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Caretta-Weyer HA, Park YS, Tekian A, Sebok-Syer SS. The Inconspicuous Learner Handover: An Exploratory Study of U.S. Emergency Medicine Program Directors' Perceptions of Learner Handovers from Medical School to Residency. TEACHING AND LEARNING IN MEDICINE 2024; 36:134-142. [PMID: 36794363 DOI: 10.1080/10401334.2023.2178438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 01/13/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
Phenomenon: Central to competency-based medical education is the need for a seamless developmental continuum of training and practice. Trainees currently experience significant discontinuity in the transition from undergraduate (UME) to graduate medical education (GME). The learner handover is intended to smooth this transition, but little is known about how well this is working from the GME perspective. In an attempt to gather preliminary evidence, this study explores U.S. program directors (PDs) perspective of the learner handover from UME to GME. Approach: Using exploratory qualitative methodology, we conducted semi-structured interviews with 12 Emergency Medicine PDs within the U.S. from October to November, 2020. We asked participants to describe their current perception of the learner handover from UME to GME. Then we performed thematic analysis using an inductive approach. Findings: We identified two main themes: The inconspicuous learner handover and barrier to creating a successful UME to GME learner handover. PDs described the current state of the learner handover as "nonexistent," yet acknowledged that information is transmitted from UME to GME. Participants also highlighted key challenges preventing a successful learner handover from UME to GME. These included: conflicting expectations, issues of trust and transparency, and a dearth of assessment data to actually hand over. Insights: PDs highlight the inconspicuous nature of learner handovers, suggesting that assessment information is not shared in the way it should be in the transition from UME to GME. Challenges with the learner handover demonstrate a lack of trust, transparency, and explicit communication between UME and GME. Our findings can inform how national organizations establish a unified approach to transmitting growth-oriented assessment data and formalize transparent learner handovers from UME to GME.
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Affiliation(s)
- Holly A Caretta-Weyer
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Yoon Soo Park
- Department of Medical Education and Office of International Education, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ara Tekian
- Department of Medical Education and Office of International Education, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Stefanie S Sebok-Syer
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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Fuller SL, Ambardekar AP, Diachun CAB, Kearney MD, Long TR, Miller Juve AK, Mitchell JD, Woodworth GE. Competency-Based Time-Variable Anesthesiology Residency Training: Identification of Problems and Solutions. Anesth Analg 2024; 138:848-855. [PMID: 37450642 DOI: 10.1213/ane.0000000000006625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Global medical education is gradually moving toward more comprehensive implementations of a competency-based education (CBE) model. Elimination of standard time-based training and adoption of time-variable training (competency-based time-variable training [CB-TVT]) is one of the final stages of implementation of CBE. While CB-TVT has been implemented in some programs outside the United States, residency programs in the United States are still exploring this approach to training. The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) are encouraging member boards and residency review committees to consider innovative ways programs could implement CB-TVT. The goals of this study were to (1) identify potential problems with the implementation of CB-TVT in anesthesiology residency training, (2) rank the importance of the problems and the perceived difficulty of solving them, and (3) develop proposed solutions to the identified problems. METHODS Study participants were recruited from key stakeholder groups in anesthesiology education, including current or former program directors, department chairs, residents, fellows, American Board of Anesthesiology (ABA) board members, ACGME residency review committee members or ACGME leaders, designated institutional officials, residency program coordinators, clinical operations directors, and leaders of large anesthesiology community practice groups. This study was conducted in 2 phases. In phase 1, survey questionnaires were iteratively distributed to participants to identify problems with the implementation of CB-TVT. Participants were also asked to rank the perceived importance and difficulty of each problem and to identify relevant stakeholder groups that would be responsible for solving each problem. In phase 2, surveys focused on identifying potential solutions for problems identified in phase 1. RESULTS A total of 36 stakeholders identified 39 potential problems, grouped into 7 major categories, with the implementation of CB-TVT in anesthesiology residency training. Of the 39 problems, 19 (48.7%) were marked as important or very important on a 5-point scale and 12 of 19 (63.2%) of the important problems were marked as difficult or very difficult to solve on a 5-point scale. Stakeholders proposed 165 total solutions to the identified problems. CONCLUSIONS CB-TVT is a promising educational model for anesthesiology residency, which potentially results in learner flexibility, individualization of curricula, and utilization of competencies to determine learner advancement. Because of the potential problems with the implementation of CB-TVT, it is important for future pilot implementations of CB-TVT to document realized problems, efficacy of solutions, and effects on educational outcomes to justify the burden of implementing CB-TVT.
