The DIO Needs a Cabinet: Identifying and Supporting Designated Institutional "Others" in Graduate Medical Education.
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ABSTRACT:
SUBMITTER: Hanyok LA
PROVIDER: S-EPMC10829925 | biostudies-literature | 2024 Feb
REPOSITORIES: biostudies-literature
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The DIO Needs a Cabinet: Identifying and Supporting Designated Institutional "Others" in Graduate Medical Education.
Hanyok Laura A LA Smith Kathy W KW Lindeman Brenessa B Best Jennifer A JA
Journal of graduate medical education 20240217 1
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Project description:The United States has a well-trained, highly specialized physician workforce yet continues to have care gaps across the nation. Deficiencies in primary care and mental health specialties are most frequently cited, though critical shortages in multiple disciplines exist, particularly in rural areas. Sponsoring institutions of physician graduate medical education (GME) have created rural residency tracks with modest federal funding and minimal incentives, though efforts targeting shortages in these specialties and geographic locations have been limited. In response to access problems in the Veterans Health Administration, Department of Veterans Affairs (VA), the second largest federal funder of GME with the most expansive clinical education platform, Congress passed the Veterans Access, Choice, and Accountability Act of 2014. This act directed the VA and provided funding to establish 1,500 new positions, a 15% expansion of VA-funded positions at the time. Priority for position selection was given to primary care, mental health, and any other specialties the secretary of VA determined appropriate. Importantly, priority was also given to VA facilities with documented physician shortages, those that did not have GME training programs, those in communities with high concentrations of veterans, and those in health profession shortage areas. Many rural facilities match this profile and were targeted for this initiative. At the conclusion of fiscal year 2021, 1,490 positions had been authorized, and 21 of the 22 VA medical centers previously without GME activity had added residents or were planning to soon. Of the authorized positions, 42% are in primary care, 24% in mental health, and 34% in critically needed additional specialties. Targeted GME expansion in the VA, the largest integrated health care system in the nation, has been successful in addressing physician GME training that aligns with physician shortages and may serve as a model to address national physician specialty and geographic workforce needs.
| S-EPMC9311468 | biostudies-literature
Project description:BackgroundACGME-I requires sponsoring institutions (SIs) to have systematic oversight of program performance. This was initially carried out through annual review, however, maintaining compliance became a challenge for a large SI like Singapore Health Services (SingHealth) as the number of residency programs grew from 5 to 34 in 3 years.ObjectiveWe assessed the impact of quarterly monitoring using a dashboard on graduate medical education (GME) program performance and institutional oversight.MethodsIn 2014, the SingHealth GME Committee (GMEC) approved the dashboard covering 13 indicators with implication on program performance, resident/faculty performance, and finance. Indicators were given color-coded scoring for compliance, borderline compliance, or concern. From annual reporting, periodicity was increased quarterly with reports distributed to program directors, head of department, and academic clinical programs.ResultsSince implementation, programs consistently met or exceeded compliance standards in 11 of 13 indicators (84%), with 7 indicators (63%) showing upward trends. Programs with borderline scores in particular quarters showed improvement in subsequent quarters. By 2015, percentage compliance for the 3 dimensions of residents' perspectives were 1 to 2 points higher than the national compliance average. Of 19 programs undergoing ACGME-I accreditation in 2014, only 4 had citations in the foundational requirement. Institutional citations were resolved, with 0 citations in the reaccreditation site visit in 2015.ConclusionsFor a large SI, increased periodicity of program performance reporting from annual to quarterly effectively addressed the gaps in a timely fashion. Institutional performance also improved through the use of quantitative data aligned with institution and national performance indicators.
