Background Equitable assessment is critical in competency-based medical education. This study explores differences in key characteristics of qualitative assessments (i.e., narrative comments or assessment feedback) of internal medicine postgraduate resident performance associated with gender and race and ethnicity. Methods Analysis of narrative comments included in faculty assessments of resident performance from six internal medicine residency programs was conducted. Content analysis was used to assess two key characteristics of comments- valence (overall positive or negative orientation) and specificity (detailed nature and actionability of comment) – via a blinded, multi-analyst approach. Differences in comment valence and specificity with gender and race and ethnicity were assessed using multilevel regression, controlling for multiple covariates including quantitative competency ratings. Results Data included 3,383 evaluations with narrative comments by 597 faculty of 698 residents, including 45% of comments about women residents and 13.2% about residents who identified with race and ethnicities underrepresented in medicine. Most comments were moderately specific and positive. Comments about women residents were more positive (estimate 0.06, p 0.045) but less specific (estimate − 0.07, p 0.002) compared to men. Women residents were more likely to receive non-specific, weakly specific or no comments (adjusted OR 1.29, p 0.012) and less likely to receive highly specific comments (adjusted OR 0.71, p 0.003) or comments with specific examples of things done well or areas for growth (adjusted OR 0.74, p 0.003) than men. Gendered differences in comment specificity and valence were most notable early in training. Comment specificity and valence did not differ with resident race and ethnicity (specificity: estimate 0.03, p 0.32; valence: estimate − 0.05, p 0.26) or faculty gender (specificity: estimate 0.06, p 0.15; valence: estimate 0.02 p 0.54). Conclusion There were significant differences in the specificity and valence of qualitative assessments associated with resident gender with women receiving more praising but less specific and actionable comments. This suggests a lost opportunity for well-rounded assessment feedback to the disadvantage of women.

PurposeCompetency-based medical education relies on equitable assessment. This study examined the influence of faculty and trainee gender on assessments of internal medicine (IM) resident performance over time. MethodA longitudinal analysis of clinical performance assessments from 7 U.S. IM residency programs (July 2014-June 2019) was conducted. Core competency scores (patient care [PC], medical knowledge [MK], practice-based learning and improvement [PBLI], systems-based practice [SBP], professionalism [PROF], and interpersonal and communication skills [ICS]) were standardized across programs. Cross-classified mixed-effects linear regression evaluated the relationship between gender and standardized competency scores within training programs, while adjusting for multiple variables including IM In Training Examination percentile rank. ResultsData included 9,346 evaluations by 1,011 faculty (552 [55%] men, 459 [45%] women) for 664 residents (358 [54%] men, 306 [46%] women). Initially, women residents' scores were significantly lower than men's in PC (estimated difference [standard error], -0.097 [0.033]; P = .004), MK (-0.145 [0.034], P < .001), and PBLI (-0.090 [0.040], P = .022). PC, MK, PBLI, and SBP scores increased more over time for women residents than men (PC: 0.050 [0.015], P = .001; MK: 0.052 [0.015], P = .001; PBLI: 0.036 [0.018], P = .048; SBP: 0.036 [0.016], P = .027). PROF and ICS scores were comparable across gender. There was a significant interaction between faculty gender and postgraduate year (PGY) across all competencies but none between resident gender, faculty gender, and PGY, indicating that men and women faculty rated residents differently over time but were consistent in how they rated men and women residents. ConclusionsGender-based assessment differences were variable across competencies and time. Women residents had lower scores initially but greater gains in "hard skill" (MK, PC, and PBLI) than in "soft skill" (ICS and PROF) competencies, suggesting assessment inequities. Efforts to ensure equitable assessment are needed.

