Pediatric Resident Exposure to Urology: Identifying a Need

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.

We aimed to clarify the scope of pediatric urological procedures that Canadian urology residents are perceived to be competent to perform upon graduation. We conducted a survey from April 2005 to June 2006 of urology residency program directors (UPDs), senior urology residents (SURs) and Pediatric Urologists of Canada (PUC) members from all 12 Canadian training programs. Questions focused on which of 23 pediatric urological procedures the 3 study groups perceived urology residents would be competent to perform upon completion of residency without further fellowship training. Procedures were based on the "A," "B" and "C" lists of procedures (least complex to most complex) as outlined in the Royal College of Physicians and Surgeons of Canada Objectives of Training in Urology. Response rates were 12/12 (100%), 41/53 (77%) and 17/23 (74%) for UPDs, SURs and PUC members, respectively. Average exposure to pediatric urology during residency was 5.4 (range 3-9) months and considered sufficient by 75% of UPDs and 69% of SURs, but only 41% of PUC members (p = 0.05). Overall, the 3 groups disagreed on the level of competence for performing level "A" and "B" procedures, with significant disagreement between PUC members and UPDs as well as SURs (p < 0.005). PUC members perceive Canadian urology residents' exposure to pediatric urology as insufficient and their competence for procedures of low to moderate complexity as inadequate. Further investigation regarding exposure to and competence in other emerging subspecialty spheres of urology may be warranted. Ongoing assessment of the objectives for training in pediatric urology is required.

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.

This study aimed to explore the prevalence of and identify risk factors for depression and burnout in paediatric residents and paediatric program directors (PDs) in Canada. Residents and PDs completed separate anonymous online surveys consisting of demographic questions, the Maslach Burnout Inventory and the Patient Health Questionnaire-2, which screens for risk of depression. A total of 166 paediatric residents completed the survey representing 14/17 Canadian paediatric residency programs. Participants were 74% female. Twenty-four (14%) were at risk of depression and 69 (42%) met criteria for burnout. Burnout was associated with year of residency (P=0.03), with third year residents at highest risk. Residents who reported unhelpful wellness curricula were at risk of burnout (81.3%) compared with those with no wellness curricula (51.1%) or curricula reported as helpful (29.1%, P=0.01). More than 79% of residents at risk of depression also met criteria for burnout (P=0.01). No associations were identified for risk of depression.Seventeen of 21 Canadian PDs completed the survey. No PDs were identified as at risk for depression. Five PDs (29%) met criteria for burnout. Paediatric PDs in Canada have relatively low rates of burnout and depression. In contrast, a large number of Canadian paediatric residents met criteria for burnout. Residents in programs with wellness curricula described as helpful are at lowest risk of burnout. Future research should include identifying features that define helpful wellness curricula and exploring interventions to help residents at risk of burnout and depression.

Community Pediatrics: A Consistent Focus in Residency Training From 2002 to 2005

The preparation of medical students for internship during medical school is variable, which can negatively affect the performance and confidence of new urology residents year 1. The primary objective is to assess the need for a workshop/curriculum to prepare medical students transitioning to urology residency. Our secondary objective is to identify the appropriate workshop/curriculum design and to identify the needed topics. A survey was developed to evaluate the utility of a Urology Intern Boot Camp for incoming first year urology residents utilizing 2 existing intern boot camp models from other surgical disciplines. Urology Intern Boot Camp content and format and programmatic structure were also considered. The survey was sent to all first- and second-year urology residents and urology residency program directors and chairs. A total of 730 surveys were sent, including 362 first- and second-year urology residents and 368 program directors/chairs. Responses were received from 63 residents and 80 program directors/chairs for an overall response rate of 20%. Only 9% of urology programs provide a Urology Intern Boot Camp. Interest in participating in Urology Intern Boot Camp was high with 92% of residents interested. Programmatic support for a Urology Intern Boot Camp was also high with 72% of program directors/chairs willing to allow time off and 51% willing to financially support intern participation. There is significant interest from urology residents and program directors/chairs in providing incoming urology interns a boot camp. The format of the Urology Intern Boot Camp preferred was a combination of didactics and hands-on skills, and a hybrid delivery model of virtual and in-person carried out in multiple sites around the country.

Residency programs are increasingly using social media for a variety of purposes. The aim of this study was to assess the views of U.S. pediatric dental residency program directors on their programs' participation in social media and use of social media in resident selection and education. This cross-sectional study used an electronic survey sent to all 89 U.S. program directors in 2018 to assess the use of social media and obtain demographic information. Forty-six surveys were completed, for a 52% response rate. Regarding resident selection, 76% of the responding directors said their programs did not conduct any online assessment of residency candidates, although 51% responded that social media postings could influence their decisions. For resident education, 78% said their programs did not provide training in challenges posed to evidence-based dentistry by social media, yet 89% expressed concern about the influence of expert opinions via social media on clinical decision making. Regarding participation in social media, 50% of respondents said their programs used social media to promote the program. These results point to a need for further evaluation of possible knowledge and behavior gaps among residency program directors and for development of formal social media assessment and education models for use in pediatric dentistry and other residency programs.