| S-EPMC6697276 | biostudies-literature
Project description:ObjectivesThe Faculty of Dentistry at King Abdulaziz University (KAU) is planning to develop a master's program in dental public health (DPH). To develop a curriculum for this program, a needs assessment was conducted in order to identify the level of DPH expertise that currently exists in Saudi Arabia, to identify gaps in knowledge, and to explore current perceptions regarding this type of program.MethodsA competency-based survey instrument was administered to private and government affiliated dental practitioners in Jeddah, Saudi Arabia. Participants' knowledge, attitudes, and competencies in DPH were assessed. In addition, questions were submitted that addressed preferred strategies of teaching, curriculum delivery methods, course content, and prerequisites for DPH. These data were combined with data previously collected from dentists holding academic positions at KAU (n = 146) and were analyzed using Statistical Analysis System version 9.3 software. Mean values and frequencies were calculated for the study variables. Proportional odds ratios and 95% confidence intervals were estimated to assess differences in educational preferences and DPH competencies according to age, gender, and qualification.ResultsMost of the participants (95%) reported a need for a DPH graduate program. The respondents had a basic knowledge of DPH and moderate experience in DPH competencies. A variety of preferred educational strategies and methods were identified and differences in educational preferences according to age, gender, and qualification of the respondents were identified. The responses obtained also acknowledged skills and competencies that the participants considered most important for a DPH practice and that would be important for students accepted into a DPH graduate program.ConclusionsThis needs assessment survey represents a preliminary step in establishing a DPH graduate program that addresses current gaps in knowledge and in the practice of public health dentistry. This survey also provided valuable feedback regarding the development of course content for a graduate education program in DPH.
| S-EPMC4501464 | biostudies-literature
Project description:BackgroundDespite the large body of evidence suggesting that effective public health infrastructure is vital to improving the health status of populations, many universities in developing countries offer minimal opportunities for graduate training in public health. In Nepal, for example, only two institutions currently offer a graduate public health degree. Both institutions confer only a general Masters in Public Health (MPH), and together produce 30 graduates per year. The objective of this assessment was to identify challenges in graduate public health education in Nepal, and explore ways to address these challenges.MethodsThe assessment included in-person school visits and data collection through semi-structured in-depth interviews with primary stakeholders of Nepal's public health academic sector. The 72 participants included faculty, students, alumni, and leaders of institutions that offered MPH programs, and the leadership of one government-funded institution that is currently developing an MPH program. Data were analyzed through content analysis to identify major themes.ResultsSix themes characterizing the challenges of expanding and improving graduate public health training were identified: 1) a shortage of trained public health faculty, with consequent reliance on the internet to compensate for inadequate teaching resources; 2) teaching/learning cultures and bureaucratic traditions that are not optimal for graduate education; 3) within-institution dominance of clinical medicine over public health; 4) a desire for practice-oriented, contextually relevant training opportunities; 5) a demand for degree options in public health specialties (for example, epidemiology); and 6) a strong interest in international academic collaboration.ConclusionDespite an enormous need for trained public health professionals, Nepal's educational institutions face barriers to developing effective graduate programs. Overcoming these barriers will require: 1) increasing the investment in public health education and 2) improving the academic environment of educational institutions. Long term, committed academic collaborations with international universities may be a realistic way to: 1) redress immediate inadequacies in resources, including teachers; 2) encourage learning environments that promote inquiry, creativity, problem-solving, and critical thinking; and 3) support development of the in-country capacity of local institutions to produce a cadre of competent, well-trained public health practitioners, researchers, teachers, and leaders.
| S-EPMC3640966 | biostudies-literature
Project description:OBJECTIVE: To investigate whether a multimethod approach, including a new position dedicated to graduate medical education (GME) educator, online education modules, and program file audits, was associated with quality improvement in our residency programs. METHOD: Data related to GME audits, residency review committee citations and cycle lengths were entered into a database. We conducted statistical analyses and calculated effect sizes to explore whether these resources were associated with program quality, as measured by maintaining necessary program policies and files, implementation of multiple assessments, increased residency review committee cycle lengths, and reductions in the number of citations. RESULTS: The statistical analyses support the implementation of the GME educator, file audits, and online courses designed to improve the quality of residency education. CONCLUSIONS: The GME office will continue to conduct audits, develop online learning resources, and provide one-on-one communication between the GME educator and program coordinators and directors. Our approach could serve as a model for other institutions interested in enhancing institutional oversight and the quality of their programs.