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Affiliation(s)
- Skylar L Fuller
- From the Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Aditee P Ambardekar
- Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Carol Ann B Diachun
- Department of Anesthesiology, University of Florida-Jacksonville, Jacksonville, Florida
| | - Matthew D Kearney
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Timothy R Long
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Amy K Miller Juve
- From the Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - John D Mitchell
- Department of Anesthesiology, Critical Care, and Perioperative Medicine, Henry Ford Health, Detroit, Michigan
| | - Glenn E Woodworth
- From the Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
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Sibicky SL, Daugherty KK, Chen AMH, Rhoney D, Nawarskas J. Enabling Factors for the Implementation of Competency-Based Curricula in Colleges and Schools of Pharmacy. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100681. [PMID: 38460599 DOI: 10.1016/j.ajpe.2024.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 09/22/2023] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES To review the implementation drivers of competency-based pharmacy education (CBPE) and provide recommendations for enablers. FINDINGS Competency-based education is an emerging model in the health professions, focusing on time-variable competency development and achievement compared with a time-bound, course-based, traditional model. CBPE is an outcomes-based organized framework of competencies enabling pharmacists to meet health care and societal needs. However, challenges need to be recognized and overcome for the successful implementation of CBPE. Competency drivers include defining the competencies and roles of stakeholders, developing transparent learning trajectories and aligned assessments, and establishing lifetime development programs for stakeholders. Organization drivers include developing support systems for stakeholders; facilitating connections between all educational experiences; and having transparent assessment plans, policies, and procedures that align with core CBPE precepts, including the sustainability of time-variability. Leadership drivers include establishing growth mindset and facilitating a culture of connection between workplace and educational environments, program advocacy by institutional leaders, accepting failures as part of the process, shifting the organizational culture away from learner differentiation toward competence, and maintaining sufficient administrative capability to support CBPE. SUMMARY The successful implementation of CBPE involves enabling the competency, organization, and leadership drivers that will lead to program success. More research is needed in the areas of creation, implementation, and assessment of CBPE to determine success in this model. We have reviewed and provided recommendations to enable the drivers of successful implementation of CBPE.
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Affiliation(s)
- Stephanie L Sibicky
- Northeastern University School of Pharmacy and Pharmaceutical Sciences, Boston, MA, USA.
| | - Kimberly K Daugherty
- Sullivan University College of Pharmacy and Health Sciences, Louisville, KY, USA
| | - Aleda M H Chen
- Cedarville University School of Pharmacy, Cedarville, OH, USA
| | - Denise Rhoney
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - James Nawarskas
- University of New Mexico College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
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Flinspach AN, Sterz J, Neef V, Flinspach MH, Zacharowski K, Ruesseler M, Janker L, Raimann FJ. Rise of public e-learning opportunities in the context of COVID-19 pandemic-induced curtailment of face-to-face courses, exemplified by epidural catheterization on YouTube. BMC MEDICAL EDUCATION 2023; 23:406. [PMID: 37277758 DOI: 10.1186/s12909-023-04409-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND In the context of the coronavirus pandemic, countless face-to-face events as well as medical trainings were cancelled or moved to online courses, which resulted in increased digitalization in many areas. In the context of medical education, videos provide tremendous benefit for visualizing skills before they are practised. METHODS Based on a previous investigation of video material addressing epidural catheterization available on the YouTube platform, we aimed to investigate new content produced in the context of the pandemic. Thus, a video search was conducted in May 2022. RESULTS We identified twelve new videos since the pandemic with a significant improvement in the new content in terms of procedural items (p = 0.03) compared to the prepandemic video content. Video content released in the course of the COVID-19 pandemic was more often created by private content creators and were significantly shorter in total runtime than those from university and medical societies (p = 0.04). CONCLUSION The profound changes in the learning and teaching of health care education in relation to the pandemic are largely unclear. We reveal improved procedural quality of predominantly privately uploaded content despite a shortened runtime compared to the prepandemic period. This might indicate that technical and financial hurdles to producing instructional videos by discipline experts have decreased. In addition to the teaching difficulties caused by the pandemic, this change is likely to be due to validated manuals on how to create such content. The awareness that medical education needs to be improved has grown, so platforms offer specialized sublevels for high-quality medical videos.
