#preliminary surgical residency programs for international medical graduates

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Top Medical Residency Programs for International Students

The international medical residency programs give chance to the applicants to enhance their skills and further their knowledge, preparing them for the tough competition in the medical field in the future. The international programs allow them to get a degree overseas for the opportunity to be well trained and skilled.

Applicants can also apply at medical residency USA international students. USA medical schools offer comprehensive training and curriculum to residents.  For a guide on how to apply to some top programs, see the following.

Residency Programs for International Medical Graduates

UC Davis

UC Davis: UC Davis is offering surgical residency programs for international medical graduates. To be selected, they require applicants to apply ahead of time and check the complete details of the application process and requirements.

Image credit: ucdmc.ucdavis.edu

Application process for the medical surgery residency international opportunity program

Hold a current certificate from Educational Commission for Foreign Medical Graduates

Have received an evaluation status letter from California Medical Board

Deadline: Application should be submitted by November 1.

Application Requirements

ERAS common application form

CV or 1 page personal statement

Official medical school transcript

USMLE step one and step two, if available

3 medical letter of recommendation

Copy of current valid ECFMG certificate

Legal right to work and remain in the US (J1 visa or permanent resident status)

University of Washington

Every year, University of Washington offers four visiting sub-internship positions to the IMG for those who are interested in pursuing the preliminary position in their residency program. The preliminary surgical residency programs for international medical graduates make sure that the applicants will be selected carefully.

Image credit: seattlepi.com

Application requirements

Current ECFMG certification in 3 areas of exam

USMLE step one and step two scores of 220 or higher. The exam should be taken in the last 3 years and it must have passed all parts of the exam, which include the clinical skills and clinical knowledge in the first attempt. The official USMLE transcript is required as well.

A medical degree in the last 7 years

Attestation that the applicant has not been subject to challenges, disciplinary action, review, informal or formal action, by an ethics committee, medical disciplinary boards, licensing board, education/training school or professional association

Applicants are planning to apply for the preliminary surgery residency position at the institution.

3 letters of recommendation from the people who are familiar with applicant clinical patient care skills as well as potential to function as a resident

Receptive English skills

Application process

Applicants need to submit the following documents to the surgical education manager of the school:

UW department surgery coversheet

Copy of latest ECFMG certificate

Medical school transcript copy

Official USMLE transcript with step one and step two scores

Current resume or curriculum vitae

3 letters of recommendation

Written statement explaining applicant career goals

University of Pittsburgh

The emergency medicine residency international medical graduates of the University of Pittsburgh allow residents to get the best training they deserve. To become part of the program, applicants should complete all the requirements.

Image credit: shrs.pitt.edu

Application

The application process starts with the ERAS. The following documents should be submitted to ERAS:

Common application form

Official medical school transcript

Dean’s letter

USMLE transcript

Photo

Personal statement

3 letters of recommendation (maximum of four)

Deadline: The deadline for the application is December 1.

Information for foreign medical graduates

Valid copy of applicants ECFMG certificate

Letter from the Health Ministry in their home country

Check for $275 payable to ECFMG

Dean’s letter

USMLE transcript

Official medical school transcript

Photo

3 letters of recommendation

NUHS

The surgery residency international medical graduates program of the NUHS is one of the best programs in the nation. Their faculty member ensures that residents will be well educated and trained for them to meet their career goals in the future.

Image credit: commons.wikimedia.org

Application requirements

To participate in the residency application, the applicant needs to be offered an employment by MOH holdings.

Applicants need to have basic medical or postgraduate degree that is recognized by the Singapore Medical Council.

Applicants who are in their final year, medical officer or house officer can apply for Phase 1 and 2 of the residency

University of Berkeley

The preventive medical residency for international graduates and public health is a joint program. The University of Berkeley offers a 2-year program for residents, wherein they will learn the basic components of preventive medicine, including core curriculum in biostatistics, epidemiology, environmental, cultural and others.

Image credit: newbostonpost.com

Application requirements

GPA

Transcripts

Letters of recommendation

Statement of purpose and personal history statement

Resume or CV

Test scores

Research or work experience

Application process

Deadline: For Fall semester, the application will be opened on August 17, 2017. Priority deadline: December 1.

Applicants applying for the priority deadline will be given the highest priority for consideration and admission for assistantships and scholarships. The admission committee evaluates applications based on future leadership potential in public health; volunteer, professional and personal experiences; review of applicants academic preparation.

Pre-requisite: All prerequisite courses should be completed before applying. All applicants should earn at least C grade in all their prerequisite coursework.

John Hopkins University

The surgical internship rotations are designed to fill the needs of applicants planning for a neurosurgical career as well as emphasize post and pre-operative career, management of the surgical patient, emergency care of trauma, neuro-critical care, intensive care and others. Applicants can apply for the neurology residency international medical graduates of the John Hopkins University, but ensure the completion of the following.

Image credit: hopkinsmedicine.org

Application process

Application for the neurosurgery program should be made through ERAS. All applicants must be registered for the match with NRMP.

The deadline for the submission of application is October 13. The interview dates will be conducted on December 4 and January 8.

When the review process is done and applicants for interview have been determined, selected applicants will be notified by telephone calls or email.

