Gregory M. Bump

The Designated Institutional Official (DIO) is a necessary but uncommon role in medical education. Every sponsoring institution (SI) in the USA that trains residents or fellows is required to have a DIO. Nationally, there are slightly more than 900 SIs. DIOs may oversee small-, medium-, or large-sized graduate medical education (GME) institutions. Based on size and complexity, the DIO may be the main person who orchestrates the day-to-day functions of GME or may manage a team who undertakes the work. Many of the DIO’s responsibilities are prescribed by the Accreditation Council for Graduate Medical Education (ACGME), but how these responsibilities are completed is variable. At its essence, the role of the DIO is to ensure every resident and fellow receives a good educational experience and meets requirements for board certification. In addition, DIOs may take on roles as a human resource expert, as a strategic content expert for GME, as a developer of educational sites and curriculum, and a quality assurance person evaluating GME programs. The DIO role is likely to increase in scope and complexity as GME evolves, and the DIO is positioned to think strategically about larger topics pertinent to GME.

Objective Physicians have equivalent rates of depression and higher rates of suicide than other professions. While death by suicide is relatively rare, it is the leading cause of death in male resident physicians and the second leading cause of death in female resident physicians. Physicians who die by suicide are less likely to receive mental health treatment than non-physicians. The authors implemented a confidential, online, interactive screening program to help residents and fellow physicians gain awareness of their mental health, with the goal of reducing physician suicide. Methods The authors implemented the American Foundation for Suicide Prevention’s Interactive Screening Program (ISP). Results During the first 2 years of ISP implementation (May 1, 2021–April 30, 2023), all trainees in 155 Accreditation Council for Graduate Medical Education-accredited residency and fellowship programs were invited to participate in the screening program. Of 1900 residents and fellows, 200 (10.5%) completed the self-screening tool. Of those who completed the screening, 197 (98.5%) were experiencing at least a moderate amount of distress (i.e., depressive symptoms, problems related to alcohol, drug use or eating behaviors, or indication that their symptoms made it somewhat difficult to function). The majority (161/200, 80.5%) logged back into the system to review their results and personalized recommendations. Conclusions Physicians with psychological distress often suffer in silence. The ISP is a tool to help self-identify residents and fellows in distress and connect them to mental health resources with the goal of improving physician well-being.

Psychological safety is the feeling that one can take interpersonal risks without fear of negative consequences including retaliation, intimidation, or rejection. The literature base on psychological safety in medical education is increasing. Despite increasing recognition in the medical literature, many medical practitioners and educators are uncertain about the background and effects of psychological safety on medical education. For learners (students and residents), having an environment with high psychological safety means being able to admit knowledge gaps and skill deficits. Psychological safety is recognized as an essential attribute for a positive learning environment and is associated with several positive behaviors. To benefit medical educators, we contextualize the benefits of improved psychological safety in medical education and highlight the limited data substantiating what interventions are known to enhance psychological safety in graduate medical education. While it is recognized that higher psychological safety is important, creating better psychological safety is a complex challenge analogous to patient safety, well-being, and healthcare disparity. The challenges for environments with lower psychological safety are understanding what to fix and how to fix it, and recognition that quick fixes are elusive. Moving forward, medical educators must have a better understanding of how to enhance psychological safety.

Background: Our institution, along with many others, struggles to recruit residents and fellows who identify as underrepresented in medicine (UIM). There have been various program-level interventions implemented across the nation; however, little is known about graduate medical education (GME)-wide recruiting events for UIM trainees. Objective: We describe the development, implementation, and evaluation of a GME-wide recruitment program, Virtual UIM Recruitment Diversity Brunches (VURDBs), to meet this need. Methods: A virtual, 2-hour event was held 6 times on Sunday afternoons between September 2021 and January 2022. We surveyed participants on a rating of the VURDBs from excellent (4) to fair (1) and their likelihood of recommending the event to their colleagues from extremely (4) to not at all (1). We used institutional data to compare pre- and post-implementation groups using a 2-sample test of proportions. Results: Across 6 sessions, 280 UIM applicants participated. The response rate of our survey was 48.9% (137 of 280). Fifty-eight percent (79 of 137) rated the event as excellent, and 94.2% (129 of 137) were extremely or very likely to recommend the event. The percentage of new resident and fellow hires who identify as UIM significantly increased from 10.9% (67 of 612) in academic year 2021-2022 to 15.4% (104 of 675) in academic year 2022-2023. The percentage of brunch attendees matriculating into our programs in academic year 2022-2023 was 7.9% (22 of 280). Conclusions: VURDBs are a feasible intervention associated with increased rates of trainees identifying as UIM matriculating in our GME programs.