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Affiliation(s)
- Armin N Flinspach
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern Kai 7, 60590, Frankfurt/Main, Germany.
| | - Jasmina Sterz
- Institute for Medical Didactics and Clinical Simulation, medical faculty, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Vanessa Neef
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern Kai 7, 60590, Frankfurt/Main, Germany
| | - Mairen H Flinspach
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Sana Clinic Offenbach GmbH, Offenbach/Main, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern Kai 7, 60590, Frankfurt/Main, Germany
| | - Miriam Ruesseler
- Institute for Medical Didactics and Clinical Simulation, medical faculty, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Lena Janker
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern Kai 7, 60590, Frankfurt/Main, Germany
| | - Florian J Raimann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern Kai 7, 60590, Frankfurt/Main, Germany
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Kraakevik JA, Haedinger LA, Guzman CEV, Kahl L, Smeraglio A, Bonura E, Hasan R, Paquin A, Moulton B, Carney PA. Impact of Students' Scheduling Choice on Clerkship Examination Score Performance in a Time-Varying Competency-Based Curriculum. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:98-104. [PMID: 36576771 DOI: 10.1097/acm.0000000000004952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Standardized end-of-clerkship examinations typically occur on the last day of the clerkship. However, recent trends toward time-varying competency-based medical education have offered students more test scheduling flexibility, creating an opportunity to study the impact of student-selected examination timing. METHOD Starting with the graduating class of 2018, students took the required standardized end-of-core clerkship examinations at any available time they chose during their clinical years. Before this change, these examinations were administered to all students on the last day of the clerkship. Students' examination dates relative to clerkship completion were analyzed between 2017 and 2020 (inclusive of before and after flexible exam timing) to assess the impact that student-selected exam timing had on test performance on National Board of Medical Examiners shelf clinical science examinations for required core clerkships. RESULTS Data on 146 medical students in 2017 (fixed exam timing) and 466 medical students between 2018 and 2020 (flexible exam timing) were included. Among students offered flexible exam timing, between 2.7% (internal medicine) and 14.6% (psychiatry) took their exam before actually taking clerkship, while between 22.7% (psychiatry) and 40.0% (surgery) took their exam more than 90 days after the clerkship ended. Exam scores were statistically higher for those who took the exam at a time of their choosing compared with those who were required to take it at the end of individual rotations and when the exam scores were combined (fixed exam timing mean = 73.9, standard deviation [SD] = 7.8; flexible exam timing mean = 77.4, SD = 6.0, P < .001). The percent of students with passing scores was statistically higher in internal medicine, pediatrics, and psychiatry. CONCLUSIONS Self-selection of shelf exam timing appears to increase shelf exam scores. As more medical schools transition to competency-based medical education, providing scheduling flexibility appears not to negatively affect student achievement.
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Affiliation(s)
- Jeff A Kraakevik
- J.A. Kraakevik is associate professor of neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Leslie A Haedinger
- L.A. Haedinger is program manager, UME Assessments, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Cirila Estela Vasquez Guzman
- C.E.V. Guzman is assistant professor of family medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Leslie Kahl
- L. Kahl is professor of medicine, Division of Arthritis and Rheumatic Diseases, and associate dean, Strategic Initiatives, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Anne Smeraglio
- A. Smeraglio is assistant professor of medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Erin Bonura
- E. Bonura is assistant professor of medicine, Division of Infectious Diseases, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Reem Hasan
- R. Hasan is associate professor of medicine and associate professor of pediatrics, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Ashley Paquin
- A. Paquin is an internal medicine resident, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Bart Moulton
- B. Moulton is associate professor of medicine, Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Patricia A Carney
- P.A. Carney is professor of family medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon; ORCID: http://orcid.org/0000-0002-2937-655X
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Ryan MS, Iobst W, Holmboe ES, Santen SA. Competency-based medical education across the continuum: How well aligned are medical school EPAs to residency milestones? MEDICAL TEACHER 2022; 44:510-518. [PMID: 34807793 DOI: 10.1080/0142159x.2021.2004303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Competency-based medical education (CBME) provides a framework for describing learner progression throughout training. However, specific approaches to CBME implementation vary widely across educational settings. Alignment between various methods used across the continuum is critical to support transitions and assess learner performance. The purpose of this study was to investigate alignment between CBME frameworks used in undergraduate medical education (UME) and graduate medical education (GME) settings using the US context as a model. METHOD The authors analyzed content from the core entrustable professional activities for entering residency (Core EPAs; UME model) and residency milestones (GME model). From that analysis, they performed a series of cross-walk activities to investigate alignment between frameworks. After independent review, authors discussed findings until consensus was reached. RESULTS Some alignment was found for activities associated with history taking, physical examination, differential diagnosis, patient safety, and interprofessional care; however, there were far more examples of misalignment. CONCLUSIONS These findings highlight challenges creating alignment of assessment frameworks across the continuum of training. The importance of these findings includes implications for assessment and persistence of the educational gap across UME and GME. The authors provide four next steps to improve upon the continuum of education.
