Background Physicians in training are at high risk for depression, and physicians in practice have a substantially elevated risk of suicide compared to the general population. The graduate medical education community is currently mobilizing efforts to improve resident wellness. Objective We sought to provide a trainee perspective on current resources to support resident wellness and resources that need to be developed to ensure an optimal learning environment. Methods The ACGME Council of Review Committee Residents, a 29-member multispecialty group of residents and fellows, conducted an appreciative inquiry exercise to (1) identify existing resources to address resident wellness; (2) envision the ideal learning environment to promote wellness; and (3) determine how the existing infrastructure could be modified to approach the ideal. The information was aggregated to identify consensus themes from group discussion. Results National policy on resident wellness should (1) increase awareness of the stress of residency and destigmatize depression in trainees; (2) develop systems to identify and treat depression in trainees in a confidential way to reduce barriers to accessing help; (3) enhance mentoring by senior peers and faculty; (4) promote a supportive culture; and (5) encourage additional study of the problem to deepen our understanding of the issue. Conclusions A multispecialty, national panel of trainees identified actionable goals to broaden efforts in programs and sponsoring institutions to promote resident wellness and mental health awareness. Engagement of all stakeholders within the graduate medical education community will be critical to developing a comprehensive solution to this important issue.

The ACGME News and Views section of JGME includes data reports, updates, and perspectives from the ACGME and its review committees. The decision to publish the article is made by the ACGME.

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The Resident Mentorship Milestones, developed by a national panel of residents, describe 3 key dimensions of mentorship: availability, defined as making time for mentorship; competence for and success in mentoring; and support of the mentee. These milestones may serve as a novel tool to develop and assess successful resident mentorship models.

Surgical residency programs have long sought objective measures of determining applicants' long-term success, given the limited training positions and significant time and money expended in their training. Current data to evaluate and rank applicants focus on academic and standardized test performance, letters of recommendation, honor society membership, and research experience. Spatial and manual skills currently are not assessed as part of the application process.We hypothesized that dexterity and visual spatial testing of applicants for general surgery and otolaryngology residency provides information that is not assessed through the current process, and that these assessments would not correlate with the variables traditionally used to rank applicants. Additionally, we wanted to assess whether these tests could be completed during a single scheduled interview day without significant disruption to the interview structure. MethodsMedical student applicants to our institution's general surgery and otolaryngology residency programs were included in the study. Applicants interviewed were given the option to participate in the study or to decline but still undergo testing to blind faculty to an individual's participation status. AbstractBackground Manual dexterity and visual spatial ability are not routinely used to evaluate candidates for surgical residency training as part of the application interview.

An African American man in his 40s initially presented with a sudden-onset unilateral hearing loss with associated vertigo and tinnitus. His medical history was unremarkable, and he specifically had no history of any auditory or vestibular symptoms. Results from his physical examination were also unremarkable and demonstrated normal otoscopic and neurologic findings. Audiometry results revealed a moderate right-sided sensorineural hearing loss across all frequencies (250-8000 Hz). Prior audiograms were unavailable for comparison. The patient was treated with tapered prednisone therapy and scheduled for magnetic resonance imaging (MRI) radiographic evaluation. Subsequent clinical and audiology evaluations at 1 week and 1 month demonstrated an almost complete resolution of his hearing loss and vertigo symptoms. His MRI was obtained 2 months after onset of his symptoms with the enhancement pattern shown (Figure). What is your diagnosis?A B Figure. Magnetic resonance images. A, Nodular enhancement of the right cerebello-pontine angle that extended laterally to the right porous acusticus and of the right sylvian fissure. B, A smooth enhancement of the anterior pons extending across the midline to the left pontine angle.

Objectives The combined impact of variable surgeon prescribing preferences and low resident prescribing comfort level can lead to significant disparity in opioid prescribing patterns for the same surgery in the same academic surgical practice. We report the results of a resident led initiative to standardize postoperative prescription practices within the Department of Otolaryngology at a single tertiary‐care academic hospital in order to reduce overall opioid distribution. Study Design Retrospective cohort study. Methods Following approval by the Institutional Review Board, performed a retrospective review of 12 months before (July 2016–June 2017) and after (July 2017–June 2018) implementation of the Postoperative Analgesia Protocol, which included all adults undergoing tonsillectomy, septoplasty, thyroidectomy, parathyroidectomy, tympanoplasty, middle ear exploration, stapedectomy, and ossicular chain reconstruction. Results Seven hundred and thirty eight procedures met inclusion criteria. Following implementation, total morphine milligram equivalents decreased by 26% (P < .0001). The number of patients requiring opioid refills decreased by 49%, and morphine milligram equivalents received as refills decreased by 16% (P < .001). Thyroid and parathyroid surgery had the greatest reduction in morphine milligram equivalents prescribed (84%, P < .001), followed by septoplasty (30%, P = .001) and tonsillectomy (18%, P < .001). The number of patients receiving refills of opioid medications decreased for all procedures (tonsillectomy 54%; septoplasty 67%; thyroid/parathyroid surgery 80%, middle ear surgery 100%). Conclusions While every patient and surgery must be treated individually, this study demonstrates that a resident led standardization of pain control regimes can result in significant reductions in total quantity of opioids prescribed. Level of Evidence IV Laryngoscope, 131:982–988, 2021

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