and research (6.2%). About one-fifth (21.2%) chose other activities. The number of graduates more than doubled between the periods 1981-1983 and 1984-1986. There was a threefold increase in the percentage of graduates involved primarily in research; however, there was a 33% decrease in the percentage of graduates who became professional academicians.     

Undergraduate medical education accreditation as a driver of lifelong learning

We describe the accreditation of medical education programs that lead to the Doctor of Medicine degree in the United States and Canada. We identify select accreditation standards that relate directly to the preparation of medical school graduates, as required for the supervised practice of medicine in residency training and for developing the skills of self-directed, independent learning. With standards that promote flexibility and encourage innovation, the Liaison Committee on Medical Education utilizes a continuous improvement model for the accreditation of undergraduate medical education with standards that promote flexibility and encourage innovation. The standards focus on curricula to meet learning objectives that address the current context of medical care. In undergraduate and graduate medical education, the relevance of the hospital as the predominant learning environment is challenged; in continuing medical education, traditional lectures are called into question for failing to change physician behavior and improve health care outcomes. To improve medical education from undergraduate through continuing medical education, all the relevant accrediting agencies must collaborate for success.     

A randomized controlled trial of an online immunization curriculum

IntroductionImmunization education for physicians-in-training is crucial to address vaccine concerns in clinical practice. Vaccine education is not standardized across residency programs. The Collaboration for Vaccination Education and Research (CoVER) team developed an online curriculum for pediatric (Peds) and family medicine (FM) residents.MethodsA cluster randomized controlled trial (RCT) was performed during the 2017–2018 academic year to evaluate the CoVER curriculum. A convenience sample of residency institutions were randomly allocated to the intervention or control group, with stratification by residency type. The intervention, the CoVER curriculum, consisted of four online modules and an in-person training guide. Control sites continued with their standard vaccine education. Pre-intervention and post-intervention surveys were emailed to residents in both groups. The primary outcomes compared between groups were changes in “vaccine knowledge,” “vaccine attitudes/hesitancy,” and “self-confidence” in immunization communication. The team assessing outcomes was unblinded to assignments. Hierarchical general linear model was used to adjust for residency type and residency year; residency site was modeled as a random effect.ResultsOverall, 1444 residents from 31 residency programs were eligible to participate (734 intervention, 710 control). The pre-intervention response rate was 730 (51%) and post-intervention was 526 (36%). Average knowledge scores increased from pre-intervention (control 53%; CoVER 53%) to post-intervention (control 58%; CoVER 60%). Increases in vaccine knowledge among FM residents were greater for CoVER compared to controls (p = 0.041). Vaccine hesitancy was more common among FM (23%) than Peds (10%) residents. In all three residency years, residents in the CoVER group showed greater increases in self-confidence in ability to discuss vaccines with parents/patients (p < 0.03) compared to control group.ConclusionThe CoVER curriculum is an effective model to standardize immunization education of physicians-in-training. This RCT demonstrated the effectiveness of the CoVER curriculum to improve resident confidence in their ability to discuss vaccines with parents and patients.     

A National Survey on Pediatric Training and Activities in School Health

National trends in school health practice and training were assessed 10 years after the report of the 1978 American Academy of Pediatrics Task Force on Pediatric Education. A questionnaire was sent to 2,237 randomly selected AAP Fellows and was returned by 1,068 (48%). Seventy-seven percent of practicing pediatricians reported involvement in some type of school-based or school consultant activity. Those having residency training in school health and those practicing in rural areas were most likely to be involved. The most common types of activity were school-based pre-athletic exams (56%), consultant to special education placement (26%), and game/event physician (23%). Pediatricians were paid for 20% of sports-related school consultation and 25% of nonsports school health activities. Didactic or clinical training in school health was offered during residency to 19%. Specific didactic topics in school health included learning and attention deficit disorders (32%), physician role in health education (15%), and sports medicine (12%). Preathletic participation exams were the most commonly performed school health activity during residency (23%), followed by serving as a school consultant (11%), and attending an individual education plan meeting (7%). Most pediatricians engaged in school health activities. However, they did so without preparation during residency and without payment for their services.     

临床型研究生培养与住院医师培训相结合可行性研究

目的研究临床型研究生培养与住院医师培训相结合的可能性。方法对上海某三级甲等医院临床型研究生和部分临床带教老师进行问卷调查。结果对于临床型研究生培养纳入住院医师培训,对其临床能力培养是否有帮助和对就业是否有帮助,带教老师和学生之间看法具有显著差异(P<0.05);临床型研究生医师资格被带教老师和学生认为是存在的障碍第一位;带教老师认为临床型研究生培养纳入住院医师规范化培训有必要的比例明显高于学生。结论从经济上、技术上、组织管理和社会影响进行分析,临床型研究生培养与住院医师培训相结合有其可行性,两条途径的临床能力培训并轨后,将利于统一的专科医师准入制度的建立。     

农村订单定向医学生就业与规培:两年跟踪分析

目的:跟踪分析两届订单定向医学生毕业后两年的就业与规培情况,探讨首届定向生规培结束后能否"回乡"履约,并提出政策建议。方法:选取中西部四所医学院校,分别对2015届305名和2016届435名订单定向生在毕业当年建立队列,随后连续两年开展随访调查和深入访谈。结果:当前订单定向毕业生履约率高于99%,工作落实率高于98%,2015届和2016届定向生编制落实的比例分别为86.7%和93. 8%,参加规培的比例分别为97. 4%和68. 3%,规培期间月总收入分别为3 879元和3 783元。结论:与首届定向生相比,2016届毕业生的工作及编制待遇落实更为顺畅,但是出现与家乡所在地签约率下降、定向工作地点限制过严、部分定向生参加规培未得到有效落实等问题。相关部门应尽早明确规培与"回乡"的转接办法,充分调动地方政府的积极性,促进定向生履约。     

Vertical integration in medical school: effect on the transition to postgraduate training

Medical Education 2010: 44 : 272–279 Objectives Recently, many medical schools’ curricula have been revised so that they represent vertically integrated (VI) curricula. Important changes include: the provision of earlier clinical experience; longer clerkships, and the fostering of increasing levels of responsibility. One of the aims of vertical integration is to facilitate the transition to postgraduate training. The purpose of the present study is to determine whether a VI curriculum at medical school affects the transition to postgraduate training in a positive way. Methods We carried out a questionnaire study among graduates of six medical schools in the Netherlands, who had followed either a VI or a non‐VI curriculum. Items in the questionnaire focused on preparedness for work and postgraduate training, the time and number of applications required to be admitted to residency, and the process of making career choices. Results In comparison with those who have followed non‐VI programmes, graduates of VI curricula appear to make definitive career choices earlier, need less time and fewer applications to obtain residency positions and feel more prepared for work and postgraduate training. Conclusions The curriculum at medical school affects the transition to postgraduate training. Additional research is required to determine which components of the curriculum cause this effect and to specify under which conditions this effect occurs.