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Graduate medical education (GME) funding comes from predominantly two public sources: Medicare and Medicaid. In recent years, concerns have been voiced as to whether these GME payments to teaching hospitals and other entities are sufficiently transparent and publicly accountable. Most of these concerns have been directed at the financing and governance of Medicare GME payments. In the past 10 years, two major reports examined this issue.The main premise of the first report, a 2014 study by the Institute of Medicine (nowthe National Academy ofMedicine), is that Medicare GME payments, and federal funding for GME more broadly, lack a clear purpose. Medicare does not produce enough physicians prepared to practice in the most needed specialties or geographic areas and has insufficient oversight and infrastructure to measure GME program outcomes and reward performance. In terms of accountability, the study found that the stewardship of the public's investment in GME was critically absent. In particular, any data that teaching hospitals are required to report to the federal government has limited use for program oversight, workforce analysis, or policy development; consequently, the report concluded that most questions about the effectiveness of the Medicare GME program are unanswerable.

Duty hour monitoring is required in accredited training programs, however trainee self-reporting is onerous and vulnerable to bias. The objectives of this study were to use an automated, validated algorithm to measure duty hour violations of pediatric trainees over a full academic year and compare to self-reported violations. Duty hour violations calculated from electronic health record (EHR) logs varied significantly by trainee role and rotation. Block-by-block differences show 36.8% (222/603) of resident-blocks with more EHR-defined violations (EDV) compared to self-reported violations (SRV), demonstrating systematic under-reporting of duty hour violations. Automated duty hour tracking could provide real-time, objective assessment of the trainee work environment, allowing program directors and accrediting organizations to design and test interventions focused on improving educational quality.

The relentless violence against Black people takes an overwhelming emotional toll on Black trainees. In those we continue to lose, we see our families, our friends and our own lives being taken.

Junior doctors in the UK must complete various educational components during their two year Foundation training programme. It is important that mandatory learning is informative and engaging. The aim of this study was to evaluate trainee doctors' perceptions of a Technology Enhanced Learning (TEL) programme developed to improve prescribing competency. Focus groups and interviews were conducted at three hospital sites in the West Midlands. Codes, sub-themes and themes were determined using deductive and inductive thematic analysis. Data were collected from 38 Foundation trainee doctors. Results revealed major themes relating to prescribing education, the user experience and user engagement. Key findings included the positive impact of preparedness following undergraduate education on the user experience of the TEL programme at the postgraduate level; the impact of content, structure, and individual learning needs and styles on the user experience; and the impact of motivation and time on engagement. Most trainees engaged with the programme owing to its mandatory nature; however, some trainees also used the programme voluntarily, for example, to acquire knowledge prior to starting a new placement. It is important to ensure that learners are willing to engage with mandatory TEL, and that they have the time and motivation to do so. It is also important to ensure that learners have a positive user experience and that in designing TEL individual differences in learning styles and needs are taken into account. These findings have implications for educators and system developers in the construction and design of mandatory eLearning programmes.

BackgroundMissed test results are a cause of medical error. Few studies have explored test result management in the inpatient setting.ObjectiveTo examine test result management practices of general internal medicine providers in the inpatient setting, examine satisfaction with practices, and quantify self-reported delays in result follow-up.DesignCross-sectional survey.ParticipantsGeneral internal medicine attending physicians and trainees (residents and medical students) at three Canadian teaching hospitals.Main MeasuresMethods used to track test results; satisfaction with these methods; personal encounters with results respondents “wish they had known about sooner.”Key ResultsWe received surveys from 33/51 attendings and 99/108 trainees (response rate 83%). Only 40.9% of respondents kept a record of all tests they order, and 50.0% had a system to ensure ordered tests were completed. Methods for tracking test results included typed team sign-out lists (40.7%), electronic health record (EHR) functionality (e.g., the electronic “inbox”) (38.9%), and personal written or typed lists (14.8%). Almost all trainees (97.9%) and attendings (81.2%) reported encountering at least one test result they “wish they had known about sooner” in the past 2 months (p = 0.001). A higher percentage of attendings kept a record of tests pending at hospital discharge compared to trainees (75.0% vs. 35.7%, p < 0.001), used EHR functionality to track tests (71.4% vs. 27.5%, p = 0.004), and reported higher satisfaction with result management (42.4% vs. 12.1% satisfied or very satisfied, p < 0.001).ConclusionsCanadian physicians report an array of problems managing test results in the inpatient setting. In the context of prior studies from the outpatient setting, our study suggests a need to develop interventions to prevent missed results and avoid potential patient harms.