INTRODUCTION:Evidence suggests gender disparities in medical education assessment, including differences in ratings of competency and narrative comments provided in resident performance assessments. This study explores how gender manifests within the content of qualitative assessments (i.e., narrative comments or performance feedback) of resident performance.METHODS:Qualitative content analysis was used to explore gender-based differences in narrative comments included in faculty assessments of resident performance during inpatient medicine rotations at six Internal Medicine residency programs, 2016-2017. A blinded, multi-analyst approach was employed to identify themes across comments. Patterns in themes with resident gender and post-graduate year (PGY) were explored, focusing on PGY2 and PGY3 when residents are serving in the team leader role.RESULTS:Data included 3,383 evaluations with narrative comments of 385 men (55.2%) and 313 women residents (44.8%). There were thematic differences in narrative comments received by men and women residents and how these themes manifested within comments changed with training time. Compared to men, comments about women had a persistent relationship-orientation and emphasized confidence over training including as interns and in PGY2 and PGY3, when serving as team leader. The relationship-orientation was characterized not only by the residents' communal attributes but also their interpersonal and communication skills, including efforts supporting others and establishing the tone for the team. Comments about women residents often highlighted confidence, including recommendations around behaviors that convey confidence in decision-making and team leadership.DISCUSSION:There were gender-based thematic differences in qualitative assessments. Comments about women resident team leaders highlight relationship building skills and urge confidence and actions that convey confidence as team leader. Persistent attention to communal skills suggests gendered expectations for women resident team leaders and a lost opportunity for well-rounded feedback to the disadvantage of women residents. These findings may inform interventions to promote equitable assessment, such as providing feedback across the competencies.

ABSTRACT In-hospital cardiac arrest resuscitation training often happens in silos, with minimal interprofessional training. The aim of this study was to implement and evaluate a simulation-enhanced, interprofessional cardiac arrest curriculum in a university hospital. The curriculum ran monthly for 12 months, training interprofessional teams of internal medicine residents, nurses, respiratory therapists, and pharmacy residents. Teams participated in a 90-min high-fidelity simulation including “code blue” (30 min) followed by a 30-min debriefing and a repeat identical simulated “code blue” scenario. Teams were tested in an unannounced mock Code Blue the following month. Advanced Cardiac Life Support (ACLS) algorithm adherence was assessed using a standardized checklist. In-hospital cardiac arrest (IHCA) incidence and survival was tracked for 2 years prior, during, and 1 year after curriculum implementation. Team ACLS-algorithm adherence at baseline varied from 47% to 90% (mean of 71 ± 11%) and improved immediately following training (mean 88 ± 4%, range 80–93%, p = .011). This improvement persisted but decreased in magnitude over 1 month (mean 81 ± 7%, p = .013). Medical resident self-reported comfort levels with resuscitation skills varied widely at baseline, but improved for all skills post-curriculum. This simulation-enhanced, spaced practice, interprofessional curriculum resulted in a sustained improvement in team ACLS algorithm adherence.

Disparities in objective assessments in graduate medical education such as the In-Training Examination (ITE) that disadvantage women and those self-identifying with race/ethnicities underrepresented in medicine (URiM) are of concern. Examine ITE trends longitudinally across post-graduate year (PGY) with gender and race/ethnicity. Longitudinal analysis of resident ITE metrics at 7 internal medicine residency programs, 2014–2019. ITE trends across PGY of women and URiM residents compared to non-URiM men assessed via ANOVA. Those with ITE scores associated with less than 90% probability of passing the American Board of Internal Medicine certification exam (ABIM-CE) were identified and odds of being identified as at-risk between groups were assessed with chi square. A total of 689 IM residents, including 330 women and URiM residents (48%). ITE score There was a significant difference in ITE score across PGY for women and URiM residents compared to non-URiM men (F(2, 1321) 4.46, p=0.011). Adjusting for program, calendar year, and baseline ITE, women and URiM residents had smaller ITE score gains (adjusted mean change in score between PGY1 and PGY3 (se), non-URiM men 13.1 (0.25) vs women and URiM residents 11.4 (0.28), p<0.001). Women and URiM residents had greater odds of being at potential risk for not passing the ABIM-CE (OR 1.75, 95% CI 1.10 to 2.78) with greatest odds in PGY3 (OR 3.13, 95% CI 1.54 to 6.37). Differences in ITE over training were associated with resident gender and race/ethnicity. Women and URiM residents had smaller ITE score gains across PGY translating into greater odds of potentially being seen as at-risk for not passing the ABIM-CE. Differences in ITE over training may reflect differences in experiences of women and URiM residents during training and may lead to further disparities.

