Background

In 2014 the ACGME modified adult training requirements for child neurology certification to reduce the number of hospital-based rotations and require inclusion of outpatient clinic and electives. We aimed to identify how these training requirements are being met and explore its impact on residents.

Methods

A REDCap questionnaire surveying resident opinion on impact of adult training on resident education, professional development, and wellness was emailed to 79 program directors in the United States for distribution in 2020. Results were analyzed using descriptive statistics and t-test calculations. Qualitative analysis of narrative responses involved theme identification.

Results

116 child neurology residents participated (30.2% PGY-3, 37.9% PGY-4, and 31.9% PGY-5 residents). 20.9% had all adult rotations during the PGY-3 year, and 79.1% had adult rotations spread throughout residency. Adult training had a small positive impact on resident autonomy and a negative impact on resident wellness regardless of training structure. However, residents with 12 months of adult training during PGY-3 year scored worse on burn out, mood changes, work-life balance, and social wellbeing (p<0.05). Some themes identified included residents feeling unsafe due to lack of supervision, that education was not prioritized, and that adult patient care lacked relevance to long term career goals.

Conclusions

Adult neurology training was found to negatively affect child neurology resident wellness, with a larger negative impact when adult training was completed in 12 months during PGY-3 year. Other identified areas where change could be implemented include improving feelings of resident safety and prioritizing quality and relevance of education.

中文翻译：

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儿童神经病学住院医师的成人神经病学轮换：探索住院医师的视角

背景

2014 年，ACGME 修改了儿童神经病学认证的成人培训要求，以减少医院轮换次数，并要求纳入门诊和选修课。我们旨在确定如何满足这些培训要求并探讨其对居民的影响。

方法

REDCap 问卷调查了居民对成人培训对居民教育、专业发展和健康的影响的看法，已通过电子邮件发送给美国的 79 名项目主管，以便在 2020 年分发。使用描述性统计和t检验计算分析结果。叙事反应的定性分析涉及主题识别。

结果

116 名儿童神经内科住院医师参与（30.2% PGY-3、37.9% PGY-4 和 31.9% PGY-5 住院医师）。20.9% 在 PGY-3 年期间进行了所有成人轮换，79.1% 的成人轮换分布在整个住院期间。无论培训结构如何，成人培训对居民自主权的积极影响很小，对居民健康产生负面影响。然而，在 PGY-3 年接受 12 个月成人培训的居民在倦怠、情绪变化、工作与生活平衡和社会福祉方面得分更差（p<0.05）。确定的一些主题包括居民因缺乏监督而感到不安全，教育没有被优先考虑，成人患者护理与长期职业目标缺乏相关性。

结论

成人神经病学培训被发现对儿童神经病学住院医师的健康产生负面影响，当成人培训在 PGY-3 年的 12 个月内完成时，负面影响更大。其他已确定的可以实施变革的领域包括改善居民的安全感以及优先考虑教育的质量和相关性。