| S-EPMC2930310 | biostudies-other
Project description:Background Physician-patient racial and cultural concordance is essential to address health care disparities. Yet, limited literature on diversity, equity, and inclusion (DEI) outcomes in graduate medical education (GME) suggests the need for high-yield DEI resources. Objectives To describe and identify DEI efforts by US residency program director (PD) associations and areas for collaboration among the GME community. Methods Through bimonthly teleconferences and 5 iterative revisions from June to September 2022, the DEI workgroup of the US Organization of PD Associations developed a 17-question needs assessment survey to investigate DEI activities across residency PD associations, which was delivered twice electronically from September to November 2022 to 30 specialty PD association representatives. Results Survey response rate was 73% (22 of 30). Specialties track resident demographics more than PD demographics (11 of 22, 50% vs 7 of 22, 32%). Tracked demographics vary and include race, gender, and sexual orientation. Most PD associations have DEI committees (16 of 22, 73%) implementing various initiatives, the most common of which was providing resources to ensure diverse representation (11 of 16, 69%). Most specialties provide residency recruitment resources (14 of 22, 64%) and funding for visiting rotations or mentorship for underrepresented trainees (12 of 22, 54%). Resources for pipeline programs (7 of 22, 32%) and retention of diverse residents (7 of 22, 32%) were less common. Faculty development training focused more on teaching DEI to residents (14 of 22, 64%) than on teaching health disparities (7 of 22, 32%). Conclusions Our study demonstrates substantial DEI interventions among specialty PD associations. Yet, educational gaps exist in specific DEI content, faculty development, and curricular dissemination.
| S-EPMC11475428 | biostudies-literature
Project description:ObjectiveThe objective of this study was to identify potential needs and barriers related to using exoskeletons to decrease musculoskeletal (MS) symptoms for workers in the operating room (OR).BackgroundMS symptoms and injuries adversely impact worker health and performance in surgical environments. Half of the surgical team members (e.g., surgeons, nurses, trainees) report MS symptoms during and after surgery. Although the ergonomic risks in surgery are well recognized, little has been done to develop and sustain effective interventions.MethodSurgical team members (n = 14) participated in focus groups, performed a 10-min simulated surgical task with a commercial upper-body exoskeleton, and then completed a usability questionnaire. Content analysis was conducted to determine relevant themes.ResultsFour themes were identified: (1) characteristics of individuals, (2) perceived benefits, (3) environmental/societal factors, and (4) intervention characteristics. Participants noted that exoskeletons would benefit workers who stand in prolonged, static postures (e.g., holding instruments for visualization) and indicated that they could foresee a long-term decrease in MS symptoms with the intervention. Specifically, raising awareness of exoskeletons for early-career workers and obtaining buy-in from team members may increase future adoption of this technology. Mean participant responses from the System Usability Scale was 81.3 out of 100 (SD = 8.1), which was in the acceptable range of usability.ConclusionAdoption factors were identified to implement exoskeletons in the OR, such as the indicated need for exoskeletons and usability. Exoskeletons may be beneficial in the OR, but barriers such as maintenance and safety to adoption will need to be addressed.ApplicationFindings from this work identify facilitators and barriers for sustained implementation of exoskeletons by surgical teams.
| S-EPMC10027361 | biostudies-literature
Project description:Graduate and professional education play an increasingly important role in economic inequality and elite formation in the United States, but sociologists have not subjected stratification in and through graduate education to the same level of scrutiny recently applied to undergraduate and sub-baccalaureate education. In this review, we discuss how prominent stratification theories might be extended to studies of the role of graduate and professional education, and we review research about stratification at junctures along student pathways into and through postbaccalaureate education to the labor market. Especially in doctoral and professional education, we find persistent stratification, including pronounced educational inheritance and disparities in participation and degree attainment by race/ethnicity and gender. We propose future directions for inquiry, highlighting unanswered questions and conceptual issues concerning how the field of and pathways through postbaccalaureate education contribute to social stratification.
| S-EPMC6335048 | biostudies-literature
Project description: Not available
| S-EPMC7301915 | biostudies-literature
Project description:The German graduate medical education system is going through an important phase of changes. Besides the ongoing reform of the national guidelines for graduate medical education (Musterweiterbildungsordnung), other factors like societal and demographic changes, health and research policy reforms also play a central role for the future and competitiveness of graduate medical education. With this position paper, the committee on graduate medical education of the Society for Medical Education (GMA) would like to point out some central questions for this process and support the current discourse. As an interprofessional and interdisciplinary scientific society, the GMA has the resources to contribute in a meaningful way to an evidence-based and future-oriented graduate medical education strategy. In this position paper, we use four key questions with regards to educational goals, quality assurance, teaching competence and policy requirements to address the core issues for the future of graduate medical education in Germany. The GMA sees its task in contributing to the necessary reform processes as the only German speaking scientific society in the field of medical education.
| S-EPMC3671322 | biostudies-other