Rose, Steven H.

ABSTRACT Background The COVID-19 pandemic affected graduate medical education (GME) by decreasing elective procedures and disrupting didactic learning activities in 2020. Editorials have hypothesized that resident physicians worked fewer hours, therefore losing valuable experience, but we are not aware of studies that have objectively assessed changes in hours worked. Objective This study aims to identify differences secondary to the COVID-19 pandemic in resident work hours across all specialties at 3 geographically dispersed, integrated academic hospitals in a large sponsoring institution. Methods We obtained de-identified work hour data from all residency programs at Mayo Clinic in Arizona, Florida, and Minnesota. Resident work hours were compared between 2020 and 2019 from March to May. Results Work hours for 1149 and 1118 residents during the pandemic and control periods respectively were compared. Decreases in resident work hours were seen, with the largest decrease demonstrated in April 2020 when 19 of 43 programs demonstrated significantly decreased work hours. Residents worked more hours from home in April 2020 compared to the previous year (Arizona: mean 1 hour in 2019 vs 5.2 hours in 2020, P<.001; Florida: mean 0.7 hour in 2019 vs 6.5 hours in 2020, P<.001; Minnesota: mean 0.8 hour in 2019 vs 10.2 hours in 2020, P<.001). Conclusions The COVID-19 pandemic was associated with a decrease in work hours in some, but not all, specialties. The decrease in on-site work was only partially offset by an increased number of hours worked from home.

ABSTRACT Background Since the Accreditation Council for Graduate Medical Education (ACGME) established the designated institutional official (DIO) role in 1998, there have been major changes in sponsoring institutions (SIs) and DIO responsibilities. Yet there remains a large gap in our knowledge regarding baseline SI and DIO characteristics as well as a need for institutions wanting to increase diversity in the DIO role and other leadership positions within the medical education community. Objective We sought to characterize demographics of DIOs and the SIs they oversee. Methods We identified SIs and DIOs on the ACGME website on February 15, 2020. Reviewed data included SI accreditation status, number of programs and resident/fellow positions, and DIO characteristics. Results We identified 831 SIs. SIs with continued accreditation sponsored more programs (median 4.0) than SIs with initial accreditation (median 1.0, P < .001). DIO age ranged from 29–81 years (median 57 years). Two-hundred eighty-three of 831 (34%) DIOs were women. Of 576 DIOs with known academic rank, 356 (62%) DIOs held senior academic rank. A higher proportion of male DIOs had senior academic rank (68% vs 52%; OR 1.90 [95% CI 1.34–2.70]; P < .001) and professor rank (39% vs 24%; OR 2.01 [95% CI 1.38–2.94]; P < .001) compared to female DIOs. Female gender was associated with a greater number of ACGME-accredited programs and filled resident/fellow positions per SI (P < .001 for both). Conclusions This study describes characteristics of DIOs and SIs and offers insights for those pursuing a DIO position.

Purpose The medical student performance evaluation (MSPE) summarizes a residency applicant’s academic performance. Despite attempts to improve standardized clerkship grading, concerns regarding grade inflation and variability at United States medical schools persist. This study’s aim was to describe current patterns of clerkship grading and applicant performance data provided in the MSPE. Method The authors evaluated Electronic Residency Application Service data submitted to a single institution for the 2016–2017 Match cycle. Clerkship grading characteristics regarding grading tiers, school rank, location, and size were obtained. Data regarding methods for summative comparisons such as key word utilization were also extracted. Descriptive statistics were generated, and generalized linear modeling was performed. Results Data were available for 137/140 (98%) MD-granting U.S. medical schools. Pass/fail grading was most commonly used during the preclinical years (47.4%). A 4-tier system was most common for clerkship grading (31%); however, 19 different grading schemes were identified. A median of 34% of students received the highest clerkship grade (range, 5%–97%). Students attending a top 20 medical school were more likely to receive the highest grade compared with those attending lower-rated schools (40% vs 32%, P < .001). Seventy-three percent of schools ranked students, most commonly using descriptive adjectives. Thirty-two different adjectives were used. Conclusions There is significant institutional variation in clinical grading practices and MSPE data. For core clerkships where most students received the highest grade, the ability to distinguish between applicants diminishes. A standardized approach to reporting clinical performance may allow for better comparison of residency applicants.

The purpose of this study was to examine the effects of the increased sympathetic activity elicited by the upright posture on blood flow to exercising human forearm muscles. Six subjects performed light and heavy rhythmic forearm exercise. Trials were conducted with the subjects supine and standing. Forearm blood flow (FBF, plethysmography) and skin blood flow (laser Doppler) were measured during brief pauses in the contractions. Arterial blood pressure and heart rate were also measured. During the first 6 min of light exercise, blood flow was similar in the supine and standing positions (approximately 15 ml.min-1.100 ml-1); from minutes 7 to 20 FBF was approximately 3-7 ml.min-1.100 ml-1 less in the standing position (P less than 0.05). When 5 min of heavy exercise immediately followed the light exercise, FBF was approximately 30-35 ml.min-1.100 ml-1 in the supine position. These values were approximately 8-12 ml.min-1.100 ml-1 greater than those observed in the upright position (P less than 0.05). When light exercise did not precede 8 min of heavy exercise, the blood flow at the end of minute 1 was similar in the supine and standing positions but was approximately 6-9 ml.min-1.100 ml-1 lower in the standing position during minutes 2-8. Heart rate was always approximately 10-20 beats higher in the upright position (P less than 0.05). Forearm skin blood flow and mean arterial pressure were similar in the two positions, indicating that the changes in FBF resulted from differences in the caliber of the resistance vessels in the forearm muscles.(ABSTRACT TRUNCATED AT 250 WORDS)

ABSTRACT Background The Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review (CLER) is an innovative element of the ACGME's new accreditation system. To date, little information has been collected regarding the value of CLER. Objective The purpose of this study is to collect information on designated institutional officials' (DIOs') perspectives about the initial CLER visits conducted at their institutions. Methods The authors created and distributed a survey to DIOs about their initial CLER visits. Demographic data were compared across survey responses with Spearman's rank correlation and the Kruskal-Wallis test. Results The authors received responses from 63% of DIOs (186 of 297) at institutions that participated in the initial CLER visits, with 88% (164 of 186) having served as DIO during the visit. Seventy-two percent (114 of 158) reported institutional changes to address CLER focus areas prior to the visit, yet only 32% (51 of 157) reported that additional resources were allocated to these areas after the site visit. Sixty-five percent (102 of 156) reported institutional executive leadership was positive about participating in CLER; 85% (134 of 158) reported that ACGME conducted the visits efficiently; 84% (133 of 158) reported that the site visit accurately assessed the institution's performance in the CLER focus areas; and 60% (93 of 156) reported CLER provided high-value information. Conclusion Survey results from DIOs suggest that CLER is an effective mechanism to improve the learning environment. Common concerns included limited advance notice for the site visit and disruptions of clinical practice.