Purpose To assess the association between internal medicine (IM) residents' race/ethnicity and clinical performance assessments. Method The authors conducted a cross-sectional analysis of clinical performance assessment scores at 6 U.S. IM residency programs from 2016 to 2017. Residents underrepresented in medicine (URiM) were identified using self-reported race/ethnicity. Standardized scores were calculated for Accreditation Council for Graduate Medical Education core competencies. Cross-classified mixed-effects regression assessed the association between race/ethnicity and competency scores, adjusting for rotation time of year and setting; resident gender, postgraduate year, and IM In-Training Examination percentile rank; and faculty gender, rank, and specialty. Results Data included 3,600 evaluations by 605 faculty of 703 residents, including 94 (13.4%) URiM residents. Resident race/ethnicity was associated with competency scores, with lower scores for URiM residents (difference in adjusted standardized scores between URiM and non-URiM residents, mean [standard error]) in medical knowledge (-0.123 [0.05], P = .021), systems-based practice (-0.179 [0.05], P = .005), practice-based learning and improvement (-0.112 [0.05], P = .032), professionalism (-0.116 [0.06], P = .036), and interpersonal and communication skills (-0.113 [0.06], P = .044). Translating this to a 1 to 5 scale in 0.5 increments, URiM resident ratings were 0.07 to 0.12 points lower than non-URiM resident ratings in these 5 competencies. The interaction with faculty gender was notable in professionalism (difference between URiM and non-URiM for men faculty -0.199 [0.06] vs women faculty -0.014 [0.07], P = .01) with men more than women faculty rating URiM residents lower than non-URiM residents. Using the 1 to 5 scale, men faculty rated URiM residents 0.13 points lower than non-URiM residents in professionalism. Conclusions Resident race/ethnicity was associated with assessment scores to the disadvantage of URiM residents. This may reflect bias in faculty assessment, effects of a noninclusive learning environment, or structural inequities in assessment.

The COVID-19 pandemic interrupted daily life and directly caused the deaths of millions of people worldwide.1Provisional death counts for coronavirus disease 2019 (COVID-19). Published June 21, 2021. Accessed June 21, 2021. https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm.Google Scholar Due to delayed and forgone preventative care, it is possible that there could be consequences of the pandemic for years to come.2Czeisler MÉ. Delay or avoidance of medical care because of COVID-19–related concerns — United States.MMWR Morb Mortal Wkly Rep. 2020; 69 (June 2020)https://doi.org/10.15585/mmwr.mm6936a4Crossref Scopus (845) Google Scholar Furthermore, interruptions to daily life, including stay-at-home orders and the closure of workplaces, social gatherings, and schools could result in negative behavioral habits. Therefore, we sought to characterize the incidence of missed preventative health appointments and changes in behavioral health habits during the COVID-19 pandemic. This study was approved by the University of Louisville and University of New Hampshire IRBs as exempt and consent was obtained from each respondent prior to starting the survey. There was no financial support for this study. We distributed an original survey online on Amazon Mturk between January 15–21 and March 7–9, 2021. All U.S.-based adults 18 years of age and older were eligible, the survey was elective, and survey participants were compensated. Respondents were asked about their healthcare utilization and health behaviors both prior to March 2021 and between March and December 2020. COVID- and non-COVID-related reasons for missed appointments were determined with multiple select questions with free text options. Attention checks were present throughout the survey and respondents could exclude their data from analysis without penalty. Data were analyzed with STATA IC/16.1 (StataCorp LLC, College Station, TX). Frequency data were reported in mean ± standard deviation. The responses of 1019 survey participants were used