68. The resident experience in a large urban teaching setting: Results of the 2005-2006 resident exit survey, University of Torontos

We developed and implemented an annual online survey to administer to residents exiting residency training in order to (1) assess the quality of the residency experience and (2) identify areas of strength and areas requiring improvement. Long-term goals include program planning, policy-making and maintenance of quality control. Survey content was developed from an environmental scan, pre-existing survey instruments, examination of training criteria established by the CFPC and the CanMEDS criteria established by the RCPSC. The survey included evaluation benchmarks and satisfaction ratings of program director and faculty, preparation for certification and practice, quality of life, quality of education, and work environment. The response rate was 28%. Seventy-five percent of respondents were exiting from Royal College training programs. Results of descriptive statistics determined that the overall educational experience was rated highly, with 98.9% of respondents satisfied or very satisfied with their overall patient care experience. Ninety-six percent of respondents were satisfied or very satisfied with the overall quality of teaching. Preparation for practice was identified as needing improvement, with 26% and 34% of respondents giving an unsatisfactory rating to career guidance and assistance with finding employment, respectively. Although 80% of respondents reported receiving ongoing feedback and 84% discussed their evaluations with their supervisors, only 38% of evaluations were completed by the end of the rotation. The results indicate that residents are generally satisfied with their experiences during residency training, especially with their overall educational experience. Areas of improvement include preparation for practice and timeliness of evaluations. Further iterations of this survey are needed to refine the instrument, identify data trends and maintain quality control in residency training programs. Frank JR (ed.). The CanMEDS competency framework: better standards, better physicians, better care. Ottawa: The Royal College of Physicians and Surgeons of Canada, 2005. Merritt, Hawkins and Associates. Summary Report: 2003 Survey of final-year medical residents. http://www.merritthawkins.com/pdf/MHA2003residentsurv.pdf. Accessed May 1, 2006. Regnier K, Kopelow M, Lane D, Alden A. Accreditation for learning and change: Quality and improvement as the outcome. The Journal of Continuing Education in the Health Professions 2005; 25:174-182

63. Developing a program for resident wellness at the postgraduate medical education office, University of Torontos

Prevalence of stress-related mental health problems in residents is equal to, or greater than, the general population. Medical training has been identified as the most significant negative influence on resident mental health. At the same time, residents possess inadequate stress management and general wellness skills and poor help-seeking behaviours. Unique barriers prevent residents from self-identifying and seeking assistance. Stress management programs in medical education have been shown to decrease subjective distress and increase wellness and coping skills. The University of Toronto operates the largest postgraduate medical training program in the country. The Director of Resident Wellness position was created in the Postgraduate Medical Education Office to develop a systemic approach to resident wellness that facilitates early detection and intervention of significant stress related problems and promote professionalism. Phase One of this new initiative has been to highlight its presence to residents and program directors by speaking to resident wellness issues at educational events. Resources on stress management, professional services, mental health, and financial management have been identified and posted on the postgraduate medical education website and circulated to program directors. Partnerships have been established with physician health professionals, the University of Toronto, and the Professional Association of Residents and Internes of Ontario. Research opportunities for determining prevalence and effective management strategies for stress related problems are being identified and ultimately programs/resources will be implemented to ensure that resident have readily accessible resources. The establishment of a Resident Wellness Strategy from its embryonic stags and the challenges faced are presented as a template for implementing similar programs at other medical schools. Earle L, Kelly L. Coping Strategies, Depression and Anxiety among Ontario Family Medicine Residents. Canadian Family Physician 2005; 51:242-3. Cohen J, Patten S. Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Medical Education; 5(21). Levey RE. Sources of stress for residents and recommendations for programs to assist them. Academic Med 2001; 70(2):142-150

69. International medical graduates (IMGs) needs assessment study: A comparison between current IMG trainees and program directorss

A needs assessment study was conducted to explore the types of issues or challenges IMG trainees encounter and the experiences of Program Directors with teaching this unique group. Both groups were asked to rate the importance of a series of issues in a horizontal curriculum using a 5-point Likert Scale. These issues fell under one of the following categories: Clinical Skills and Knowledge, Other Skills, Communication and Working Relationships, Macro Issues and Other Work-Related Issues. The scale was then collapsed to a 3-point Likert scale. Results were used to develop a horizontal curriculum for incoming IMGs to help ease their transition into residency training within the Canadian context. The majority of program directors (93%) and IMG trainees (63%) surveyed agreed that a horizontal curriculum for IMGs should be developed. Program Directors indicated that basic clinical skills and communication with team members were important to include (79% and 90%, respectively). IMGs felt that Marco Issues were importance in a horizontal curriculum, namely an orientation about the Canadian healthcare system and site hospitals (71% and 59%, respectively), followed by communication with patients (67%). Significant differences were found with regards to the inclusion of communication with other residents and the inclusion of orientation sessions on the Canadian Health Care System and site hospitals. These findings demonstrate there is a need for a core IMG curriculum. There is a slight disparity regarding what specific topics to include but a consensus between both groups exists on the primary domains of communication, inclusion of specialty specific skills and knowledge as well as professional interaction. Kraemer M. Educational Challenges of International Medical Graduates in Psychiatric Residents. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry 2006; 34(1):163-171. Whelan GP. Coming to American: The integration of the International Medical Graduates into the American Medical Culture. Academic Medicine 2005; 81(2):176-178. Majumdar, B, Keystone JS, Cuttress LA. Cultural Sensitivity Training among Foreign Medical Graduates. Medical Education 1999; 33:177-184