Brown University

Brown University gives research and teaching opportunities for students, residents and practicing physician. Their ophthalmology residency for international medical graduates offers a great education for residents.

Image credit: blab.com

Application requirements for ophthalmology residency for international medical graduates student doctor

Completion of approved medical school

Applicants with one of the following qualifications to be eligible:

Graduates of medical institutions in Canada and US accredited by Liaison Committee on Medical Education

Graduates of college of osteopathic medicine in the US accredited by American Osteopathic Association

Graduates of medical schools outside Canada and US who meet one of the qualifications:

Has received valid certification from FMG prior to appointment

Has full license to practice medicine in US licensing jurisdiction

Graduates of medical universities outside the US who have completed the 5th Pathway

Completion of approved postgraduate clinical year PGY 1 year

Selection criteria are based on applicants ability, preparedness, academic credentials, and aptitude and communication skills. The program does not discriminate with regard to race, sex, religion, national origin, veteran status or disability.

Career Paths

Medical doctors are required to earn Doctor of Medicine from an accredited school. They need to complete seven or more years of training as well as earn a medical license to practice medicine. Doctors treat patients in different areas, like oncology, radiology, anesthesia, pediatrics, internal medicine, gynecology, surgery, and psychiatry. They use the knowledge to treat and diagnose injuries and illnesses, perform diagnostic tests, prescribe medications as well as perform surgery. They can delegate some tasks such as a nurse or nurses’ practitioners.

General Requirements in Applying to Medical Residency

Application for ECFMG certification: Submit an application for ECFMG certification before applying for the examination.Examination requirements: International medical graduates need to pass the step one and two of US medical licensing examination, which is the same examination taken by Canadian and US graduates.

Medical examination

Pass step one of the USMLE

Pass step two USMLE clinical knowledge

Clinical skills examination

Medical education credential requirements

IMG are awarded for credit for at least 4 credit years of medical school

Final medical school transcripts

Documentation for completion of all credits as well as receipt of final medical diploma

Graduation year and physician’s medical school year listed in World Directory of Medical schools

Why Are They Popular?

Medical residency programs are popular because there are many students and professionals who want to get a higher education. It is their help to become a certified and licensed medical doctors or practitioners.  With the recent growth in the number of medical school class size and medical schools, the demand for medical training is getting larger annually.

Additionally, the medical residency programs are popular because it is being offered not only to local applicants but also to international students.

Why Applicants Choose the Programs

Applicants can choose one from the medical schools above for an excellent medical education. With the best training from these medical schools, students can ensure the proper knowledge, abilities, and skills they need in preparing for their future career. Professional faculty members help students and residents to engage in research and teaching opportunities.

Some Schools or Universities Offering Medical Residency

Here are some of the great schools offering medical residency to students, professionals, and residents. You can check out the school to know what medical residency they offer to applicants.

NUHS

Vanderbilt University

UNC

University of Toronto

University of Massachusetts

Maryland Radiation Program

Start applying in your chosen program, prepare and complete the required documents. In applying, you need to check the website of the school for complete details and to get also an idea about the submission deadline for documents.

Don’t be left behind! Get help from us for international medical residency programs today!

[rationalsanskar]

A Cultural Sea Change: Mindfulness for Surgical Residents

The Problem

Burnout, an occupational syndrome included in the World Health Organization’s International Classification of Diseases, 11th Revision, has been defined as a “prolonged response to chronic interpersonal stressors on the job.”

Burnout contributes to surgeons’ medical errors and lapses in professionalism. Despite how widespread burnout, depression, and suicidality are among surgeons, evidence-based interventions that ease their debilitating effects remain scarce.

In an effort to fill this gap, researchers at the University of California, San Francisco (UCSF) have turned to mindfulness practices for solutions. Mindfulness is “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally,” according to Jon Kabat-Zinn, PhD, an emeritus professor of medicine at the University of Massachusetts Medical School who developed secular MBSR and is largely credited for introducing mindfulness into Western medicine. Previous studies suggest such mindfulness-based interventions can improve the resilience, affect, executive function, and performance among people in other high-stress professions.

In 2018, the UCSF team reported that tailored MBSR training was feasible and useful among 21 surgical residents in a pilot clinical trial. In their recent JNO follow-up study, the researchers analyzed the program’s effects on these trainees’ well-being and performance.

The Design

First-year surgical residents were randomized to modified MBSR training or an active control group. The MBSR group participated in an 8-week program that comprised weekly 2-hour classes and daily 20-minute home practice including body awareness, yoga, meditation, and transition breathing sessions. The control group had similar class-time and home-practice requirements that explored topics such as perseverance, honesty, self-care, and the ethos of surgery.

Using validated surveys and tests, the researchers measured postintervention changes in the following outcomes:

Perceived stress (primary)

Functional neuroimaging during an emotional regulation task

Key Findings

The MBSR group had half as much perceived stress and twice as much mindfulness as the control group, differences that were associated with medium to large effect sizes.

Motor performance and aspects of executive function, including working memory capacity, improved in the MBSR group compared with the control group. Associated effect sizes were medium to large.

In contrast, burnout increased to a similar degree in both groups.

Depressive symptoms increased twice as much in the control group compared with the MBSR group.