after excluding 12.3% of respondents who failed attention checks or elected to exclude their data due to inattention. Table 1 details the incidence of missed medical care and reported reasons. Procedural care was missed more frequently than primary care appointments, though a large portion of primary care occurred via telehealth during the pandemic. Almost half of respondents who normally would have sought immediate care did not due to pandemic related reasons, though 30 respondents (14%) were able to utilize telehealth to see their PCP instead. The most cited overall reason for missed care, including those not related to the pandemic, was fear of contracting COVID-19.Table 1Incidence of missed and cancelled appointments between March and December 2020.Primary CareColonoscopyMammogramCervical Ca ScreeningPreventative TotalER/Urgent CareIndicated/Scheduled4971166 PCP appointments occurred via telehealth.2398156774482Did not occur (%)22 (4.4%)7 (30%)10 (10%)24 (15%)63 (8.1%)259 unique respondents missed appointments.220 (46%)Rescheduled (%)8 (36%)3 (43%)4 (40%)20 (83%)35 (56%)N/AFear of Contracting COVID-1914741742 (67%)104 (47%)Loss of Insurance342413 (21%)31 (14%)Facility Closed due to COVID-19224210 (16%)0Loss of Income due to COVID-1922026 (10%)18 (8%)Patient Quarantined12014 (6%)22 (10%)1 166 PCP appointments occurred via telehealth.2 59 unique respondents missed appointments. Open table in a new tab Self-reported weight changes, cigarette smoking, and alcohol consumption are reported in Table 2. Average BMI increased during the pandemic. Cigarette smoking increased during the pandemic in the 220 respondents who reported smoking, though the results were not statistically significant. Alcohol consumption (drinks/week) increased significantly. Furthermore, 642 respondents (63%) consumed alcohol during the pandemic compared with 517 (51%) before March 2020.Table 2Reported body mass, cigarette smoking, and alcohol consumption prior to and during the COVID-19 pandemic.Prior to the PandemicDuring the PandemicPaired T testBMI (kg/m2)25.9 ± 6.426.2 ± 6.4p = .0026Cigarettes per day31.0 ± 31.033.5 ± 30.0p = .33Alcohol per week4.5 ± 4.15.8 ± 4.0p < .001 Open table in a new tab Previous research indicated that 40% of US adults delayed or avoided urgent or emergency care due to the pandemic,2Czeisler MÉ. Delay or avoidance of medical care because of COVID-19–related concerns — United States.MMWR Morb Mortal Wkly Rep. 2020; 69 (June 2020)https://doi.org/10.15585/mmwr.mm6936a4Crossref Scopus (845) Google Scholar and our data support these findings. However, our results indicate that telemedicine unexpectedly offset this lack of care, with some respondents able to see their PCP via telehealth rather than go to an urgent care center or emergency room. Furthermore, primary care appointments were not missed as often as we hypothesized, likely due to the utilization of telemedicine. In fact, during the pandemic, almost 40% of patients covered by Medicare and Medicaid received care through telemedicine.3Zulman D.M. Verghese A. Virtual care, telemedicine visits, and real connection in the era of COVID-19: unforeseen opportunity in the face of adversity.JAMA. 2021; 325: 437-438https://doi.org/10.1001/jama.2020.27304Crossref PubMed Scopus (59) Google Scholar On the other hand, procedural screenings were frequently missed. Many screenings, specifically colonoscopies and mammograms, were not rescheduled. There has been little study on cancer screenings during the pandemic, but previous studies estimated that over the next decade there would be a 1% increase in deaths from breast and colorectal cancer due to the delay of elective treatments alone.4Sharpless N.E. COVID-19 and cancer.Science. 