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Affiliation(s)
- Michael S Ryan
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - William Iobst
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
| | - Eric S Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
| | - Sally A Santen
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Hissink E, Fokkinga WA, Leunissen RRM, Lia Fluit CRMG, Loek Nieuwenhuis AFM, Creugers NHJ. An innovative interprofessional dental clinical learning environment using entrustable professional activities. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:45-54. [PMID: 33512747 PMCID: PMC9291122 DOI: 10.1111/eje.12671] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/14/2020] [Accepted: 01/22/2021] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Changes in society, new public demands for dental care and contemporary educational insights have influenced dental education worldwide and demand a renewed perspective. Following this perspective, an innovative interprofessional dental Master curriculum was developed at Radboud University Nijmegen in the Netherlands. EDUCATIONAL PRINCIPLES The curriculum is based on five contemporary educational principles and the core of the curriculum consists of a Student Run Dental Clinic that is fully run by students under professional supervision. THE NEW CURRICULUM In the Student Run Dental Clinic, Master dental students and Bachelor oral hygiene students are responsible for the care of approximately 750 patients. The students work within the same clinic for 3 years and patients receive oral health care from the same students over a long period. The clinic is a longitudinal cross-disciplinary clinic with different dental subdisciplines. Entrustable professional activities (also known as EPAs), to our knowledge not yet widely used in dental education, were introduced to facilitate learning and assessment. Fourteen EPAs have been developed to stimulate interprofessional education and learning. Of these, five EPAs are identical for the dental and oral hygiene curriculum, leading to extended interprofessional education and learning in the Student Run Dental Clinic. DISCUSSION Preliminary results show that EPAs are generally well received by supervisors and students. CONCLUSION To monitor and investigate the exact effect of the interventions and underlying mechanisms, a research programme on interprofessional learning, practice-based learning and EPAs and entrustment in dental education was recently set up.
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Affiliation(s)
- Elske Hissink
- Department of DentistryRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Wietske A. Fokkinga
- Department of DentistryRadboud University Medical CenterNijmegenThe Netherlands
| | - Ronald R. M. Leunissen
- Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - C. R. M. G. Lia Fluit
- Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Nico H. J. Creugers
- Department of DentistryRadboud University Medical CenterNijmegenThe Netherlands
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Muntz MD, Franco J, Ferguson CC, Ark TK, Kalet A. Telehealth and Medical Student Education in the Time of COVID-19-and Beyond. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1655-1659. [PMID: 35134026 PMCID: PMC8603435 DOI: 10.1097/acm.0000000000004014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The COVID-19 pandemic continues to limit medical students' full reintegration into clinical learning environments, thus exacerbating an ongoing challenge in identifying a robust number of clinical educational activities at excellent clinical sites for all students. Because medical students across the United States were removed from direct patient care activities in mid-March 2020 due to COVID-19, medical centers have prioritized and implemented changes to the process of patient care. As some barriers are being lifted in the face of a highly contagious and deadly infection, the use of telehealth (delivery of health services remotely via telephone, video, and secure messaging), although not new, is rapidly expanding into all aspects of patient care. Health care providers have been encouraged to conduct many interactions at a physical distance. Telehealth largely replaced face-to-face visits for nonemergency care in an attempt to slow viral transmission while enabling physicians to continue to deliver patient education, manage acute and chronic illness, and nurture caring doctor-patient relationships. Health care providers, many of whom were initially reluctant to embrace telehealth technology and logistics, are becoming nimbler and more aware of the many positive aspects of telehealth. The authors suggest that integrating medical students into telehealth activities would help maintain and improve patients' health, extend the capabilities of health care teams and systems during and after the pandemic, and increase medical students' opportunities for experiential learning and professional identity formation. The authors expand on these 3 goals, suggest several concrete student telehealth activities, propose a curricular strategy, and outline opportunities to overcome key barriers to full alignment of telehealth and undergraduate medical education.