The MBSR group showed greater activation in brain regions associated with executive function and self-awareness during an emotional regulation task.

However, none of the changes in any outcomes were significantly different between groups. The study was not powered to detect such differences.

A Word of Caution

Given the study’s small sample size and single-institution setting, the results should be interpreted cautiously, the authors noted.

“The mindfulness exercises reported did not yield statistically significant differences between groups, suggesting that mindfulness itself may not be effective,” said Edward Livingston, MD, JAMA deputy editor and professor of surgery at UCLA, who was not involved in the study. However, because these are preliminary studies, the findings aren’t definitive, he added.

Mindfulness vs Autopilot

In an editorial accompanying the recent study, Brooke Gurland, MD, clinical professor of surgery at Stanford University, wrote that current surgical training doesn’t address “the emotional consequences of life-and-death decision-making or the impact of surgical complications on surgeon well-being.”

The surgical training culture has long rested on the notion that sleep deprivation, constant challenges, and brutalization were necessary to ensure that exhausted surgeons would be on autopilot to respond appropriately to dramatic events, Livingston explained.

The thinking went that “when a surgeon steps back to reflect on the experience of being a surgeon, there is a high likelihood he or she will crack, ” he said. “Mindfulness is a process of refocusing the brain, to take it out of autopilot mode.”

By switching off autopilot, mindfulness-based interventions may reduce stress and strengthen a person’s ability to tolerate uncomfortable experiences through cultivating nonreactivity to difficult thoughts, events, and emotions, according to the study authors.

The Take Away

Mindfulness-based stress reduction training may help mitigate stress and enhance executive function among surgeons, but larger, more definitive trials are needed, the authors wrote.

The take-away message is “that burnout and health care reform for physician well-being are of paramount importance” and the study’s tailored MBSR program “shows highly promising impact on stress and executive function,” lead author Carter Lebares, MD, assistant professor of surgery at UCSF, said in an interview.

Why Is This Important?

Physician stress, burnout, depression, and other mental health concerns aren’t limited to surgical residents. Case in point: a recent survey of US ophthalmology residents found that 68.4% of respondents reported their program faced issues with depression, burnout, or suicide among trainees in the past year.

In recognition of this pervasive problem, the Accreditation Council for Graduate Medical Education (ACGME) recently introduced new requirements aimed at promoting a “culture of well-being” in physician training programs. The authors of the JNO study point out that mindfulness-based interventions are “a promising means to address [ACGME] programming mandates.”

However, the importance of the study may ultimately lie not in the specific intervention or outcomes, but rather in acknowledging that physicians are stressed and that this has adverse consequences, according to Livingston. “[T]he basic concept of addressing the stress surgeons experience and changing the culture of surgery so that it is allowable for surgeons to seek help is an important advance,” he added.

Looking Ahead

The researchers plan to test their MBSR intervention in larger populations of surgeons and in other contexts, such as the military and trauma, according to Lebares.

This content was originally published here.

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Exploring the Pre-Novice Phenomenon in Undergraduate Nursing Education-Juniper Publishers

Journal of Nursing & Health Care

Introduction

Background and significance

There are 2,745,910 Registered Nurses (RN's) employed in the United States with an anticipated work force of 3.24 million RN's in practice by the year 2022 [1]. With the projected rate of 525,000 nurses leaving the profession, it is estimated that the total number of job openings for RN's will be 1.05 million by 2022 [1]. A total of 111,634 nursing students graduated from an accredited baccalaureate program in the United States between August 2013-July 2014 [2]. Of these students 63,857 had entry- level baccalaureate status and 47,777 were RN's returning to obtain their bachelor of science in nursing (BSN) degrees [2].

Upon graduation and successful completion of the NCLEX licensure exam, these new graduates are deemed capable of providing safe nursing care to the population. Colleges of Nursing as well as the employers of these new RN's demand competent new graduates able to provide safe client care and they expect a smooth transition to practice. The new graduate rates of actual turnover or intent to leave the organization and/or profession within the first year of practice are staggering. In the United States, approximately 1 in 5 newly licensed RN's leave their first job within the first 12 months and 1 in 3 within the first 24 months [3]. The cost to replace one RN in the United States ranges from $10,098 to $88,000 (AACN, 2015) and Australia reports costs of $48,000 - $100,000 [4]. Other countries report widely varying rates of new graduate turnover including Canada (60%) [5], Australia (50%) [6], South Korea (33.4%) [7], and Sweden (20%) [8].

In recognition of this crisis, AACN [2] has developed their 2017- 2019 Strategic Plan which includes objectives and initiatives to improve the quality and advancement of nursing education in the United States [2]. The National Council of State Boards of Nursing (NCSBN) has released the results of a longitudinal simulation study designed to provide data regarding the use of simulation as an alternative to traditional clinical experiences in nursing education [9]. New graduate RN orientation and mentorship guidelines are being reviewed with healthcare organizations instituting Nurse Residency programs intended to improve the outcomes associated with transition to practice [10]. Even with graduate nurse transition to practice programs, research indicates that outcomes remain dismal [11]

