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RATIONALE AND OBJECTIVES - The percentage of clinical scientists in radiology has historically been low. Increasing the pipeline of trainees interested in research could occur by recruiting MD-PhD trainees and providing protected research time during residency. The purpose of this work is to assess the attitudes of radiology program directors toward MD-PhD trainees, resident research productivity, and dedicated research time.
METHODS - An online survey was sent to residency program directors of all diagnostic radiology departments that received National Institutes of Health (NIH) awards in 2014 (n = 63). Survey questions included program size; perception of overall performance, clinical performance, and research productivity of MD-PhD residents compared to non-PhD residents; and presence of dedicated research time. Responses comparing MD-PhD residents to non-PhD residents were reported as a five-point Likert scale. Student t test was used to assess for significance (alpha = 0.05).
RESULTS - Response rate was 37%. Clinical performance of MD-PhD residents was judged inferior (P < .05) to non-PhD residents, although that of all residents engaged in research trended toward superiority compared to those not involved in research. Dedicated research time is offered by 61% of programs in years R1-R3 and all programs in year R4. Research productivity during residency was judged to be similar (P = .5) between MD-PhD and non-PhD residents.
CONCLUSIONS - Survey results suggest that clinical performance during residency and research involvement is often individually based and difficult to generalize based on prior PhD training. All programs offered dedicated research time, and the vast majority of residents were reported to engage in research during residency, which may increase the pipeline of trainees interested in an academic career.
Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
BACKGROUND - Mentorship programs in surgery are used to overcome barriers to clinical and academic productivity, research success, and work-life balance. We sought to determine if the Eastern Association for the Surgery of Trauma (EAST) Mentoring Program has met its goals of fostering academic and personal growth in young acute care surgeons.
METHODS - We conducted a systematic program evaluation of EAST Mentoring Program's first 4 years. Demographic information was collected from EAST records, mentorship program applications, and mentee-mentor career development plans. We reviewed the career development plans for thematic commonalities and results of a structured, online questionnaire distributed since program inception. A mixed methods approach was used to better understand the program goals from both mentee and mentor perspectives, as well as attitudes and barriers regarding the perceived success of this career development program.
RESULTS - During 2012 to 2015, 65 mentoring dyads were paired and 60 completed the program. Of 184 surveys distributed, 108 were returned (57% response rate). Respondents were evenly distributed between mentees and mentors (53 vs. 55, p = 0.768). In participant surveys, mentoring relationships were viewed to focus on research (45%), "sticky situations" (e.g., communication, work-life balance) (27%), education (18%), or administrative issues (10%). Mentees were more focused on research and education versus mentors (74% vs. 50%; p = 0.040). Mentees felt that goals were "always" or "usually" met versus mentors (89% vs. 77%; p = 0.096). Two barriers to successful mentorship included time and communication, with most pairs communicating by email. Most respondents (91%) planned to continue the relationship beyond the EAST Mentoring Program and recommended the experience to colleagues.
CONCLUSION - Mentee satisfaction with the EAST Mentoring Program was high. Mentoring is a beneficial tool to promote success among EAST's young members, but differences exist between mentee and mentor perceptions. Revising communication expectations and time commitment to improve career development may help our young acute care surgeons.
BACKGROUND - Open communication between healthcare professionals about care concerns, also known as 'speaking up', is essential to patient safety.
OBJECTIVE - Compare interns' and residents' experiences, attitudes and factors associated with speaking up about traditional versus professionalism-related safety threats.
DESIGN - Anonymous, cross-sectional survey.
SETTING - Six US academic medical centres, 2013-2014.
PARTICIPANTS - 1800 medical and surgical interns and residents (47% responded).
MEASUREMENTS - Attitudes about, barriers and facilitators for, and self-reported experience with speaking up. Likelihood of speaking up and the potential for patient harm in two vignettes. Safety Attitude Questionnaire (SAQ) teamwork and safety scales; and Speaking Up Climate for Patient Safety (SUC-Safe) and Speaking Up Climate for Professionalism (SUC-Prof) scales.