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Affiliation(s)
- Martin D. Muntz
- M.D. Muntz is professor of medicine and curriculum pillar director, Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, and vice chair for faculty development, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; ORCID: http://orcid.org/0000-0001-5969-4754
| | - Jose Franco
- J. Franco is professor of medicine, surgery, and pediatrics, associate dean for educational improvement, and community and institutional engagement pillar director, Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Catherine C. Ferguson
- C.C. Ferguson is associate professor of pediatrics and student pillar director, Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tavinder K. Ark
- T.K. Ark is assistant professor, Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Adina Kalet
- A. Kalet is professor of medicine and director, Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, and Stephen and Shelagh Roell Endowed Chair, Medical College of Wisconsin, Milwaukee, Wisconsin; ORCID: http://orcid.org/0000-0003-4855-0223
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de Graaf J, Bolk M, Dijkstra A, van der Horst M, Hoff RG, Ten Cate O. The Implementation of Entrustable Professional Activities in Postgraduate Medical Education in the Netherlands: Rationale, Process, and Current Status. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S29-S35. [PMID: 34183599 DOI: 10.1097/acm.0000000000004110] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Postgraduate medical education in the Netherlands has adopted competency-based education since the turn of the century. In 2006, the CanMEDS competency framework was introduced. A 2013 government plan to reduce the length and budgets of training programs led the Dutch Association of Medical Specialists (DAMS) to respond with a proposal to create more flexibility and individualization rather than a blunt cut in the length across all training programs. DAMS launched a government-funded, nation-wide, 4-year project (2014-2018) to blueprint the reform of postgraduate medical education in this direction. To achieve competency-based individualization, the fixed duration of postgraduate programs was abandoned, and entrustable professional activities (EPAs) were introduced in all specialty programs. Implementation of this new generation of programs took place in 2017-2019 in all disciplines. The project focused on EPA-based individualization of all programs, while addressing issues of the continuity of patient care in time-variable programs and the legal and regulatory consequences of individualization. About 30 specialty programs were revised at national, regional, local, and individual levels to incorporate EPAs; portfolio systems were adapted, clinical competency committees were installed for all programs, and procedures for summative entrustment decision making were elaborated. This paper reports on the rationale and the process that led to a more time-variable postgraduate education landscape, and, on average, a shortening of training length by 3 months.
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Affiliation(s)
- Jacqueline de Graaf
- J. de Graaf is professor of Professional Performance in PGME and Director of PGME, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands; ORCID: https://orcid.org/0000-0001-7662-9284
| | - Marieke Bolk
- M. Bolk is freelance educationalist in postgraduate medical education, currently project manager "Interprofessional education and collaboration" at the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Auk Dijkstra
- A. Dijkstra is freelance educationalist in postgraduate medical education, currently project manager "Integration of current topics and innovation in training" at the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Marieke van der Horst
- M. van der Horst is freelance educationalist in postgraduate medical education, currently project manager "Sustainable development and collaboration" at the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Reinier G Hoff
- R.G. Hoff is professor of education and training in perioperative, intensive, and emergency care and program director, Anesthesiology Residency, Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands; ORCID https://orcid.org/0000-0002-7432-7087
| | - Olle Ten Cate
- O. ten Cate is professor of medical education and senior scientist, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780
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10
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Schumacher DJ, Caretta-Weyer H, Busari J, Carraccio C, Damodaran A, Gruppen LD, Hall AK, Kinnear B, Warm E, Ten Cate O. Competency-based time-variable training internationally: Ensuring practical next steps in the wake of the COVID-19 pandemic. MEDICAL TEACHER 2021; 43:810-816. [PMID: 34038645 DOI: 10.1080/0142159x.2021.1925098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Competency-based medical education has been advocated as the future of medical education for nearly a half-century. Inherent to this is the promise that advancement and transitions in training would be defined by readiness to practice rather than by time. Of the logistical problems facing competency-based, time-variable (CBTV) training, enacting time variability may be the largest hurdle to clear. Although it is true that an 'all or nothing' approach to CBTV training would require massive overhauls of both medical education and health care systems, the authors propose that training institutions should gradually evolve within their current environments to incrementally move toward the best version of CBTV training for learners, supervisors, and patients. In support of this evolution, the authors seek to demonstrate the feasibility of advancing toward the goal of realistic CBTV training by detailing examples of successful CBTV training and describing key features of initial steps toward CBTV training implementation.
