Marquardt Robert J, Ross Lindsay A, Thompson Nicolas R, Soni Payal, Mays MaryAnn, Buletko Andrew B
From the Department of Neurology (R.J.M., L.A.R., P.S., M.M., A.B.B.), and Department of Quantitative Health Sciences (N.R.T.), Cleveland Clinic Foundation, OH.
Neurol Educ. 2024 Sep 9;3(3):e200148. doi: 10.1212/NE9.0000000000200148. eCollection 2024 Sep 25.
Adult neurology clinical trainees in Accreditation Council for Graduate Medical Education (ACGME)-accredited residency programs spend their postgraduate year (PGY)-1 within the internal medicine department, potentially causing a perceived disconnect with their neurology program. Our Adult Neurology Clinical Competency Committee found this disconnect may decrease resident well-being. We hypothesized implementing a novel PGY-1 Director role focusing on unique aspects of this first year would improve resident well-being and connection to the neurology program.
The PGY-1 Director was established as an associate program director in the adult neurology residency program with goals to improve wellness, advocacy, compliance with ACGME requirements, education, and communication. Anonymous surveys compared preintervention (before the PGY-1 Director role) with postintervention resident opinions on PGY-1 experience, assessing wellness, burnout, and perception of advocacy.
A total of 15 (75%) preintervention residents and 23 (96%) postintervention residents completed the study surveys. 53.7% of preintervention residents agreed or strongly agreed to feeling burned out, while only 17.4% of postintervention residents agreed they felt burned out and none strongly agreed. Significant improvement occurred in feeling supported clinically and emotionally and feeling validated. Most postintervention residents felt the PGY-1 Director was valuable and directly led to positive change. The relationship between the neurology and internal medicine departments was improved.
A dedicated PGY-1 Director position can improve trainee wellness outcomes and relationships between preliminary and matched departments. This mutually benefits both programs but requires substantial resources. We propose this as a best practice when feasible for ACGME programs with the following suggestions: (1) provide dedicated full-time equivalent time, (2) meet with preliminary program leadership regularly, (3) meet with PGY-1 trainees during orientation and at least quarterly, (4) serve as an advocate, and (5) facilitate mentorship in areas of interest.
在研究生医学教育认证委员会（ACGME）认可的住院医师培训项目中，成人神经科临床实习生在其第一年住院医师培训（PGY-1）期间隶属于内科，这可能导致他们感觉与神经科项目脱节。我们成人神经科临床能力委员会发现这种脱节可能会降低住院医师的幸福感。我们假设设立一个专注于这第一年独特方面的新型PGY-1主任职位，将改善住院医师的幸福感以及与神经科项目的联系。
PGY-1主任在成人神经科住院医师培训项目中被设立为副项目主任，目标是改善健康状况、提供支持、确保符合ACGME要求、开展教育以及促进沟通。通过匿名调查比较干预前（PGY-1主任职位设立之前）和干预后住院医师对PGY-1经历的看法，评估健康状况、职业倦怠以及对支持的感受。
共有15名（75%）干预前住院医师和23名（96%）干预后住院医师完成了研究调查。53.7%的干预前住院医师同意或强烈同意感到职业倦怠，而干预后只有17.4%的住院医师同意他们感到职业倦怠，且无人强烈同意。在临床和情感上得到支持以及感到被认可方面有显著改善。大多数干预后住院医师认为PGY-1主任很有价值，并直接带来了积极的变化。神经科和内科之间的关系得到了改善。
设立专门的PGY-1主任职位可以改善培训学员的健康状况以及初步匹配科室和目标科室之间的关系。这对两个项目都有好处，但需要大量资源。我们建议在可行的情况下，这是ACGME项目的最佳实践，并提出以下建议：（1）提供相当于全职的专门时间，（2）定期与初步匹配科室的领导会面，（3）在迎新期间以及至少每季度与PGY-1培训学员会面，（4）担任支持者，（5）在感兴趣的领域促进指导关系。