Moving towards adulthood: (re)defining the concept of an "emerging adult" among African refugee youth in Canada

Paper presented at the 30th International Congress of Psychology, Cape Town, 20-23 Jul

6. CanMEDSification: The role of postgraduate medicine office in supporting the learning and teaching of CanMEDs Roles

The Postgraduate Medical Education Office at the University of Toronto has implemented a range of faculty development initiatives targeted at supporting the full implementation of CanMEDS roles and competencies in the day to day learning, teaching and evaluation of residents across the highly distributed postgraduate medicine training programs. In October 2005, the Royal College of Physicians and Surgeons of Canada (RCPSC) released a revised version of the CanMEDS roles. In June 2006, the RCPSC accreditation standards for postgraduate medicine changed some standards which result in an increased expectation of implementation of the CanMEDS roles in teaching and evaluation of residency programs. From 2005 to 2007, there have been numerous initiatives by the Postgraduate Medical Education Office to support the understanding and implementation of the CanMEDS roles into the learning, evaluation and outcomes of postgraduate training at the University of Toronto. The PGME Office supported the ‘CanMEDSification’ or integration of the CanMEDS framework by: 1) Supporting the development of teacher/faculty teaching and evaluation resources; 2) Providing faculty development in the understanding of these competencies; 3) Providing explicit program feedback through the Internal Review process The CanMEDS roles have been widely integrated into teaching and evaluation at the University of Toronto. The high attendance rates at workshops and positive workshop evaluations indicate the value of centralized faculty development initiatives and also indicate an increasing confidence in using CanMEDS. The workshop evaluations also indicate a need for additional faculty development in evaluating the non Medical Expert roles. Shorter E. Oxford English Dictionary (5th ed.). Oxford, UK: Oxford University Press, 2002. Harris, IB. Deliberative inquiry: The arts of planning. in E.C. Short (ed.), Forms of curriculum inquiry. Albany: State University of New York Press, 1991; 285-307. Harris, IB. New expectations for professional competence. In L. Curry & J. F. Wergin (Eds.), Educating professionals: Responding to new expectations for competence and accountability. San Francisco: Jossey-Bass, 1993; 17-52

4. Leadership in postgraduate medicine: Results from the first annual chief resident leadership workshop

In the spring of 2006, chief and senior residents were surveyed to determine how they prepared for their senior administrative/leadership role, what topics should be included in a leadership workshop and how this workshop should be delivered. Overall, 32.3% had no prior contact with the previous chief resident. Among those prepared, 46% consulted previous chiefs/seniors and/or program directors. Eighty-five percent agreed that a leadership workshop would be beneficial for future chiefs. Using the results from this environmental scan, a planning committee was formed to design the First Annual Chief Resident Leadership Workshop, held in August 2006, to identify and develop leadership skills while providing them with the resources to ease their transition into this senior administrative role. Seven sessions were offered: Your Role as Chief Resident, Mentorship, overview of the residents’ work/education contract, Personality Inventory (i.e. Myers-Briggs), Anti-Racism and Harassment, Resident Wellness and Public Speaking. A keynote address on leadership in academic medicine was given by a well-known Canadian clinician leader. To reinforce the experience, a resource binder and handbook was distributed to all participants. Quality and content of each session was evaluated using on a 5-point Likert scale. Mean scores were calculated. Mentorship scored the highest in terms of quality (4.46) and content (4.47), followed by Leadership in Academic Medicine (4.43 and 4.62, respectively). Over 90 % agreed that a leadership program is necessary. Parallel to our earlier findings, many chief residents use multiple sources to prepare for their role, primarily the pairing of contact with the previous chief resident and the Program Director. The results indicate that a formal, centralized leadership workshop/seminar is valued and should highlight the necessary skills set and provide key resources. Susman J, Gilbert C. Family practice residency directors’ perceptions of the position of chief resident. Academic Medicine 1992; 67(3):212-213. Awad JJ, Levenson SM, Osman CH, James S. The impact of a novel resident leadership training curriculum. The American Journal of Surgery 2004; 188:481-484. Kasuya RT, Nip IL. A retreat on leadership skills for residents. Academic Medicine 2001; 76(5):554