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Desy J, Mineyko A, Davis M, McLaughlin K. We should use learning rather than short-term performance to evaluate the effectiveness of undergraduate remediation. MEDICAL TEACHER 2023:1-3. [PMID: 38104564 DOI: 10.1080/0142159x.2023.2292481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Janeve Desy
- Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aleksandra Mineyko
- Office of Postgraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Melinda Davis
- Office of Postgraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin McLaughlin
- Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Santen SA, Hemphill RR, Pusic M, Cico SJ, Wolff M, Merritt C. Our responsibility to patients: Maintain competency or … stop practicing. AEM EDUCATION AND TRAINING 2023; 7:e10916. [PMID: 37997590 PMCID: PMC10664403 DOI: 10.1002/aet2.10916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/06/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Sally A. Santen
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Office of the DeanVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | | | - Martin Pusic
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
- American Board of Medical SpecialtiesChicagoIllinoisUSA
| | - Stephen John Cico
- Department of Emergency Medicine & Pediatrics College of MedicineUniversity of Central FloridaOrlandoFloridaUSA
| | - Meg Wolff
- Department of Emergency Medicine & PediatricsUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Chris Merritt
- Department of Emergency MedicineAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
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Ryan MS, Lomis KD, Deiorio NM, Cutrer WB, Pusic MV, Caretta-Weyer HA. Competency-Based Medical Education in a Norm-Referenced World: A Root Cause Analysis of Challenges to the Competency-Based Paradigm in Medical School. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1251-1260. [PMID: 36972129 DOI: 10.1097/acm.0000000000005220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Competency-based medical education (CBME) requires a criterion-referenced approach to assessment. However, despite best efforts to advance CBME, there remains an implicit, and at times, explicit, demand for norm-referencing, particularly at the junction of undergraduate medical education (UME) and graduate medical education (GME). In this manuscript, the authors perform a root cause analysis to determine the underlying reasons for continued norm-referencing in the context of the movement toward CBME. The root cause analysis consisted of 2 processes: (1) identification of potential causes and effects organized into a fishbone diagram and (2) identification of the 5 whys. The fishbone diagram identified 2 primary drivers: the false notion that measures such as grades are truly objective and the importance of different incentives for different key constituents. From these drivers, the importance of norm-referencing for residency selection was identified as a critical component. Exploration of the 5 whys further detailed the reasons for continuation of norm-referenced grading to facilitate selection, including the need for efficient screening in residency selection, dependence upon rank-order lists, perception that there is a best outcome to the match, lack of trust between residency programs and medical schools, and inadequate resources to support progression of trainees. Based on these findings, the authors argue that the implied purpose of assessment in UME is primarily stratification for residency selection. Because stratification requires comparison, a norm-referenced approach is needed. To advance CBME, the authors recommend reconsideration of the approach to assessment in UME to maintain the purpose of selection while also advancing the purpose of rendering a competency decision. Changing the approach will require a collaboration between national organizations, accrediting bodies, GME programs, UME programs, students, and patients/societies. Details are provided regarding the specific approaches required of each key constituent group.
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Affiliation(s)
- Michael S Ryan
- M.S. Ryan is professor and associate dean for assessment, evaluation, research and innovation, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, and a PhD student, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0003-3266-9289
| | - Kimberly D Lomis
- K.D. Lomis is vice president, undergraduate medical education innovations, American Medical Association, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-3504-6776
| | - Nicole M Deiorio
- N.M. Deiorio is professor and associate dean for student affairs, Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia; ORCID: https://orcid.org/0000-0002-8123-1112
| | - William B Cutrer
- W.B. Cutrer is associate professor of pediatrics and associate dean for undergraduate medical education, Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0003-1538-9779
| | - Martin V Pusic
- M.V. Pusic is associate professor of emergency medicine and pediatrics, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-5236-6598
| | - Holly A Caretta-Weyer
- H.A. Caretta-Weyer is assistant professor and associate residency director, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California; ORCID: https://orcid.org/0000-0002-9783-5797
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Santen SA, Hemphill RR. Embracing our responsibility to ensure trainee competency. AEM EDUCATION AND TRAINING 2023; 7:e10863. [PMID: 37013132 PMCID: PMC10066499 DOI: 10.1002/aet2.10863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Sally A. Santen
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Virginia Commonwealth University School of MedicineRichmondVirginiaUSA
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Katsufrakis PJ, Chaudhry HJ. Evolution of Clinical Skills Assessment in the USMLE: Looking to the Future After Step 2 CS Discontinuation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1236-1238. [PMID: 34166234 DOI: 10.1097/acm.0000000000004214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic interrupted administration of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) exam in March 2020 due to public health concerns. As the scope and magnitude of the pandemic became clearer, the initial plans by the USMLE program's sponsoring organizations (NBME and Federation of State Medical Boards) to resume Step 2 CS in the short-term shifted to long-range plans to relaunch an exam that could harness technology and reduce infection risk. Insights about ongoing changes in undergraduate and graduate medical education and practice environments, coupled with challenges in delivering a transformed examination during a pandemic, led to the January 2021 decision to permanently discontinue Step 2 CS. Despite this, the USMLE program considers assessment of clinical skills to be critically important. The authors believe this decision will facilitate important advances in assessing clinical skills. Factors contributing to the decision included concerns about achieving desired goals within desired time frames; a review of enhancements to clinical skills training and assessment that have occurred since the launch of Step 2 CS in 2004; an opportunity to address safety and health concerns, including those related to examinee stress and wellness during a pandemic; a review of advances in the education, training, practice, and delivery of medicine; and a commitment to pursuing innovative assessments of clinical skills. USMLE program staff continue to seek input from varied stakeholders to shape and prioritize technological and methodological enhancements to guide development of clinical skills assessment. The USMLE program's continued exploration of constructs and methods by which communication skills, clinical reasoning, and physical examination may be better assessed within the remaining components of the exam provides opportunities for examinees, educators, regulators, the public, and other stakeholders to provide input.
