Homme, James

Objective This survey study assessed trainee attitudes and perceptions of the longitudinal public speaking curriculum at Mayo Clinic Pediatric and Adolescent Residency Program. Methods This 3-part survey of Mayo Clinic pediatric residents was conducted from 2013 to 2017 and utilized yes/no questions, Likert scales, and open-ended questions. Code book content analysis was used to analyze open-ended questions. Results A total of 121 participants (96.8%, n = 121/125) completed the survey. Most respondents (93.3%, n = 111/119) either agreed or strongly agreed that the public speaking requirement enabled them to be more effective in delivering information to large groups. Most respondents (89.2%, n = 107/120) agreed or strongly agreed that they incorporated feedback from previous public speaking feedback sessions into subsequent presentations. The 2 activities that respondents found most useful for preparing later presentations were setting goals for future presentations in a feedback session and discussing performance in a feedback session. Conclusions There was a perceived effectiveness of a longitudinal public speaking curriculum among pediatric residents at our program. Multidimensional feedback seems to be a critical aspect of a public speaking curriculum in graduate medical education.

AbstractBackgroundIn 2013 the Accreditation Council for Graduate Medical Education (ACGME) introduced “Milestones” designed to nationally standardize the assessment of resident physicians. Previous studies compare resident self‐assessment on milestones to faculty assessment, with varying degrees of agreement, but integration of self‐assessment into the formative feedback process has not yet been directly studied. This study uses a conceptual framework of self‐determination theory, integrated with concepts from adult learning theory, to compare the perception of the feedback quality given in semiannual reviews before and after the incorporation of resident self‐assessment into the feedback process.MethodsThis was an interventional study conducted in a single emergency medicine residency program at a major academic hospital over 1 calendar year. Residents first engaged in a semiannual review without self‐assessment. At subsequent semiannual reviews, residents completed a Milestone‐based self‐assessment that was provided to the faculty member assigned to conduct their semiannual review. Residents and faculty completed surveys rating perception of feedback quality. Two‐sided Wilcoxon signed‐rank tests were used in comparison analysis.ResultsOne resident did not self‐assess prior to the semiannual review and was excluded leaving 25 paired surveys for analysis. Residents found feedback after the self‐assessment more actionable (p = 0.013), insightful (p = 0.010), and better overall (p = 0.025). Similarly, faculty felt the feedback they provided was more actionable (p < 0.001), more insightful (p < 0.001), and better communicated (p < 0.001); led to improved resident understanding of milestones (p < 0.001); and were overall more satisfied (p < 0.001). Free‐text comments explore pre‐ and postintervention perceptions of feedback.ConclusionsIntegration of self‐assessment into semiannual reviews improves perception of feedback given to residents as perceived by both residents and faculty. Although limited by sample size, the results are promising for a simple, evidence‐based intervention to improve feedback during an existing mandated feedback opportunity.

Selective serotonin reuptake inhibitors are a commonly used and often effective class of medications in the treatment of mood disorders such as anxiety and depression. Sertraline (1S,4S-N-methyl-4-[3,4-dichlorophenyl]-1,2,3,4-tetrahydro-1-naphthylamine [Zoloft; Pfizer, New York City, NY]) is a frequently used selective serotonin reuptake inhibitor that has shown efficacy in children, adolescents, and adults. We report the case of a 13-year-old boy with sertraline-induced rhabdomyolysis and renal failure, trismus, and cardiopulmonary arrest. Pharmacogenetic testing later revealed our patient had serotonin transporter polymorphisms and enzymatic alterations that put him at risk for increased levels of sertraline and greater likelihood for untoward side effects.