Vast resources are being directed at the problem of new graduate nurse turnover yet it remains a threat to the profession of nursing. Patricia Benner's Novice to Expert Theory (1984) has been cited throughout the literature as a framework for understanding the progressive development of nurses. Benner's theory defines as the entry point on the continuum of the development of a professional nurse to be the novice. However, the novice stage encompasses a wide range of individuals including nursing students, new graduate nurses and those nurses changing specialty work areas such as moving from a medical-surgical unit to a labor and delivery unit. This researcher proposes the need to explore the concept of nursing students as pre-novices; as a separate and distinct stage occurring before Benner's novice stage

Domains of nursing knowledge: the practice domain

Of the four theoretical domains of nursing as defined by Kim [12], the typology of practice is most relevant to the phenomenon of the pre-novice nursing student. Within the practice domain lie the concepts of clinical reasoning, prioritization, nursing decision making and nursing enactment [12]. Considering Benner's Novice to Expert theory (1984), all components of this domain develop beginning with the novice and progressing to the expert. As with the pre-novice, understanding the developmental process that occurs in each of these areas will be an important contribution to the theoretical foundation of nursing education.

A nursing students' ability to recognize a change in client condition and determine the reason for the change (clinical reasoning) is paramount to their academic success. Some students are able to recognize that something is wrong but then have no idea what to do about the problem. Others may continue to perform tasks in a check-box type fashion without seeing the larger picture of client deterioration. Recognizing the need for action and then deciding what to do (decision-making), and in what order (prioritization) are clear examples of the decisionmaking component of the practice domain.

The nursing enactment portion of the practice domain is also key in that some students given a client care scenario are able to sit down and write a comprehensive care plan. Being able to gather relevant data and deliver organized and effective client care to a real live human being may not be as easy. Student nurses, prior to graduation, are expected to be able to assimilate the knowledge they have learned in school and apply it to live client care situations. Given the previous descriptions regarding new nurse transition to practice issues, there is work to be done within the practice domain in nursing education.

    Purpose of the Review

The purpose of this preliminary integrated review of the literature is to explore the state of the science surrounding the development of undergraduate nursing students as pre-novices. Included in this review are barriers faced by nurse educators and employers of graduate nurses, strategies being attempted to ease transition to practice and the outcomes associated with the existing system. Finally, the gap in the literature regarding the need for theoretical foundation will be presented.

    General Methods for Review Process

Search strategy and yield

An integrated review of the state of the science was conducted via on-line searches as well as through interaction with regional, national and international organizations, councils and accrediting bodies involved in nursing education. Searches were conducted over the time period of 2014-2016. Web databases CINAHL, PubMed, Medline, ResearchGate, HealthSource (Academic Version), WorldCat, ProQuest, Education Resource Complete and EBSCO were searched with the following keywords used both independently and in various combinations: "experiential learning", "pre-novice", "Benner", "critical thinking", "situational awareness", "simulation", "new graduate nurses", "transition", "turnover", "novice" and "undergraduate nursing education". The searches retrieved a total of 798 articles.

    Inclusion/Exclusion Criteria

Inclusion criteria used to screen the large volume of articles for relevance in this study were publication dates of 2010-2016 and while care was taken to ensure an international selection of articles, those chosen were limited to literature written in the English language. Lastly, articles were screened for the exclusion criteria to ensure than if there was a nursing program involved in the study, at least a portion of the sample must include students/ programs at the undergraduate bachelor of science in nursing (BSN) level. All full-text articles remaining were reviewed and duplicates removed leaving a total of 33 articles.

Finally, contact was made and resources explored within the Ohio Consortium of Nursing Learning Labs (OCONLL), the National Council for the State Boards of Nursing (NCSBN), the American Association of Colleges of Nursing [2], the National League for Nursing [13] and the International Nursing Association for Clinical Simulation and Learning (INASCL) and the U.S. Bureau of Labor Statistics to ensure this literature review is up to date and thorough.

    Data Extraction and Management

From the 33 eligible articles and the materials obtained from regional, national and international organizations, councils and accrediting bodies involved in nursing education, data was extracted. Articles were initially read through once to ensure comprehension of the aims, methods and findings. During the second reading of the articles, key components such as aim(s), research question(s), design, method, sample, setting, data analysis, findings and significance to nursing were considered and extracted for inclusion in one of three Integrated Review of Literature (IROL) tables. The need for three separate IROL tables became evident during the reading and extracting of information from the literature and other sources. Recognition of concepts as well as similarities and differences across and between the literature crystallized.

    Results/Findings of Integrative Review Process

Sample characteristics

Of the articles selected for inclusion in this review, both settings and samples varied widely with studies conducted in the United States ranging from single site to one study that used 23 sites across multiple states. Single sites were the most frequently used in Australia, Canada, South Korea, Singapore and Finland with settings ranging from private catholic and public universities to large multi-site healthcare systems. Sample sizes ranged from 5 to >250 participants with five studies using 6-50, eight studies with 51-100, seven studies with 101-200 and thirteen studies with >250 participants. It is difficult to generalize findings from these studies due to wide diversity in geographical location, cultural and economic implications and such variance in sample size. The studies with larger sample sizes may have more generalizable results however a private university setting is extremely different than a multi-site healthcare system in a different country.

