Internists (n = 15) spent 70% of discussions on intrinsic roles (56% aligned) 66% for communicator, 73% for collaborator, and 72% for professional. Radiologists' goals were to offer advice (66%), reflections (21%), and agreements (7%). Internists offered advice (41%), reflections (40%), and clarifying questions (10%). We saw no consistent effects when residents explicitly requested feedback on an intrinsic role. Case discussions represent frequent opportunities for substantial feedback on intrinsic roles, largely aligned with the clinical case. Supervisors predominantly offered monologues of advice and agreements.Case discussions represent frequent opportunities for substantial feedback on intrinsic roles, largely aligned with the clinical case. Supervisors predominantly offered monologues of advice and agreements. The residency selection process relies on subjective information in applications, as well as subjective assessment of applications by reviewers. This inherent subjectivity makes residency selection prone to poor reliability between those reviewing files. We compared the interrater reliability of 2 assessment tools during file review one rating applicant traits (ie, leadership, communication) and the other using a global rating of application elements (ie, curriculum vitae, reference letters). Ten file reviewers were randomized into 2 groups, and each scored 7 general surgery applications from the 2019-2020 cycle. The first group used an element-based (EB) scoring tool, while the second group used a trait-based (TB) scoring tool. Feedback was collected, discrimination capacities were measured using variation in scores, and interrater reliability (IRR) was calculated using intraclass correlation (ICC) in a 2-way random effects model. Both tools identified the same top-ranked and bottom-ranked applicants; however, discrepancies were noted for middle-ranked applicants. The score range for the 5 middle-ranked applicants was greater with the TB tool (6.43 vs 3.80), which also demonstrated fewer tie scores. The IRR for TB scoring was superior to EB scoring (ICC [2, 5] = 0.82 vs 0.55). https://www.selleckchem.com/products/3bdo.html The TB tool required only 2 raters to achieve an ICC ≥ 0.70. Using a TB file review strategy can facilitate file review with improved reliability compared to EB, and a greater spread of candidate scores. TB file review potentially offers programs a feasible way to optimize and reflect their institution's core values in the process.Using a TB file review strategy can facilitate file review with improved reliability compared to EB, and a greater spread of candidate scores. TB file review potentially offers programs a feasible way to optimize and reflect their institution's core values in the process. Quality improvement (QI) is a required component of graduate medical education. Many medical educators struggle to foster an improvement mindset within residents. We conducted a mixed-methods study to compare a Design Thinking (DT) approach to QI education with a Lean, A3 problem-solving approach. We hypothesized that a DT approach would better promote a mentality of continuous improvement, measured by residents' resistance to change. Thirty-eight postgraduate year 2 internal medicine residents were divided into 4 cohorts during the 2017-2018 academic year. One cohort participated in an experimental QI curriculum utilizing DT while 3 control cohorts participated in the existing curriculum based on Lean principles. Participants voluntarily completed a quantitative Resistance to Change (RTC) scale pre- and post-curriculum. To inform our understanding of these results, we also conducted semistructured interviews for qualitative thematic analysis. The effect size on the overall RTC score (response rate 92%) was trivial in both groups. Three major themes emerged from the qualitative data factors influencing the QI learning experience, factors influencing creativity, and general attitudes toward QI. Each contained several subthemes with minimal qualitative differences between groups. This study found similar results in terms of their effect on attitudes toward systems change, ability to promote creative change agency, and educational experience. Despite positive educational experiences, many residents still did not view systems-based problem-solving as part of their professional identity.This study found similar results in terms of their effect on attitudes toward systems change, ability to promote creative change agency, and educational experience. Despite positive educational experiences, many residents still did not view systems-based problem-solving as part of their professional identity. The American Board of Psychiatry and Neurology and the Accreditation Council for Graduate Medical Education (ACGME) developed Milestones that provide a framework for residents' assessment. However, Milestones do not provide a description for how programs should perform assessments. We evaluated graduating residents' status epilepticus (SE) identification and management skills and how they correlate with ACGME Milestones reported for epilepsy and management/treatment by their program's clinical competency committee (CCC). We performed a cohort study of graduating neurology residents from 3 academic medical centers in Chicago in 2018. We evaluated residents' skills identifying and managing SE using a simulation-based assessment (26-item checklist). Simulation-based assessment scores were compared to experience (number of SE cases each resident reported identifying and managing during residency), self-confidence in identifying and managing these cases, and their end of residency Milestones assigned by a CCch as identification and management of SE. Residency programs apply varying criteria to the resident selection process. However, it is unclear which applicant characteristics reflect preparedness for residency. We determined the applicant characteristics associated with first-year performance in internal medicine residency as assessed by performance on Accreditation Council for Graduate Medical Education (ACGME) Milestones. We examined the association between applicant characteristics and performance on ACGME Milestones during intern year for individuals entering Northwestern University's internal medicine residency between 2013 and 2018. We used bivariate analysis and a multivariable linear regression model to determine the association between individual factors and Milestone performance. Of 203 eligible residents, 198 (98%) were included in the final sample. One hundred fourteen residents (58%) were female, and 116 residents (59%) were White. Mean Step 1 and Step 2 CK scores were 245.5 (SD 12.0) and 258 (SD 10.8) respectively. Step 1 scores, Alpha Omega Alpha membership, medicine clerkship grades, and interview scores were not associated with Milestone performance in the bivariate analysis and were not included in the multivariable model.