2020; 368: 1290https://doi.org/10.1126/science.abd3377Crossref PubMed Scopus (264) Google Scholar Without intervention, the lack of screening could compound this increase in mortality due to later stage diagnoses. Behavioral health habits were worse during the pandemic for all outcomes measured. Self-reported weight increased among most respondents. Our results agree with previous research and suggest that primary prevention efforts need to be refocused on behavior changes, as body mass is correlated with all-cause mortality.5Xu H. Cupples L.A. Stokes A. Liu C.T. Association of obesity with mortality over 24 years of weight history: findings from the Framingham heart study.JAMA Netw Open. 2018; 1e184587https://doi.org/10.1001/jamanetworkopen.2018.4587Crossref PubMed Scopus (87) Google Scholar,6Lin A.L. Vittinghoff E. Olgin J.E. Pletcher M.J. Marcus G.M. Body weight changes during pandemic-related shelter-in-place in a longitudinal cohort study.JAMA Netw Open. 2021; 4 (e212536-e212536)https://doi.org/10.1001/jamanetworkopen.2021.2536Crossref Scopus (80) Google Scholar Furthermore, respondents reported higher alcohol and tobacco consumption, and many respondents who did not consume alcohol prior to the pandemic started drinking during the pandemic. This is especially concerning as previous research reported a substantial increase in alcohol-related problems during the pandemic.7Pollard M.S. Tucker J.S. Green H.D. Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US.JAMA Netw Open. 2020; 3 (e2022942-e2022942)https://doi.org/10.1001/jamanetworkopen.2020.22942Crossref PubMed Scopus (529) Google Scholar Since behaviors developed during the pandemic could continue afterwards, a renewed focus on healthy lifestyle habits is necessary. Because this was a retrospective study of patient reported data, recall and reporting bias are possible. Furthermore, we only examined causes of missed appointments and procedures, and it is likely that fewer appointments and procedures than usual were scheduled during the pandemic and consequently rates of preventative care were even lower than reported. Therefore, physicians and health systems should renew the focus on preventative health and screenings and address behaviors such as alcohol use, smoking, and diet and exercise to mitigate long-term negative health consequences of the pandemic. The authors received no financial support for this study.

Introduction: Per recent World Health Organization data, 71 million people live with hepatitis C virus (HCV) infection globally, about 19% (13.1 million) know their diagnosis, and only 5 million have been treated. In 2019, the United States Preventive Services Task Force expanded HCV screening from patients born between 1945-65 and high-risk individuals to universal screening in adults age 18-79 years old. We performed a quality improvement study to analyze the effect of a low-cost, low-tech intervention on rates of screening for HCV among patients born between 1945-65 in the University of Louisville’s internal medicine residency continuity clinic. Methods: Patients born between 1945-1965 seen in the internal medicine residency clinic were included. Data was collected from pre-intervention (July 2018-August 2020) and post-intervention (September 2020-February 2021) cohorts. Those with already established/previous HCV diagnosis were excluded. Patients were considered to have been successfully screened if an order was placed for hepatitis C serum antibody testing, or if a referral was placed to the local hepatitis C specialty clinic (an indicator that upon discussing screening with the patient, it was revealed that the patient already had previously diagnosed but untreated HCV). For the intervention, sticky notes were pre-printed with information about screening patients born between 1945-1965, and instructions for ordering the HCV test. Notes were placed by medical assistants on patient information sheets which are routinely handed to residents prior to entering each patient’s room. Screening rates among both groups were compared. Results: A total of 1,244 patients were included in the pre-intervention cohort, of which 727 had been screened for HCV. 660 patients were included in the post-intervention cohort, of which 451 were successfully screened. This resulted in a significant increase in the rate of HCV screening from 59.4% to 68.3% (p-value = 0.0067 from student T-test). Conclusion: Our data suggests that a low-cost, low-tech intervention may be used in an academic internal medicine clinic to increase awareness about and ordering of HCV screening, and therefore improve quality of care.

