Program Size and Content
Residency programs in otolaryngology remain small compared to those of other surgical specialties, which Dr. Malekzadeh sees as an advantage. “Successful mentorship depends on developing strong relationships, and this can be challenging in a large residency program, where residents are rotating at many hospitals with limited long-term faculty interactions. In the end, I believe the department culture and faculty dedication to education [are] more important than the program size,” she said.
Explore This IssueJanuary 2019
Residency training should include not just skills training and leadership, but taking a leadership role in quality improvement and safety, said Dr. Bradford.
“Residents are on the ground level of patient care. They can find opportunities for improvement. Also, they come in with no preconceived notions. They see things that others may not notice because of the way they move through the healthcare system,” she said. “Surgical training has become competency-based. Surgical education has largely been a preceptorship, a model with a growing responsibility for the surgical trainee. In a competency-based model, the learner can set individual educational goals, and the faculty members can facilitate the process of achieving them.”
Faculty may ask residents about their educational goals at the beginning of training for a surgical procedure; then afterward, they can provide evaluative feedback and discuss whether the learner’s goals were achieved, which helps learners create and achieve their own educational goals, said Dr. Bradford.
“Self-evaluation is helpful, but so is peer evaluation. It’s good to have a cadre of residents evaluating each other, and we’re moving toward a 360-degree evaluation process” at her institution. Peers offer perspectives that faculty cannot, she said. “How do they function in a team? How do they function in the surgical theater?”
Burnout Still an Issue
Program directors juggle time-consuming responsibilities that may lead to burnout and stress, including meeting evolving accreditation requirements, balancing resident education and service, updating curriculum in the face of growing medical knowledge and new procedures, and ensuring the competence and professionalism of graduating residents, said Dr. Malekzadeh. “The greatest obstacle is time, as program directors are also often juggling research, teaching, and patient care in addition to the program director duties.”
Program directors must master a “balancing act,” and burnout is a real concern, said Dr. Barnes.
“I don’t think we do a fantastic job of ensuring that our program directors have enough time to do all that is necessary. There is a time constraint for resident education. We need better awareness of this issue so we can address it and carve out more time for true educators to do their work. In academics, if you’re not publishing, you’re not advancing your career,” she said. “Many things can take time away from training. We have to train our residents, but we have less time to do it.”