RESULTS - Respondents more commonly observed unprofessional behaviour (75%, 628/837) than traditional safety threats (49%, 410/837); p<0.001, but reported speaking up about unprofessional behaviour less commonly (46%, 287/628 vs 71%, 291/410; p<0.001). Respondents more commonly reported fear of conflict as a barrier to speaking up about unprofessional behaviour compared with traditional safety threats (58%, 482/837 vs 42%, 348/837; p<0.001). Respondents were also less likely to speak up to an attending physician in the professionalism vignette than the traditional safety vignette, even when they perceived high potential patient harm (20%, 49/251 vs 71%, 179/251; p<0.001). Positive perceptions of SAQ teamwork climate and SUC-Safe were independently associated with speaking up in the traditional safety vignette (OR 1.90, 99% CI 1.36 to 2.66 and 1.46, 1.02 to 2.09, respectively), while only a positive perception of SUC-Prof was associated with speaking up in the professionalism vignette (1.76, 1.23 to 2.50).
CONCLUSIONS - Interns and residents commonly observed unprofessional behaviour yet were less likely to speak up about it compared with traditional safety threats even when they perceived high potential patient harm. Measuring SUC-Safe, and particularly SUC-Prof, may fill an existing gap in safety culture assessment.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
BACKGROUND - Accreditation Council for Graduate Medical Education (ACGME) core competencies of systems-based practice and practice-based learning and improvement are difficult to assess, as they are often not directly measurable or observable. Reviewing day-of-surgery cancellations could provide resident learning opportunities in these areas.
OBJECTIVE - An automated system to facilitate anesthesiology resident review of cancelled cases was implemented on the Preoperative Evaluation Clinic (PEC) rotation at the authors' institution. This study aims to evaluate its impact on resident education.
METHODS - Residents on the PEC rotation during the 6 months preceding (n = 22) and following (n = 13) implementation in 2014 were surveyed about their experience performing cancelled case reviews in order to ascertain the effect of the intervention on their training.
RESULTS - Significant changes were reported in the number of cases reviewed by each resident (p < 0.0001), perceived importance of review (p = 0.03), and ease of review (p = 0.03) after system implementation. There was also an increase in the proportion of cancelled cases reviewed from 17.3% (34 of 196) to 95.6% (194 of 203) (p < 0.0001). Non-significant trends were seen in perceived rotation effect on ACGME competencies, including systems-based practice. Several specific improvements to our clinical practice, including the creation of standardized guidelines, arose from these case reviews.
CONCLUSION - Implementation of automated systems can improve compliance with educational goals by clarifying priorities and simplifying workflow. This system increased the number of cases reviewed by residents and the perceived importance of this review as a part of their educational experience.
OBJECTIVE - To develop and test the psychometric properties of two new survey scales aiming to measure the extent to which the clinical environment supports speaking up about (a) patient safety concerns and (b) unprofessional behaviour.
METHOD - Residents from six large US academic medical centres completed an anonymous, electronic survey containing questions regarding safety culture and speaking up about safety and professionalism concerns.
RESULTS - Confirmatory factor analysis supported two separate, one-factor speaking up climates (SUCs) among residents; one focused on patient safety concerns (SUC-Safe scale) and the other focused on unprofessional behaviour (SUC-Prof scale). Both scales had good internal consistency (Cronbach's α>0.70) and were unique from validated safety and teamwork climate measures (r<0.85 for all correlations), a measure of discriminant validity. The SUC-Safe and SUC-Prof scales were associated with participants' self-reported speaking up behaviour about safety and professionalism concerns (r=0.21, p<0.001 and r=0.22, p<0.001, respectively), a measure of concurrent validity, while teamwork and safety climate scales were not.
CONCLUSIONS - We created and provided evidence for the reliability and validity of two measures (SUC-Safe and SUC-Prof scales) associated with self-reported speaking up behaviour among residents. These two scales may fill an existing gap in residency and safety culture assessments by measuring the openness of communication about safety and professionalism concerns, two important aspects of safety culture that are under-represented in existing metrics.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECT - Various bibliometric indices based on the citations accumulated by scholarly articles, including the h-index, g-index, e-index, and Google's i10-index, may be used to evaluate academic productivity in neurological surgery. The present article provides a comprehensive assessment of recent academic publishing output from 103 US neurosurgical residency programs and investigates intradepartmental publishing equality among faculty members.