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Affiliation(s)
- Daniel J Schumacher
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Jamiu Busari
- Maastricht University and A Consultant pediatrician and Dean, Horacio Oduber Hospital, Aruba
| | | | - Arvin Damodaran
- Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | | | - Andrew K Hall
- Department of Emergency Medicine, Queen's University, Ontario, KN, Canada
| | - Benjamin Kinnear
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Eric Warm
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Bisgaard CH, Rodt SA, Musaeus P, Petersen JAK, Rubak SLM. Early procedural training increases anesthesiology residents' clinical production: a comparative pre-post study of the payoff in clinical training. BMC MEDICAL EDUCATION 2021; 21:262. [PMID: 33957915 PMCID: PMC8103582 DOI: 10.1186/s12909-021-02693-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Competency-based education has been shown to enhance clinical skills, improve patient care, and reduce number of complications resulting in a better return on investments. Residents constitute an important workforce at many hospitals. Yet, the effect of training on residents' contribution to production in patient care is scarcely studied. This study evaluated the effects of early competency-based procedural training on residents' contribution to patient care in central venous catheterization and spinal and epidural anesthesia. METHODS The design was a non-randomized cohort study of first-year anesthesiology residents. The intervention group received additional early focused skills training while three control groups received traditional competency-based education. The residents' contributions to patient care were compared between the intervention group (n = 20), a historical control group (n = 19), and between a contemporary control group (n = 7) and a historical control group (n = 7) from different departments. The residents' vs specialists' procedural production share was compared between years within each study group. We calculated specialist time saved compared to the time spent providing additional skills training in the intervention group. RESULTS We found statistically significant increases in residents' vs specialists' share of total production after the intervention for epidural anesthesia: 2015: 0.51 (0.23, 0.70) to 2017: 0.94 (0.78, 1.05), p = 0.011 and central venous catheterization: 2015: 0.30 (0.23, 0.36) to 2016: 0.46 (0.35, 0.55), p = .008; and to 2017: 0.64 (0.50, 0.79), p = 0.008. Comparison between residents and specialists on production of the three procedures before and after the intervention showed a surplus of 21 h of freed specialist time per year. CONCLUSIONS Early procedural training results in more productive residents and freed specialist time for additional supervision, other clinical tasks or research. This provides empirical support for a positive correlation between early focused training and increased independent production among residents.
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Affiliation(s)
- Claus Hedebo Bisgaard
- Centre for Health Sciences Education, Faculty of Health, Aarhus University, Palle Juul Jensens Boulevard 82, Building B, DK-8200 Aarhus N, Denmark
| | - Svein Aage Rodt
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Peter Musaeus
- Centre for Educational Development, Aarhus University, Palle Juul Jensens Boulevard 82, Building B, DK-8200 Aarhus N, Denmark
| | - Jens Aage Kølsen Petersen
- Department of Anaesthesiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Sune Leisgaard Mørck Rubak
- Department of Paediatrics and Adolescent Medicine, Center of Paediatric Pulmonology and Allergology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Shrivastava S, Shrivastava P. De-emphasizing time-based training in the delivery of competency-based medical education for undergraduates in India: Justification, challenges, and potential solutions. INTERNATIONAL JOURNAL OF ACADEMIC MEDICINE 2021. [DOI: 10.4103/ijam.ijam_71_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Stoddard HA, Brownfield ED. Culture transformation by stealth: Leveraging incremental change to revamp the curriculum. MEDICAL TEACHER 2020; 42:1350-1353. [PMID: 32795249 DOI: 10.1080/0142159x.2020.1805421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Reshaping an existing education program from traditional structures and processes into competency-based medical education (CBME) is formidable. Emory University School of Medicine applied organizational change theory to introduce CBME into an established MD program by employing 'sustainable innovation', which introduces change incrementally. METHODS Implementation of CBME began with the identification of core institutional values. Using the sustainable innovation approach, the first change was adoption of new program outcomes and student performance expectations. There were few changes that occurred to the structure of required courses and clerkships. This intentional approach allowed stakeholders to familiarize themselves with CBME prior to full implementation. RESULTS Existing assessment processes remained intact while the faculty was trained for innovative assessment uses. For example, the assessment process was augmented by tagging all exam items using a controlled taxonomy and students' performance was linked longitudinally. Using sustainable innovation allowed time for data collection and evaluation throughout the implementation of CBME. DISCUSSION Representing student achievement according to competencies, rather than as letter grades, is perceived as revolutionary by many stakeholders. Employing sustainable, incremental innovation facilitated stakeholder buy-in to the underlying principles of CBME. Fostering a new organizational culture will be the 'rate-limiting factor' for full implementation of CBME.