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Affiliation(s)
- Peter J Katsufrakis
- P.J. Katsufrakis is president and CEO, NBME, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0001-9077-9190
| | - Humayun J Chaudhry
- H.J. Chaudhry is president and CEO, Federation of State Medical Boards, Euless, Texas; ORCID: https://orcid.org/0000-0003-3356-1106
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Beck Dallaghan GL, Alexandraki I, Christner J, Keeley M, Khandelwal S, Steiner B, Hemmer PA. Medical School to Residency: How Can We Trust the Process? Cureus 2021; 13:e14485. [PMID: 34007741 PMCID: PMC8121123 DOI: 10.7759/cureus.14485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background To say that the transition from undergraduate medical education (UME) to graduate medical education (GME) is under scrutiny would be an understatement. Findings from a panel discussion at the 2018 Association of American Medical Colleges Annual meeting entitled, “Pass-Fail in Medical School and the Residency Application Process and Graduate Medical Education Transition” addressed what and when information should be shared with residency programs, and how and when that information should be shared. Materials and Methods Over 250 participants representing UME and GME (e.g. leadership, faculty, medical students) completed worksheets addressing these questions. During report-back times, verbal comments were transcribed in real time, and written comments on worksheets were later transcribed. All comments were anonymous. Thematic analysis was conducted manually by the research team to analyze the worksheet responses and report back comments. Results Themes based on suggestions of what information should be shared included the following: 1) developmental/assessment benchmarks such as demonstrating the ability/competencies to do clinical work; 2) performance on examinations; 3) grades and class ranking; 4) 360 evaluations; 5) narrative evaluations; 6) failures/remediation/gaps in training; 7) professionalism lapses; 8) characteristics of students such as resiliency/reliability; and 9) service/leadership/participation. In terms of how this information should be shared, the participants suggested enhancements to the current process of transmitting documents rather than alternative methods (e.g., video, telephonic, face-to-face discussions) and information sharing at both the time of the match and again near/at graduation to include information about post-match rotations. Discussion Considerations to address concerns with the transition from medical school to residency include further enhancements to the Medical Student Performance Evaluation, viewing departmental letters as ones of evaluation and not recommendation, a more meaningful educational handoff, and limits on the number of residency applications allowed for each student. The current medical education environment is ready for meaningful change in the UME to GME transition.
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Affiliation(s)
- Gary L Beck Dallaghan
- Office of Medical Education, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
| | - Irene Alexandraki
- Medicine, Florida State University College of Medicine, Tallahassee, USA
| | | | - Meg Keeley
- Pediatrics, University of Virginia School of Medicine, Charlottesville, USA
| | - Sorabh Khandelwal
- Emergency Medicine, The Ohio State University College of Medicine, Columbus, USA
| | - Beat Steiner
- Family Medicine, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Paul A Hemmer
- Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
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Desy J, Harvey A, Busche K, Weeks S, Paget M, Naugler C, Welikovitch L, McLaughlin K. COVID-19, curtailed clerkships, and competency: Making graduation decisions in the midst of a global pandemic. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e181-e187. [PMID: 33349776 PMCID: PMC7749667 DOI: 10.36834/cmej.70432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Janeve Desy
- Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Adrian Harvey
- Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kevin Busche
- Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Sarah Weeks
- Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Michael Paget
- Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Christopher Naugler
- Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Lisa Welikovitch
- Office of Post-graduate Medical Education, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kevin McLaughlin
- Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Student Discipline. The Construction and Use of Warnings Concerning Past Behaviour. HEALTH PROFESSIONS EDUCATION 2020. [DOI: 10.1016/j.hpe.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bartley GB. Verifying Surgical Competence: Our Fiduciary Responsibility. Ophthalmology 2020; 127:997-999. [PMID: 32703391 DOI: 10.1016/j.ophtha.2020.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/18/2020] [Indexed: 10/23/2022] Open
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