METHODS - Each institution was considered a single entity, with the 5-year academic yield of every neurosurgical faculty member compiled to compute the following indices: ih(5), cumulative h, ig(5), ie(5), and i10(5) (based on publications and citations from 2009 through 2013). Intradepartmental comparison of productivity among faculty members yielded Gini coefficients for publications and citations. National and regional comparisons, institutional rankings, and intradepartmental publishing equality measures are presented.
RESULTS - The median numbers of departmental faculty, total publications and citations, ih(5), summed h, ig(5), ie(5), i10(5), and Gini coefficients for publications and citations were 13, 82, 716, 12, 144, 23, 16, 17, 0.57, and 0.71, respectively. The top 5 most academically productive neurosurgical programs based on ih(5)-index were University of California, San Francisco, University of California, Los Angeles, University of Pittsburgh, Brigham & Women's Hospital, and Johns Hopkins University. The Western US region was most academically productive and displayed greater intradepartmental publishing equality (median ih-index = 18, median Ginipub = 0.56). In all regions, large departments with relative intradepartmental publishing equality tend to be the most academically productive. Multivariable logistic regression analysis identified the ih(5)-index as the only independent predictor of intradepartmental publishing equality (Ginipub ≤ 0.5 [OR 1.20, 95% CI 1.20-1.40, p = 0.03]).
CONCLUSIONS - The ih(5)-index is a novel, simple, and intuitive metric capable of accurately comparing the recent scholarly efforts of neurosurgical programs and accurately predicting intradepartmental publication equality. The ih(5)-index is relatively insensitive to factors such as isolated highly productive and/or no longer academically active senior faculty, which tend to distort other bibliometric indices and mask the accurate identification of currently productive academic environments. Institutional ranking by ih(5)-index may provide information of use to faculty and trainee applicants, research funding institutions, program leaders, and other stakeholders.
Data monitoring is a key recommendation of the WHO Global Code of Practice on the International Recruitment of Health Personnel, a global framework adopted in May 2010 to address health workforce retention in resource-limited countries and the ethics of international migration. Using data on African-born and African-educated physicians in the 2013 American Medical Association Physician Masterfile (AMA Masterfile), we monitored Sub-Saharan African (SSA) physician recruitment into the physician workforce of the United States (US) post-adoption of the WHO Code of Practice. From the observed data, we projected to 2015 with linear regression, and we mapped migrant physicians' locations using GPS Visualizer and ArcGIS. The 2013 AMA Masterfile identified 11,787 active SSA-origin physicians, representing barely 1.3% (11,787/940,456) of the 2013 US physician workforce, but exceeding the total number of physicians reported by WHO in 34 SSA countries (N = 11,519). We estimated that 15.7% (1,849/11,787) entered the US physician workforce after the Code of Practice was adopted. Compared to pre-Code estimates from 2002 (N = 7,830) and 2010 (N = 9,938), the annual admission rate of SSA émigrés into the US physician workforce is increasing. This increase is due in large part to the growing number of SSA-born physicians attending medical schools outside SSA, representing a trend towards younger migrants. Projection estimates suggest that there will be 12,846 SSA migrant physicians in the US physician workforce in 2015, and over 2,900 of them will be post-Code recruits. Most SSA migrant physicians are locating to large urban US areas where physician densities are already the highest. The Code of Practice has not slowed the SSA-to-US physician migration. To stem the physician "brain drain", it is essential to incentivize professional practice in SSA and diminish the appeal of US migration with bolder interventions targeting primarily early-career (age ≤ 35) SSA physicians.
The Society of Cardiovascular Computed Tomography has developed general (level 1) cardiovascular CT (CCT) training guidelines for radiology resident and cardiology fellow education. As CCT use has expanded over the past decade, it is essential to incorporate such training in both diagnostic radiology residency programs and cardiology fellowship programs. This curriculum will ensure residents and fellows-in-training obtain a fundamental understanding of CCT to stay current in the evolving landscape of cardiovascular imaging and know how and when to use CCT. The curriculum will also help narrow the present knowledge and training gap that exists for CCT between different programs and may encourage trainees to pursue additional training in advanced cardiovascular imaging.
Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.