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Affiliation(s)
- Hugh A Stoddard
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Erica D Brownfield
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Chiel L, Hasselfeld B, Marcus CH, Winn AS. Time Well Spent: Resident Promotion of Microcompetency-Based Medical Education During Inpatient Pediatric Experiences. J Pediatr 2020; 223:6-7.e1. [PMID: 32711753 DOI: 10.1016/j.jpeds.2020.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Laura Chiel
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
| | - Brian Hasselfeld
- Office of Johns Hopkins Physicians and Johns Hopkins Community Physicians, Baltimore, MD; Division of General Internal Medicine, Department of Medicine, and Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Carolyn H Marcus
- Department of Pediatrics, Harvard Medical School, Boston, MA; Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Ariel S Winn
- Department of Pediatrics, Harvard Medical School, Boston, MA; Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA
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Keeley MG, Gusic ME, Morgan HK, Aagaard EM, Santen SA. Moving Toward Summative Competency Assessment to Individualize the Postclerkship Phase. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1858-1864. [PMID: 31169542 DOI: 10.1097/acm.0000000000002830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
In the move toward competency-based medical education, leaders have called for standardization of learning outcomes and individualization of the learning process. Significant progress has been made in establishing defined expectations for the knowledge, skills, attitudes, and behaviors required for successful transition to residency training, but individualization of educational processes to assist learners in reaching these competencies has been predominantly conceptual to date. The traditional time-based structure of medical education has posed a challenge to individualization within the curriculum and has led to more attention on innovations that facilitate transition from medical school to residency. However, a shift of focus to the clerkship-to-postclerkship transition point in the undergraduate curriculum provides an opportunity to determine how longitudinal competency-based assessments can be used to facilitate intentional and individualized structuring of the long-debated fourth year.This Perspective demonstrates how 2 institutions-the University of Virginia School of Medicine and the University of Michigan Medical School-are using competency assessments and applying standardized outcomes in decisions about individualization of the postclerkship learning process. One institution assesses Core Entrustable Professional Activities for Entering Residency, whereas the other has incorporated Accreditation Council for Graduate Medical Education core competencies and student career interests to determine degrees of flexibility in the postclerkship phase. Individualization in addition to continued assessment of performance presents an opportunity for intentional use of curriculum time to develop each student to be competently prepared for the transition to residency.