Primary chest wall abscess due to hematogenous spread is very rare and has seldom been documented in the literature, with most reported cases attributed to Mycobacterium tuberculosis. Prompt diagnosis and management with antibiotics, and evacuation of the abscess, is imperative as the infection can lead to systemic or disseminated infection, including erosion into surrounding bone if left untreated. We describe the case of a 67-year-old female with severe Crohn’s disease receiving anti-tumor necrosis factor-alpha (TNF-α) therapy, Etanercept presenting with localized Escherichia coli (E. coli) chest wall abscess with erosion into the surrounding rib. This case highlights a rare clinical entity, chest wall abscess, which is also an unusual site of E. coli infection. Only three previous cases of E. coli primary chest wall abscess can be found in the published literature. This case also highlights a possible association of severe Crohn’s disease predisposing to complicated soft tissue infection.

As SARS-CoV-2 sweeps across the United States, residency program directors everywhere are racing to adapt the graduate medical education experience to reflect the realities of our "new normal." Rambaldini et al's1Rambaldini G. Wilson K. Rath D. et al.The impact of severe acute respiratory syndrome on medical house staff: a qualitative study.J Gen Intern Med. 2005; 20: 381-385Crossref PubMed Scopus (77) Google Scholar observations during the 2004 SARS outbreak remind us that residents may indeed feel that their education has been disrupted during this time, yet in 2020 we have the advantage of additional technology and resources to mitigate this. One of the obvious questions that arises is how to best continue to deliver experiences and content that are critical to the educational mission of a residency training program, but would ordinarily involve gathering large groups in close quarters. The didactic curriculum of a residency program traditionally is conveyed through a series of in-person conferences. How will we reconfigure delivery of core curricular content to meet the demands of the immediate future? A look at the medical education literature offers some evidence for best practices that perhaps can serve as starting points for facing this challenge. Core curricular content is largely dictated according to the specific body of knowledge needing to be taught in a particular medical specialty, however even the most foundational of educational topics can be packaged in innovative ways for more effective learning. Focus groups of internal medicine residents conducted to identify desirable characteristics for educational conferences revealed a preference for shorter, high yield lectures centering around a clinical question or case, targeted to the particular level of post-graduate training.2Sawatsky A.P. Zickmund S.L. Berlacher K. et al.Understanding resident learning preferences within an internal medicine noon conference lecture series: a qualitative study.J Grad Med Ed. 2014; 6: 32-38Crossref PubMed Google Scholar The most effective structure for delivery of the core didactic curriculum has been debated among residency program directors. The traditional offering of daily conferences has been compared to the "academic half-day" model, which concentrates didactic conferences into an extended, once weekly session consisting of several lectures or learning opportunities held back-to-back. Randall et al.3Randall M.H. Schreiner A.D. Clyburn E.B. et al.Effects of an academic half day in a residency program on perceived educational value, resident satisfaction, and wellness.Am J Med Sci. 2020; 360: 342-347Abstract Full Text Full Text PDF Scopus (3) Google Scholar add to this conversation by examining the effects of a culture-changing switch to the academic half-day model in their internal medicine residency program. Their finding that resident satisfaction is increased is mirrored in the experience of other programs who have reported success with the academic half-day.4Batalden M.K. Warm E.J. Logio L.S Beyond a curricular design of convenience: replacing the noon conference with an academic half day in three interal medicine residency programs.Acad Med. 2013; 88: 644-651Crossref PubMed Scopus (26) Google Scholar,5Ha D. Faulx M. Isada C. et al.Transitioning from a noon conference to an academic half-day curriculum model: effect on medical knowledge acquisition and learning satisfaction.J Gen Med Ed. 2014; 6: 93-99Google Scholar,6Chen L.Y. McDonald J.A. Pratt D.D. et al.Resident's views of the role of classroom-based learning in graduate medical education through the lens of academic half day.Acad Med. 2015; 90: 532-538Crossref PubMed Scopus (15) Google