    Sample Designs and Methods

Quantitative methods

Publications included 33 primary research studies: nineteen (19) used quantitative methods, seven (7) mixed-methods and seven (7) qualitative. Of the quantitative designs, there were (15) studies that used a pre-test/post-test design: (6) were one- group, (5) were two-group (3) were three-group and (1) had >4 groups. The remaining quantitative studies used post-test only (1), repeated measures longitudinal (4), repeated measures descriptive co-rrelational (1) and single time period descriptive correlational (3). Reliability and validity were inconsistently reported across these studies. Considering the nature of the phenomenon of the pre-novice nursing student and the literature related to barriers in education through transition to practice problems, the longitudinal design would be a preferred method if the researcher were exploring development from student to practicing nurse. In the four longitudinal studies, participant attrition was a factor inherent in the problem of new nurses leaving their positions and in some cases, the profession.

Qualitative methods

Of the qualitative research articles reviewed, (4) used grounded theory, (2) used descriptive exploratory and (3) used retrospective analysis designs. The selected qualitative approaches were appropriate based on the research questions of these studies. In all of the qualitative studies, researchers were interested in new graduate perception of the reasons nurses leave their positions and/or the profession within 1-2 years. Researchers were exploring influencing factors such as environment, manager and administrative support and perceptions of preparedness with the intent to uncover new information making their choice to use qualitative methodologies appropriate. Trustworthiness, member-checking, security of data and other indicators of rigor in qualitative methods were addressed in various levels of detail in (7) of the (9) studies.

Mixed methods

Seven of the studies used a mixed methods approach with questionnaires or surveys for the quantitative portion. Two used an open-ended question on the questionnaire and (4) used focus groups however only one of the two that used open-ended questions presented the findings of this portion of the study. Two of the four that used focus groups adequately addressed data collection, research team preparation and member-checking; the other two did not provide enough detailed information to determine the studies were rigorous. One study self-reported the research as mixed methods however, no qualitative component could be identified.

    Frameworks Used

The frameworks cited in the articles reviewed vary widely and will be presented in two sections: those related to simulation as an alternative to live client experiences in nursing education and those used in research on transition to practice. Both bodies of literature are based around the phenomena of preparing individuals to become successful RN's, able to function effectively to provide safe client care. Yet across the spectrum of this preparation, there is a lack of consistency in theoretical foundation while in twelve (12) of the studies, no frameworks were mentioned.

    Simulation as a Strategy in Nursing Education

Several studies (6) cited Kolb's Experiential Learning Theory as the foundation. This theory explores learning outcomes which in the context of the articles reviewed were studied in simulated environments. Three (3) studies combined Kolb's Experiential Learning Theory with Benner’s Novice to Expert Theory which allowed integration of both outcomes and the development of novices. The FIRST2 ACT model was used in one study to explore another aspect of safe client care which the authors presented as 'situational awareness'; observing whether or not participants were able to recognize and take action when a patients' condition deteriorated. The last framework cited once in this section of the literature was Perry's Schema of Cognitive and Ethical Development which added the ethical component not considered in the design of the other studies.

    New Graduate RN Transition to Practice

The literature surrounding the content of new graduate RN's transition to practice cited numerous different theoretical foundations as the framework for the research. Theories cited included the Affective Critical Thinking Model, the Areas of Worklife Model, the Theory of Work-Life Balance, Appreciative Inquiry Theory, Bandura’s Self-Efficacy Theory, Social Identity Theory, the Theory of Organisational Socialisation, Kanter's Theory of Structural Power in Organizations and the Psychological Capital Theory. As is evident, there is a complete lack of consistency in the theoretical foundations of the research related to the phenomenon of the pre-novice. Lack of a cohesive theory for this research may well be a contributing factor to the continued issues and negative consequences of unsuccessful transition to practice by new graduate nurses.

    Concepts and Variables

All articles included in this review will be discussed in total in this section as there was evidence of researchers using some of the same concepts and variables both in nursing education literature as well as the studies that focused on new graduate transition to practice issues. The variables most frequently identified which were used inter-changeably were 'critical thinking’ and 'decision-making' (CT-DM) (13 of the 33 articles reviewed). As with the lack of theoretical consistency mentioned in the previous section, the operational definitions of these variables were also varied. Seven (7) of the studies used 'knowledge' as a means of describing CT-DM with two (2) of these seven studies adding 'competence' and one of these two adding 'situational awareness' as a third component. 'Readiness to practice/NCLEX pass’ was another concept used in two of the studies while 'cognitive development' was listed as a component of CT-DM in one article.

While the operational definitions of CT-DM were varied, the number of remaining dependent variables used in the studies is indicative of a lack of consensus regarding what concepts should be measured within the phenomenon of the pre-novice. The articles that studied pre-graduate nursing students (Appendix A) explored the dependent variables of 'satisfaction and confidence’ (4), 'open-mindedness' (1), 'truth-seeking' (2), and 'judiciousness/maturity of judgment' (1).

Among the articles exploring the issues of new graduate nurses transitioning to practice (Appendix B), 'job satisfaction' (5) was the most frequently studied dependent variable. 'Intent to leave', was also a variable studied but in variations such as 'intended/actual turnover from organization' (4), 'intended/ actual turnover from profession' (1), and occupational commitment (2). Remaining variables included presence or absence of 'support' (2), 'stressors’ (1), 'empowerment' (1), 'environment and ethical climate’ (1) and 'sense of belonging, accomplishment, worth and recognition' (1). 'Confidence in reasoning’ and 'competence' were the only two variables studied in both the pre-graduate nursing students and new graduate nurses (4).