Pediatric Program Leadership\u2019s Contribution Toward Resident Wellness

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.

The numerous changes in the urology application and match process over the past several years have far-reaching implications for both applicants and programs alike. Many changes have occurred concomitantly including the implementation of geographic preferences, transition of Step 1 to pass-fail in 2022, initiation and subsequent expansion of preference signals (PS), and change from in person to virtual or hybrid interviews. In this article, Bushweller et al1 attempt to glean the Program Directors' perspectives as to the functional value each element of an application may play in weighing a residency candidate. The article demonstrates that a strategy used by applicants, omitting Step 2 scores, is likely not helpful, but harmful.2 More interesting, the shift of Step 1 to pass-fail has not created an undue weight on Step 2 scores as was previously conjectured.2 The authors most notably highlight the central importance that PS and away Sub-Internship's play in strengthening a candidate's application, confirming previous work that only 6% of applicants matched without either a PS or Sub-Internship at that program.3 The expansion of PS almost certainly contributed to the decreased number of applications sent by applicants in the 2024 cycle,4 indicating the significant downstream ramifications of any changes. Although the authors investigational work is illuminating for program leadership and urology match administrators, its most tangible value is for future applicants who are considering how best to make their applications stand out to urology program directors when applying for interviews. In the ever-changing and high stakes urology match, this study identifies that interpersonal interactions will take an even more central role as part of the application process as program directors rely more heavily on letters of recommendation and Sub-Internships to help identify desirable candidates.

PD60-09 CHIEF RESIDENT PERFORMANCE IN PEDIATRIC UROLOGY: DO EXPECTATIONS AND REALITY ALIGN?

Breastfeeding Education and Support Services Offered to Pediatric Residents in the US

Background Industry payments to physicians exceed millions of dollars. Payments can influence physicians' practices and potentially impact trainees. Objective To examine the magnitude of industry payments to obstetrics and gynecology (OB/GYN) and urology residency directors and department chairs in the United States. Methods For this retrospective cross-sectional study, program directors and department chairs of OB/GYN and urology residency programs were identified in December 2021. Nonresearch payments between August 1, 2013, and December 31, 2020, from drug or device manufacturers to program directors and department chairs of OB/GYN and urology residency programs were compiled from the Centers for Medicare & Medicaid Services Open Payments Database. Statistical analysis was conducted using the Kruskal-Wallis test and a linear mixed-effects model. Results A total of 19 903 payments, totaling $6,041,585, were provided to 396 physicians, with a median of $232.62 per physician over the 6 years analyzed. Urologists received more payments and higher amounts per payment than OB/GYNs (7820 vs 12 083, P<.01; $1,689,519.48 vs $4,352,066.40, P<.01). Department chairs received more payments per year than program directors (8 vs 4, P<.01). There were also geographic differences, with higher payments in the Northeast US region ($131.10 more, P<.01). Based on the linear mixed-effects model, 3 variables predicted the magnitude of industry payments received: physician age, number of years in leadership position, and geographic location. Conclusions Urologists and OB/GYN US residency program directors and department chairs received considerable nonresearch industry payments from 2013 to 2020.

Asynchronous e-learning allows for targeted teaching, particularly advantageous when bedside and didactic education is insufficient. An asynchronous e-learning curriculum has not been studied across multiple centers in the context of a clinical rotation. We hypothesize that an asynchronous e-learning curriculum during the pediatric emergency medicine (EM) rotation improves medical knowledge among residents and students across multiple participating centers. Trainees on pediatric EM rotations at four large pediatric centers from 2012 to 2013 were randomized in a Solomon four-group design. The experimental arms received an asynchronous e-learning curriculum consisting of nine Web-based, interactive, peer-reviewed Flash/HTML5 modules. Postrotation testing and in-training examination (ITE) scores quantified improvements in knowledge. A 2 × 2 analysis of covariance (ANCOVA) tested interaction and main effects, and Pearson's correlation tested associations between module usage, scores, and ITE scores. A total of 256 of 458 participants completed all study elements; 104 had access to asynchronous e-learning modules, and 152 were controls who used the current education standards. No pretest sensitization was found (p = 0.75). Use of asynchronous e-learning modules was associated with an improvement in posttest scores (p < 0.001), from a mean score of 18.45 (95% confidence interval [CI] = 17.92 to 18.98) to 21.30 (95% CI = 20.69 to 21.91), a large effect (partial η(2) = 0.19). Posttest scores correlated with ITE scores (r(2) = 0.14, p < 0.001) among pediatric residents. Asynchronous e-learning is an effective educational tool to improve knowledge in a clinical rotation. Web-based asynchronous e-learning is a promising modality to standardize education among multiple institutions with common curricula, particularly in clinical rotations where scheduling difficulties, seasonality, and variable experiences limit in-hospital learning.

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