Scholar One question that arises now is whether residents will continue to have greater satisfaction with an academic half-day format if the conferences are delivered on a virtual platform rather than in person. We hope to hear again from Randall or others in the future to see whether satisfaction with the academic half-day persists when delivered via video-conferencing. Best practices in the post-COVID era will certainly need to capitalize on the ability to use technology to allow core curricular learning in an asynchronous fashion. Given the busy clinical demands and work hour restrictions faced by our trainees, programs have increasingly utilized asynchronous learning to provide education outside of the constraints of time and place. Residency programs with multiple training sites have already been utilizing teleconferencing to reach a wider audience in real time. Branzetti et al.7Branzetti J.B. Aldeen A.Z. Foster A.W. et al.A novel online didactic curriculum helpls improve knowledge acquisition among non-emergency medicine rotating residents.Acad Emerg Med. 2011; 18: 53-59Crossref PubMed Scopus (13) Google Scholar and Burnette et al.8Brunette K. Ramundo M. Stevenson M. et al.Evaluation of a web-based asynchronous pediatric emergency medicine learning tool for residents and medical students.Acad Em Med. 2009; 16: S46-S50Crossref PubMed Scopus (64) Google Scholar both demonstrated success using asynchronous didactics to improve the medical knowledge of trainees rotating through the emergency department. Handoff performance was similar among trainees who completed an asynchronous module when compared to those who attended a live training session.9Hill E. Cartabuke R.H. Mehta N. et al.Resident-Led Handoffs training for interns: online versus live instruction with subsequent skills assessment.Am J Med. 2017; 130: 1225-1230Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar In our own internal medicine residency program at the University of Louisville, we have successfully combined traditional conferences with recorded lectures available online, as well as a robust and specific expectation for independent study10Burk M.J. Bishop L. Rahman T. et al.Louisville lectures: FOAMed meets internal medicine residency.Am J Med Sci. 2017; 353: 263-264Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar; attendance at in-person lectures, in-training exam scores and board exam pass rates all remained steady upon introduction of this asynchronous curricular component. As evidenced by the thoughtful and multi-pronged approach Randall et al. describe in implementing an academic half-day, major curricular changes have traditionally been undertaken with an abundance of advance planning, but the challenges brought by the novel coronavirus have not allowed the luxury of time. A few graduate medical education programs have already offered brief reports in the literature regarding their pivot to a "COVID-friendly" style of conference delivery. For example, a "flipped classroom" approach to didactics for surgery residents was recently converted to a completely virtual format. Use of a live chat function to allow for discussion while maintaining a fluid presentation and use of a closed Facebook group were key components for maintaining interactivity.11Chick R.C. Clifton G.T. Peace K.M. et al.Using technology to maintain the education of residents during the COVID-19 pandemic.J Surg Ed. 2020; 77: 729-732Crossref PubMed Scopus (637) Google Scholar Looking even further into the future, Stambough and colleagues challenge us to think past immediate needs to the further possibilities of shared resources between residency programs and fully virtual national meetings.12Stambough J.B. Curtin B.M. Gililland J.M. et al.The past, present, and future of orthopedic education: lessons learned from the COVID-19 pandemic.J Arthroplasty. 2020; 35: 60S-64SAbstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar Though many uncertainties remain, it is clear that the SARS-CoV-2 pandemic will have a lasting impact on the delivery of core curricula in residency programs. Just as Randall et al. describe a culture change to the academic half-day in their program, all residency programs are called up on to innovate, study the effects of changes made, and share their results, both positive and negative, with the graduate medical education community. The change to modes of curriculum delivery which rely heavily on virtual platforms presents an opportunity for residency programs to maximize collaboration, share resources, and create a new repository of best practices.

This cross-sectional study evaluates the association of gender with assessment of internal medicine residents.