As with the diversity of theoretical frameworks, so too is the wide variance in those concepts researchers studied in an effort to enhance CT-DM in pre-graduates and improve new graduation adaptation to practice. This lack of agreement across the literature regarding consistent variables being studied undermines the development of a solid base of knowledge to aid the understanding of how to successfully educate and transition new nurses into practice. Finally, it should be noted that among all of the studies included in this review, there were (37) different tools used to collect the data with only one of the tools being used more than once: the California Critical Thinking Disposition Inventory which was used in two studies. Reliability and validity for the quantitative tools were presented adequately in <30% of the literature and trustworthiness as an indicator of the rigor of the qualitative studies was acknowledged and well-described in <20% of the studies in which this level of description is expected.

    Findings and Gaps

What is known

Potential healthcare employers of new graduates expect competent, prepared nurses capable of providing safe nursing care. Nurse residency programs, changes in orientation and mentoring and the exploration of factors impacting outcomes are being studied. The issues with transition to practice of new graduate nurses has been well-established and extensively researched yet we still have unacceptably high rates of turnover, burnout and intent to leave a position or the profession [14-27].

Organizations with an interest in nursing education are committing vast resources with the intent oftrying to improve the quality and marketability of new graduates. Colleges of nursing are facing barriers to providing those learning opportunities necessary to ensure new graduates have the critical thinking and decision-making capabilities to 'hit the ground running' in an environment that is faster paced and more technologically advanced than at any time in the past. Challenges such as competition for clinical sites, faculty shortages and restrictions on student access to electronic medical records have driven nursing programs to integrate simulation and virtual scenarios into their curriculum. While organizations and accrediting bodies have granted some leniency on the required clinical hours allowing educational institutions to use simulation as an alternative to traditional direct live patient interactions, the literature regarding the benefits of this teaching strategy remain highly contradictory [28-37].

Where do we go from here?

As is evident from this integrated review of the literature, the problem of new nurse transition to practice remains. While nurse residency programs and changes on the employer side and the integration of questionably beneficial simulation on the educator side are being implemented, we are missing the connection between the two arenas. The lack of consistent theoretical underpinnings reaching from the nursing student through to the practicing nurse may well be the missing link.

While Patricia Benner’s (1984) Novice to Expert Theory is widely used in both the academic and practice realms as a foundation for understanding how a nurse develops; she defines the nurse at the novice level as including nursing students, new graduate nurses and those nurses changing specialty work areas [38-48] such as moving from a medical-surgical unit to a labor and delivery unit. Based on this definition, pre-graduate nursing students who have not yet completed their formal education to become a registered nurse (RN) nor taken and passed the licensure exam or independently practiced nursing in any setting are grouped together with those nurses who have completed these tasks.

This researcher proposes and has begun research preparations under the premise that there is a difference between the nursing student, specifically the pre-licensed, undergraduate junior/senior level bachelor of science in nursing (BSN) student, and other novices as described in the current theory; a phenomenon which occurs before the novice stage...the pre-novice. Questions such as "Is there a need for an extension of this theory to include the pre-novice? Are these pre-novices developmentally different and unique?" are not only valuable, they are crucial. If we discover that these pre-novices are developmentally different from those other novices, future research on how to improve or facilitate the developmental process of the pre-novice nursing student will allow curricular decisions to be made on a strong theoretical foundation. Preparing our new graduates to provide safe and effective, high quality care begins during their student journey - before they are faced with the challenges inherent in the transition to practice.

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[rationalsanskar]

A Cultural Sea Change: Mindfulness for Surgical Residents

The Problem

Burnout, an occupational syndrome included in the World Health Organization’s International Classification of Diseases, 11th Revision, has been defined as a “prolonged response to chronic interpersonal stressors on the job.”

Burnout contributes to surgeons’ medical errors and lapses in professionalism. Despite how widespread burnout, depression, and suicidality are among surgeons, evidence-based interventions that ease their debilitating effects remain scarce.

In an effort to fill this gap, researchers at the University of California, San Francisco (UCSF) have turned to mindfulness practices for solutions. Mindfulness is “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally,” according to Jon Kabat-Zinn, PhD, an emeritus professor of medicine at the University of Massachusetts Medical School who developed secular MBSR and is largely credited for introducing mindfulness into Western medicine. Previous studies suggest such mindfulness-based interventions can improve the resilience, affect, executive function, and performance among people in other high-stress professions.

In 2018, the UCSF team reported that tailored MBSR training was feasible and useful among 21 surgical residents in a pilot clinical trial. In their recent JNO follow-up study, the researchers analyzed the program’s effects on these trainees’ well-being and performance.

The Design

First-year surgical residents were randomized to modified MBSR training or an active control group. The MBSR group participated in an 8-week program that comprised weekly 2-hour classes and daily 20-minute home practice including body awareness, yoga, meditation, and transition breathing sessions. The control group had similar class-time and home-practice requirements that explored topics such as perseverance, honesty, self-care, and the ethos of surgery.