Objective The virtual patient (VP) is a computer program that simulates real-life clinical scenarios and allows learners to make diagnostic and therapeutic decisions in a safe environment. Although many VP cases are available, few focus on junior trainees as their target audience. In addition, there is wide variability in trainees’ clinical rotation experiences, based on local practice and referral patterns, duty hour restrictions, and competing educational requirements. In order to standardize clinical exposure and improve trainees’ knowledge and perceived preparedness to manage core internal medicine cases, we developed a pool of VP cases to simulate common internal medicine presentations. We used quantitative and qualitative analyses to evaluate the effectiveness of one of our VP cases among medical trainees at University of Toronto. We also evaluated the role of VP cases in integrated teaching of non-medical expert competencies. Results Despite modest effects on knowledge acquisition, a majority of participants enjoyed using VP cases as a resource to help them prepare for and reinforce clinical experiences. Cognitive interactivity and repetitive practice were particularly appreciated by study participants. Trainees perceived VP cases as a useful resource as their learning can be customized to their actions within the case, resulting in unique learning trajectories.

Background The learning climate within a learning environment is a key factor to determine the potential quality of learning. There are different groups of postgraduate trainees who study primarily in the operating theater (OT), which is a complex, high-stake environment. This study created and validated an interprofessional measure of the OT educational climate and explored how postgraduate trainees from different health professions experienced the learning climate within the operating theater. Methods An explanatory, sequential mixed-method design was used. The quantitative phase used and validated a newly developed questionnaire, the Operating Theater Educational Climate Test (OTECT), to evaluate the perceptions of anesthesia residents, surgical residents and student registered nurse anesthetists. In the qualitative phase, three mono-professional focus groups participants’ opinions on the factors influencing their learning climate were explored. Results The OTECT questionnaire was found to be valid. The questionnaire response rate was 78.9% (142 respondents from 180). Questionnaire results indicated similar perceptions of the OT learning climate by learners from all disciplines. Focus groups revealed three major influencing factors on the experienced learning climate: 1) nature of work in the OT, 2) the role of the supervisor, and 3) the interprofessional dimension of work in the OT. Conclusions The OT learning climate was perceived similarly by trainees from three health profession. The high stakes nature of the OT inhibited learning most as it impacted both trainees and supervisors. The results can be applied to improve the overall learning environment in the OT for all groups of learners.

This article is for nurses and nursing students who are writing abstracts for poster or oral presentations, journal articles, or grants. The use of storytelling principles for scholarly writing demonstrated how a potentially dreary abstract can be created to captivate a reader. [ J Contin Educ Nurs. 2019;50(3):107–108.]

Objectives To evaluate the effect of monetary grants on young physicians’ choice of remote or rural hospital-based practice. Background In late 2011, The Israeli Ministry of Health attempted to address a severe physician maldistribution, which involved severe shortages in remotely-located institutions (RLI). The policy intervention included offering monetary grants to residents who chose a residency program in a RLI. Methods A total of 222 residents from various disciplines were recruited; 114 residents from RLI and 108 residents from central-located institutions (CLI), who began their residency during 2012–2014. Participants were surveyed on demographic, academic and professional data, and on considerations in the choice of residency location. Results Residents in RLI attributed significantly more importance to the grant in their decision-making process than did residents from CLI. This effect remained significant in a multivariate model (OR 1.65, 95% CI 1.20–2.27, p  = 0.002). The only parameter significantly associated with attributing importance to the grant was older age (OR 1.09, 95% CI 1.00–1.19, p  = 0.049). Conclusion The choice of a RLI for residency may be influenced by monetary grants. This is consistent with real-life data showing an increase in medical staffing in these areas during the program’s duration. Further studies are needed to determine causality and physical practicality of such programs.

Medical students on clinical placements value positive experiences with specialty trainees. We aimed to document student contact with general practice registrars and other specialty registrars and any relationship between this contact and student career interests. Medical students were surveyed following their general practice, general medicine, general surgery, psychiatry and medicine-in-society placements. One hundred and twenty-four students completed the survey (73% response rate). Participants reported substantially less contact with general practice registrars and rural generalist trainees than with other registrars. Compared with students placed in regional areas, metropolitan students were more likely to have no contact at all with general practice registrars. Interest in specialty careers was correlated with interest in knowing more about specialty training, but not with the extent of contact with registrars or personal connections in any specialty studied. Student exposure to general practice registrars in at least one Australian medical school is relatively low. Opportunities to increase this should be explored. Students themselves may have little influence over their contact with specialty trainees, despite valuing it highly.