Problem Gender equity in leadership across academic medicine remains a concern. The case of chief resident (CR) offers an opportunity to explore novel strategies in leadership selection in graduate medical education (GME). Means of identifying potential candidates for CR often rely on faculty assessment of resident performance, yet implicit gender bias has the potential to influence this assessment. Approach To diversify the metrics used in CR selection, an intervention was implemented to solicit resident input to identify candidates for CR at 2 U.S. internal medicine residency programs in 2018 and 2019. This involved a simple, cross-sectional survey of residents in which they were asked to identify individual residents as good candidates for consideration for CR. Outcomes There were 298 of 518 internal medicine resident responses to this intervention across sites and years (mean 58.2% response rate). Nomination patterns of residents and program leaders correlated significantly (correlation coefficient 0.62, P < .001). Controlling for site and year, gender was a significant factor associated with who residents nominated for CR (β-coefficient 0.325, P = .004) with women residents more likely to identify women for CR (odds ratio 1.38, 95% confidence interval 1.11–1.73). Fifty residents nominated themselves for CR, and there was no significant difference by gender (β-coefficient 0.038, P = .91). Next Steps Soliciting resident input to identify candidates for CR may enable gender representation of candidates for this position. Influencing candidate choices may be a promising way to impact leadership selection in medicine.

BACKGROUND:Competency-based medical education relies on meaningful resident assessment. Implicit gender bias represents a potential threat to the integrity of resident assessment. We sought to examine the available evidence of the potential for and impact of gender bias in resident assessment in graduate medical education. METHODS:A systematic literature review was performed to evaluate the presence and influence of gender bias on resident assessment. We searched Medline and Embase databases to capture relevant articles using a tiered strategy. Review was conducted by two independent, blinded reviewers. We included studies with primary objective of examining the impact of gender on resident assessment in graduate medical education in the USA or Canada published from 1998 to 2018. RESULTS:Nine studies examined the existence and influence of gender bias in resident assessment and data included rating scores and qualitative comments. Heterogeneity in tools, outcome measures, and methodologic approach precluded meta-analysis. Five of the nine studies reported a difference in outcomes attributed to gender including gender-based differences in traits ascribed to residents, consistency of feedback, and performance measures. CONCLUSION:Our review suggests that gender bias poses a potential threat to the integrity of resident assessment in graduate medical education. Future study is warranted to understand how gender bias manifests in resident assessment, impact on learners and approaches to mitigate this bias.

In this issue of The American Journal of the Medical Sciences, Huang et al 1 Huang K.-C. Lin Y.-R. Syue Y.-J. Comparison of clinical practice in the emergency department: female versus male emergency physicians. Am J Med Sci. 2018; 355: 215-219https://doi.org/10.1016/j.amjms.2017.12.001 Abstract Full Text Full Text PDF Scopus (2) Google Scholar add to the growing body of medical literature studying and describing the current experience of women physicians by examining practice habits and outcomes of emergency medicine physicians in an academic center’s hospital network in Taiwan. Why is it important to gather and analyze data about gender differences in the experience of practicing medicine? Because, like anything in medicine, we must accurately define the problems—in this case, disparities between the experiences of male and female physicians—so that we can work toward improving them.

A faculty-delivered lecture series provides the framework for traditional graduate medical education, especially in internal medicine. There are common problems within individual programs, including resident attendance and accessibility of content for those unable to attend. Owing to patient care, scheduling conflicts and duty-hour requirements, residents are unable to attend traditional conferences at least 25% of the time, with significant minorities arriving late or leaving early. 1 Ha D. Faulx M. Isada C. et al. Transitioning from a noon conference to an academic half-day curriculum model: effect on medical knowledge acquisition and learning satisfaction. J Grad Med Educ. 2014; 6: 93-99https://doi.org/10.4300/jgme-d-13-00185.1 Crossref PubMed Google Scholar Some programs reconcile this by recording lectures and placing them on university-based online curriculum platforms for their trainees to access.