Background: The Accreditation Council for Graduate Medical Education has begun to evaluate teaching institutions' learning environments with Clinical Learning Environment Review visits, including trainee involvement in institutions' patient safety and quality improvement efforts. Objective: We sought to address the dearth of metrics that assess trainee patient safety perceptions of the clinical environment. Methods: Using the Hospital Survey on Patient Safety Culture (HSOPSC), we measured resident and fellow perceptions of patient safety culture in 50 graduate medical education programs at 10 hospitals within an integrated health system. As institution-specific physician scores were not available, resident and fellow scores on the HSOPSC were compared with national data from 29 162 practicing providers at 543 hospitals. Results: Of the 1337 residents and fellows surveyed, 955 (71.4%) responded. Compared with national practicing providers, trainees had lower perceptions of patient safety culture in 6 of 12 domains, including teamwork within units, organizational learning, management support for patient safety, overall perceptions of patient safety, feedback and communication about error, and communication openness. Higher perceptions were observed for manager/supervisor actions promoting patient safety and for staffing. Perceptions equaled national norms in 4 domains. Perceptions of patient safety culture did not improve with advancing postgraduate year. Conclusions: Trainees in a large integrated health system have variable perceptions of patient safety culture, as compared with national norms for some practicing providers. Administration of the HSOPSC was feasible and acceptable to trainees, and may be used to track perceptions over time.

Since implementation of resident duty-hour restrictions, many academic medical centers utilize night-float teams to admit patients during off hours. Patients are transferred to other resident physicians the subsequent morning as “hold-over admissions.” Despite the increase of hold-over admissions, there are limited data on resident perceptions of their educational value. This study investigated resident perceptions of hold-over admissions, and whether they approach hold-over admissions differently than new admissions. Survey of internal medicine residents at an academic medical center. A total of 111 residents responded with a response rate of 71 %. Residents reported spending 56.2 min (standard deviation [SD] 18.9) compared to 80.0 min (SD 25.8) admitting new patients (p < 0.01). Residents reported spending significantly (p < 0.01) less time reviewing the medical record, performing histories, examining patients, devising care plans and writing orders in hold-over admissions compared to new admissions. Residents had neutral views on the educational value of hold-over admissions. Features that significantly (p < 0.01) increased the educational value of admissions included severe illness, patient complexity, and being able to write the initial patient care orders. Residents estimated 42.5 % (SD 14) of their admissions were hold-over patients. Residents spend less time in all aspects of admitting hold-over patients. Despite less time spent admitting hold-over patients, residents had neutral views on the educational value of such admissions.

Although residents commonly perform patient care sign-out during training, faculty do not frequently supervise or evaluate sign-out. The authors designed a sign-out checklist, and they investigated whether use of the checklist, paired with faculty member review and feedback, would improve interns' written sign-out. In a randomized, controlled design in 2011, the authors compared the sign-out content and the overall sign-out summary scores of interns who received twice-monthly faculty member sign-out evaluation with those of interns who received the standard sign-out instruction. A sign-out checklist, which the authors developed on the basis of internal needs assessment and published sign-out recommendations, guided the evaluation of written sign-out content and sign-out organization as well as the twice-monthly, face-to-face evaluation that the interns in the intervention group received. Using the sign-out checklist and receiving feedback from a faculty member led to statistically significant improvements in interns' sign-out. Through regression analysis, the authors calculated a 23% difference in the sign-out content (P = .005) and a 2.2-point difference in the overall summary score (on a 9-point scale, P = .009) between the interns who received sign-out feedback and those who did not. The content and quality of the intervention group's sign-outs improved, whereas the content and quality of the control group's worsened. A sign-out checklist paired with twice-monthly, face-to-face feedback from a faculty member led to improvements in the content and quality of interns' written sign-out.