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Affiliation(s)
- Meg G Keeley
- M.G. Keeley is assistant dean for student affairs, director of the fourth-year program, and professor of pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia; ORCID: https://orcid.org/0000-0001-8602-2638. M.E. Gusic is senior advisor in educational affairs and professor of medical education, University of Virginia School of Medicine, Charlottesville, Virginia. H.K. Morgan is associate professor of learning health sciences and associate professor of obstetrics and gynecology, University of Michigan Medical School, Ann Arbor, Michigan. E.M. Aagaard is senior associate dean for education and professor of medicine, Washington University School of Medicine, St. Louis, Missouri. S.A. Santen is senior associate dean for assessment, evaluation, and scholarship and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Evolution of Advanced Practice Provider Education. Pediatr Crit Care Med 2019; 20:1192-1193. [PMID: 31804439 DOI: 10.1097/pcc.0000000000002092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cate OT, Carraccio C. Envisioning a True Continuum of Competency-Based Medical Education, Training, and Practice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1283-1288. [PMID: 31460916 DOI: 10.1097/acm.0000000000002687] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The existing structure of physician education has developed in siloed stages, with consecutive degrees and certifications and progressively longer training programs. As further fragmentation of health care and training systems will not improve the quality of care and education, the authors argue that a new vision of education, training, and practice as a continuum is needed.They advocate for a model of competency-based medical education that merges with competency-based medical practice. In this system, education and training will result in individual, dynamic portfolios of valid entrustable professional activities (EPAs) for which physicians are certified. Physicians can maintain and renew that entrustment as long as the EPAs remain within their scope of practice. Entrustment occurs initially during training but is then granted for new activities as physicians' careers evolve.This model accounts for the need to keep pace with changes in population health needs and expectations of competence over time. It de-emphasizes the divides between the stages of training and views the continuum from undergraduate medical education until retirement as a whole. Key obligations of self-regulating medical professionals include both the reception and the provision of supervision from and for others, respectively. Learning must be embedded in practice to address expectations regarding new knowledge and skills as they evolve with scientific and technological advances.Entrusting physicians to deliver effective and safe care, based on their performance of the requisite EPAs without supervision, should ensure that they provide high-value, quality care to patients.
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Affiliation(s)
- Olle Ten Cate
- O. ten Cate is professor of medical education and senior scientist, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780. C. Carraccio is vice president of competency-based assessment, American Board of Pediatrics, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0001-5473-8914
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O'Brien BC. What to Do About the Transition to Residency? Exploring Problems and Solutions From Three Perspectives. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:681-684. [PMID: 29419551 DOI: 10.1097/acm.0000000000002150] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Transitions are both a blessing and a curse for learning and professional development. While transitions can afford valuable opportunities for growth, they can also burden learners in ways that stymie performance and development. In this Invited Commentary, the author focuses on the transition from medical school to residency-a transition that many believe has tipped too far toward burden. The commentary explores three ways of problematizing the transition to residency. The first is as a transaction problem involving a complex exchange of information among programs and people. The second is as a transfer problem in which learners must apply knowledge in new contexts. The third is a trajectory problem concerning each learner's progression through medical education. The author describes current efforts aligned with each framing of the problem and discusses potential gaps in these efforts that might be addressed through an overarching framing of transitions in medical education as transformative processes. This framing may help the medical educational community think more holistically about the problems and solutions with transitions.
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Affiliation(s)
- Bridget C O'Brien
- B.C. O'Brien is associate professor, Department of Medicine, and educational researcher, Center for Faculty Educators, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0001-9591-5243
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Lucey CR, Thibault GE, Ten Cate O. Competency-Based, Time-Variable Education in the Health Professions: Crossroads. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:S1-S5. [PMID: 29485479 DOI: 10.1097/acm.0000000000002080] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Health care systems around the world are transforming to align with the needs of 21st-century patients and populations. Transformation must also occur in the educational systems that prepare the health professionals who deliver care, advance discovery, and educate the next generation of physicians in these evolving systems. Competency-based, time-variable education, a comprehensive educational strategy guided by the roles and responsibilities that health professionals must assume to meet the needs of contemporary patients and communities, has the potential to catalyze optimization of educational and health care delivery systems. By designing educational and assessment programs that require learners to meet specific competencies before transitioning between the stages of formal education and into practice, this framework assures the public that every physician is capable of providing high-quality care. By engaging learners as partners in assessment, competency-based, time-variable education prepares graduates for careers as lifelong learners. While the medical education community has embraced the notion of competencies as a guiding framework for educational institutions, the structure and conduct of formal educational programs remain more aligned with a time-based, competency-variable paradigm.The authors outline the rationale behind this recommended shift to a competency-based, time-variable education system. They then introduce the other articles included in this supplement to Academic Medicine, which summarize the history of, theories behind, examples demonstrating, and challenges associated with competency-based, time-variable education in the health professions.
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Affiliation(s)
- Catherine R Lucey
- C.R. Lucey is executive vice dean, vice dean for education, and professor of medicine, University of California, San Francisco, School of Medicine, San Francisco, California. G.E. Thibault is president, Josiah Macy Jr. Foundation, New York, New York. O. ten Cate is professor of medical education, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands
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