Pediatric Residency Program Handover: Before and After the ACGME Requirement

A 2011 study evaluating oral health training in pediatric medical residency programs highlighted opportunities to improve residents' oral health competence. The aim of this 2017 follow-up study was to assess progress since 2011 in promoting development of pediatric residents' oral health competence. A survey was sent to all 281 pediatric and med-peds medical residency program directors to assess the structure and determinants of oral health training in their programs. A total of 110 program directors responded to the 2017 survey (response rate 40%). Just over half (54%) of the respondents reported that their residents received one to two hours of oral health education during residency, while 38% received ≥3 hours (compared to 47% and 48%, respectively, in 2011). There was improvement in the proportion of respondents reporting that their residents integrated fluoride varnish application training in 2017 vs. 2011 (83% vs. 43%; p<0.001). Departmental support for integrating oral health and having an oral health elective were significantly associated with satisfaction with residents' oral health competence. These findings suggest that pediatric and med-peds medical residency programs have improved their residents' oral health awareness and training through integration of at least one hour of oral health education and fluoride varnish training. However, given deficiencies in program structure and uneven perceptions of residents' oral health competence found in this study, opportunities remain to improve pediatric residency programs' oral health curricula.

A questionnaire designed to elicit information about the work environment, knowledge, and stresses of pediatric residency program directors was mailed to the 235 member programs of the Association of Pediatric Program Directors (APPD). At the time that the 187 respondents (80% return rate) assumed responsibility for their training programs, many rated their knowledge of various aspects of residency program administration as "poor." The respondents indicated that a lack of time, the pressures of too many other academic responsibilities, and a fear of not "filling" all positions in the National Intern Matching Program created much personal stress. Most program directors felt that educational conferences designed to teach educational methods, and administrative skills, and provide technical information knowledge necessary for residency program supervision would be beneficial.

Is Nephrology Fellowship Training on the Right Track?

View from the Association of Pediatric Program Directors (APPD)

ACGME's Early Adaptation to the COVID-19 Pandemic: Principles and Lessons Learned.

Need for Time and Training: Pediatric Program Directors’ Perceptions About Mentorship of Residents

The goals were to examine pediatric resident and program director experiences implementing the Accreditation Council for Graduate Medical Education work hour limits and to compare duty hours, moonlighting, and fatigue before and after the limits became effective. National random samples of 500 pediatric residents who graduated in 2002 and in 2004 were surveyed to compare resident duty hours and fatigue before and after the Accreditation Council for Graduate Medical Education limits were implemented. In addition, all US pediatric residency program directors were surveyed at the end of the 2003/2004 academic year, to provide a complementary retrospective examination of limit implementation. Totals of 65%, 61%, and 83% of 2002 residents, 2004 residents, and program directors, respectively, responded. The proportion of residents who reported working >80 hours per week declined from 49% for NICU/PICU rotations before the limits to 18% after limit implementation. Resident well-being was the factor identified most often by both residents and program directors as being improved since the limitations. Multivariate modeling also showed reductions in the proportions of residents who reported falling asleep while driving from work or making errors in patient care because of fatigue. Overall, 89% of pediatric residents and program directors reported that the current system is effective in ensuring appropriate working hours. Since the Accreditation Council for Graduate Medical Education duty hour limits went into effect, pediatric residents report working fewer hours and making fewer patient care errors because of fatigue. Although room for additional improvement remains, the experiences of residents and program directors suggest that implementation of the Accreditation Council for Graduate Medical Education limits in pediatric residency programs is improving resident well-being.

The Gastroenterology Core Curriculum, Third Edition

Fellowship Training in Adult Cardiothoracic Anesthesiology: Navigating the New Educational Landscape as a Result of the Coronavirus Crisis

An educational handover at the completion of medical school that transmits competency information about individual learners has been proposed as a means for improving the sub-optimal communication between medical school and residency. The authors created an Accreditation Council for Graduate Medical Education (ACGME) milestones handover (MH) for graduating medical students entering surgery, pediatrics, and OBGYN residencies utilizing assessments primarily from residency preparatory courses. This pilot study investigated residency program directors’ (PDs) perspectives on the potential utility of the MH. The authors mapped medical school assessment data to the specialty-specific ACGME level one milestones for 39 graduating medical students. The MH reported whether the student had met the level one milestone competencies. After the residency match, the MH was sent to PDs with an electronic survey asking about their perceptions of the handover. The MHs reported level one competency determinations for most of the ACGME milestones (12 of 16 for surgery, 26 of 28 for OBGYN, and 18 of 21 milestones for pediatrics). Of the 38 surveyed PDs, 25 (66%) responded. PDs reported that the MH provided better level one competency information for new trainees compared to the Medical Student Performance Evaluation [Likert score 2.07 (SD 1.16) vs. 3.67 (SD 1.14), P < 0.05] however did not feel that it was superior in describing the attributes of a new intern [Likert score 3.32 (SD 0.95) vs. 3.68 (SD 0.95), P = 0.09]. This preliminary data suggests that the MH could be a potentially useful tool. Further work will need to expand these efforts to improve the generalizability and validity evidence of a competency-based educational handover between medical school and residency.