Using validated surveys and tests, the researchers measured postintervention changes in the following outcomes:

Perceived stress (primary)

Functional neuroimaging during an emotional regulation task

Key Findings

The MBSR group had half as much perceived stress and twice as much mindfulness as the control group, differences that were associated with medium to large effect sizes.

Motor performance and aspects of executive function, including working memory capacity, improved in the MBSR group compared with the control group. Associated effect sizes were medium to large.

In contrast, burnout increased to a similar degree in both groups.

Depressive symptoms increased twice as much in the control group compared with the MBSR group.

The MBSR group showed greater activation in brain regions associated with executive function and self-awareness during an emotional regulation task.

However, none of the changes in any outcomes were significantly different between groups. The study was not powered to detect such differences.

A Word of Caution

Given the study’s small sample size and single-institution setting, the results should be interpreted cautiously, the authors noted.

“The mindfulness exercises reported did not yield statistically significant differences between groups, suggesting that mindfulness itself may not be effective,” said Edward Livingston, MD, JAMA deputy editor and professor of surgery at UCLA, who was not involved in the study. However, because these are preliminary studies, the findings aren’t definitive, he added.

Mindfulness vs Autopilot

In an editorial accompanying the recent study, Brooke Gurland, MD, clinical professor of surgery at Stanford University, wrote that current surgical training doesn’t address “the emotional consequences of life-and-death decision-making or the impact of surgical complications on surgeon well-being.”

The surgical training culture has long rested on the notion that sleep deprivation, constant challenges, and brutalization were necessary to ensure that exhausted surgeons would be on autopilot to respond appropriately to dramatic events, Livingston explained.

The thinking went that “when a surgeon steps back to reflect on the experience of being a surgeon, there is a high likelihood he or she will crack, ” he said. “Mindfulness is a process of refocusing the brain, to take it out of autopilot mode.”

By switching off autopilot, mindfulness-based interventions may reduce stress and strengthen a person’s ability to tolerate uncomfortable experiences through cultivating nonreactivity to difficult thoughts, events, and emotions, according to the study authors.

The Take Away

Mindfulness-based stress reduction training may help mitigate stress and enhance executive function among surgeons, but larger, more definitive trials are needed, the authors wrote.

The take-away message is “that burnout and health care reform for physician well-being are of paramount importance” and the study’s tailored MBSR program “shows highly promising impact on stress and executive function,” lead author Carter Lebares, MD, assistant professor of surgery at UCSF, said in an interview.

Why Is This Important?

Physician stress, burnout, depression, and other mental health concerns aren’t limited to surgical residents. Case in point: a recent survey of US ophthalmology residents found that 68.4% of respondents reported their program faced issues with depression, burnout, or suicide among trainees in the past year.

In recognition of this pervasive problem, the Accreditation Council for Graduate Medical Education (ACGME) recently introduced new requirements aimed at promoting a “culture of well-being” in physician training programs. The authors of the JNO study point out that mindfulness-based interventions are “a promising means to address [ACGME] programming mandates.”

However, the importance of the study may ultimately lie not in the specific intervention or outcomes, but rather in acknowledging that physicians are stressed and that this has adverse consequences, according to Livingston. “[T]he basic concept of addressing the stress surgeons experience and changing the culture of surgery so that it is allowable for surgeons to seek help is an important advance,” he added.

Looking Ahead

The researchers plan to test their MBSR intervention in larger populations of surgeons and in other contexts, such as the military and trauma, according to Lebares.

This content was originally published here.

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Top Medical Residency Programs for International Students

If you want to be accepted in an international medical residency programs, there are numerous choices you can choose from in the following. Now if you are planning to apply for medical residency programs internationally, you need to ensure that you get the best quality education that you deserve back home. Keep reading for medical residency USA international students and medical letter of recommendation guide.

List of Medical Residency for International Students

University of Washington: This is one of the surgical residency programs for international medical graduates program you can choose and each year, the surgery department is offering four visiting sub-internship positions to IMGs’ who are interested to pursue a preliminary position in the school residency program. Upon completion, students can apply for their preliminary residency program via ERAS. Students in the program physician’s certification will get 16 continuing units as well as certificate upon completion at the end of the year. 

Stanford University: Emergency care systems play a great role in the health care of a country that is why Stanford University is offering emergency medicine program. The emergency medicine residency international medical graduates program is a 1-year program with optional 2nd year for students who want to obtain an associated Masters degree. With the program, students can build the skills they need to work in developing nations as well as participate in different ongoing international health programs. The emergency medicine program focuses on the human development through emergency care systems, research and education.

Emory University: The University is offering preventive medical residency for international graduates. In the year 1994, the school received full accreditation and trained more than 40 residents. The program is flexible to accommodate individuals with diverse interests and backgrounds. The preventive medicine program seeks to train students to become board certified specialists in public health and general preventive medicine with potential to become policy, industry and academic leaders.

University of Berkeley: The University is offering ophthalmology residency for international medical graduate student doctor and they accept international student applications who meet all the requirements. On the other hand, the school does not offer advanced standing for foreign-trained ophthalmologist, opticians or optometrists.

John Hopkins University: John Hopkins University offers neurology residency international medical graduates. They are a global leader, wherein numerous leaders and students benefit from their offered program.