Pediatric Emergency Medicine (PEM) fellowship programs use Milestones to assess fellows, but validity evidence for these ratings is needed. (1) Define benchmark levels of competence for the 6 Milestones competency domains and 23 competencies. (2) Determine if Milestones ratings at graduation predict passing the American Board of Pediatrics (ABP) certification exam. This multi-site retrospective cross-sectional study included all PEM fellows (2014-2022) from 80 programs in the U.S. who took the ABP certification exam. Milestones ratings from the Accreditation Council for Graduate Medical Education (ACGME) were provided to the Association of Pediatric Program Directors and analyzed. Logistic mixed effects regression models assessed associations between American Board of Pediatrics (ABP) exam pass rates and Milestones at graduation. Data from 1302 fellows (1171 from 3-year and 131 2-year graduates) yielded 90,229 Milestones ratings from which benchmarks were established. Systems-based practice consistently had the lowest mean across all fellowship years. 3-year graduates had significantly higher Milestones at graduation compared to 2-year graduates (p < 0.001). 3-year graduates with ABP certification had significantly higher graduating mean Milestone ratings averaged over all domains compared to those without evidence of certification (p = 0.003), but 2-year graduates had no significant difference (p = 0.78). This national study of PEM fellows establishes validity evidence for use of year-end Milestones ratings from fellowship within all domains as a potential predictor for achieving ABP certification exam. Fellows from 3-year programs had higher mean Milestones at graduation and higher certification exam pass rates.

Becoming compliant with the Accreditation Council for Graduate Medical Education (ACGME) requirements for scholarly activity and remaining compliant over time requires time and attention to the development of an environment of inquiry, which is reflected in detailed documentation submitted in program applications and annual updates. Since the beginning of the next accreditation system, all ACGME programs have been required to submit evidence of scholarly activity of both residents and faculty on an annual basis. Since 2014, American Osteopathic Association-accredited programs have been able to apply for ACGME accreditation under the Single Graduate Medical Education Accreditation initiative. The Residency Program Director, Chair, Designated Institutional Official, Faculty, and coordinator need to work cohesively to ensure compliance with all program requirements, including scholarly activity in order for American Osteopathic Association-accredited programs to receive Initial ACGME Accreditation and for current ACGME-accredited programs to maintain accreditation. Fortunately, there are many ways to show the type of scholarly activity that is required for the training of surgeons. In this article, we will review the ACGME General Surgery Program Requirements and definitions of scholarly activity. We will also offer suggestions for how programs may show evidence of scholarly activity.

After completing their critical care rotations, pediatric residents are expected to have acquired skills in the resuscitation of critically ill newborns and children. Recent Accreditation Council on Graduate Medical Education (ACGME) guidelines have limited the time devoted to critical care training during pediatric residency. We sought to determine how individual programs have structured their critical care training experience in light of these changes. A questionnaire was mailed to each pediatric residency program listed in the 1996-1997 Graduate Medical Education Directory. Information was obtained regarding the structure of critical care training. Data were analyzed using descriptive techniques, one-way analysis of variance with Scheffé post hoc test, and Fisher exact test as appropriate. Data were received from 149 programs (71% response rate). Most programs were in compliance with ACGME standards regarding the number of months devoted to neonatal intensive care, pediatric intensive care, and emergency medicine. There were no significant differences in the total number of rotations in either the neonatal intensive care unit (NICU) or the pediatric intensive care unit (PICU) when the programs were stratified by size. There were no significant differences in the percentage of programs requiring night call in either the NICU or the PICU during off-service months. However, small programs (< 25 residents) required significantly fewer rotations in emergency medicine (P < 0.001). Most programs complemented the critical care experience by offering additional rotations and advanced life support training. Pediatric residency programs have structured their critical care rotations in a similar fashion in accordance with ACGME guidelines. The success in meeting the stated objectives, as measured by the ability of graduating residents to stabilize critically ill children, is not known and will require further study.

The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project has shifted the focus for accrediting residency training programs from structure and process to documented outcomes. A central part of the ACGME's Next Accreditation System (NAS) is “articulating milestones of competency development in each discipline.”1 Resident achievement of educational Milestones will be an indicator of the educational effectiveness of residency programs. Most specialties have developed their Milestones through a collaborative effort involving representatives from the ACGME, the pertinent American Board of Medical Specialties (ABMS) organization, the pertinent professional specialty society, and the pertinent program directors' association. In contrast, the approach was quite different for Transitional Year (TY) residency programs, which comprise only 1 year of accredited postgraduate medical education, where there is no corresponding ABMS board certification entity or professional specialty society. In addition, graduates of TY training programs are not expected to demonstrate sufficient competency to enter the independent practice of medicine, as is the case with other specialty (categorical) residency programs.

Pediatric Resident Exposure to Urology: Identifying a Need