University of Michigan: The institution medical school was founded in 1850 and they were the first medical university in US to recognize the essence of and to build, a school hospital for physician instruction. They are a pioneer in the modern science-based curriculum and they are also the first university to change the student role from passive observer up to active participant in learning process of clerkships and laboratory instruction.

EVMS: The school is the only universities of medicine and health professions founded by the community. They are focused on preparing student and giving them the best health care education that they deserve. They have a vision to become the best community-oriented college of medicine and health professions in US. The school is offering preliminary surgical residency programs for international medical graduates.

 Keck University: The school offers ophthalmology residency for international medical graduates. They are one of the top 10 private research schools and ranked on the top 25 of United States medical schools when it comes to federal research support. The faculty physicians educate students, oversee patient care and lead research investigations in the university’s 5 partner hospitals. Their faculty does not only teach biological and medical science, but they actively contribute to the new knowledge creation at the same time give students a great hands-on education.

University of Oxford: The medical science department is internationally recognized center for excellence in clinical and biomedical research as well as teaching. They aim to become the best school for biomedical and they have commitment to give an inclusive environment that promotes values diversity, equality and maintains a social and learning environment in which the dignity and rights of all its students and staff are respected.

BUMC: The medical school is situated in South End of Boston. The medical school of the institution started its history as New England Female Medical College that opened in 1848 as the first university in the world offering medicine education to women. Throughout their history, they maintained a great commitment to practice and study medicine in the context of service to society. The school is home to one of the rapidly growing and largest research programs around the world.

UAB: The objective of the program is to prepare highly qualified and highly skilled international physicians to become the best health care leaders. They accomplish it by giving strong research and clinical experience. Throughout the program, they actively participate as well as work alongside researchers, students and education of current United States medical system.

University of Toronto: The University is the most diverse and largest academic department of Gynecology and Obstetrics that is represented by more than 324-faculty that is situated in 6 fully affiliated teaching as well as 9 community-affiliated associated hospitals and hospitals, including healthcare facilities in Ontario province. They are doing their best to give the best education that medical students need for a medical career. Their faculty exerts effort to make sure that they help students to the best they can.

Education and Career Path

It is essential to keep in mind that there is growing number of residency programs that developed to foster the physicians’ career development. After pursuing subspecialty clinical training and residency education, they can apply for cardiology, hematology-oncology, pediatrics or medicine.

Certification, licensure and continuing medical education:

Physicians need to obtain a licensure in the nation in which they practice their chosen specialties

24 specialty boards present criteria that physicians need to meet to be certified

Specialty boards require recertification on regular basis

Degree level: M.D. or D.O

Degree fields: Pre-med, then medical school

License or certification: All states require license or certifications

Experience: 3 to 7 year residency, which is required for licensure

Key skills:

Leadership, problem solving, communication and empathy

Proficiency with specialized tools as well as technology, ability to handle stress and emotional stability

Why Medical Residency for International Students Is Popular

Residency programs are the next professional step after graduates earn their Doctor of Medicine degree. They will get their specialty training after participating in the National Residency Match program. Residency programs for international medical graduates are popular because they further the education of students. They help students to fund their education without investing much money.

Why Choose from the Best List

If you want to become a medical practitioner, you need to make sure that you possess all the knowledge, skills and training so that you will become in demand and easily seek a job.

With the listed schools for residency programs for medicine, you can get more ideas about your chosen medical program. They will help you to become exposed on challenges. These programs can also help you cope up and succeed with the help of their well-distinguished faculty. With the best medical residency programs, you are assured to get a high quality education that you deserve. Their faculty will help you to be well equipped and to know more about the latest medical technologies.

Medical Residency USA International Students General Requirements

To apply for residency program in US, applicants need to be certified by the Educational Commission for Foreign Medical Graduates or ECFMG – an organization that evaluates whether applicants are prepared for the United States medical residency program or not.

Educational requirements: As an international medical graduate, applicants need to have a completed degree at medical institutions that have been approved by ECFMG.

Examination requirements: To have an ECFMG certification, applicants need to pass the USMLE step one and step two of U.S medical licensing examination. The first step test is to test the knowledge of applicants about medical science, while the second test will assess applicant’s clinical skills.

ECFMG application: To be certified, applicants need to submit their application form to ECFMG.

Visa requirements: For applicants who are not legal resident or citizen of U.S, they need to get a visa. There are two visa options for applications; the H1-B and J-1 visas. After applicants are accepted to the residency program, their visa may be sponsored by their university or by ECFMG. 

Residency program requirements:

Medical school graduation year

Number of attempts on USMLE

Type of visa

Medical letter of recommendation from United States based providers

Previous clinical experience in US

Other Universities Offering Residency Programs for International Students

Here are other schools that you might want to check out to know their offered medical programs:

UNC

Harvard University

Kenyon College

University of Maryland

If you are looking for medical surgery residency international opportunity or surgery residency international medical graduates, it is essential to visit the website of the program so that you will get the full information about the application requirements and process. In applying, you need to ensure that you complete all the requirements and submit them on time. Do your best to get into the school you are dreaming of for quality education.

Increase your chances for international medical residency programs. Seek expert help for application papers today!