Introduction to core competencies in residency: a description of an intensive, integrated, multispecialty teaching program

Core Professionalism Education in Surgery: A Systematic Review

BACKGROUND

Professionalism education is one of the major elements of surgical residency education.

AIMS

To evaluate the studies on core professionalism education programs in surgical professionalism education.

STUDY DESIGN

Systematic review.

METHODS

This systematic literature review was performed to analyze core professionalism programs for surgical residency education published in English with at least three of the following features: program developmental model/instructional design method, aims and competencies, methods of teaching, methods of assessment, and program evaluation model or method. A total of 27083 articles were retrieved using EBSCOHOST, PubMed, Science Direct, Web of Science, and manual search.

RESULTS

Eight articles met the selection criteria. The instructional design method was presented in only one article, which described the Analysis, Design, Development, Implementation, and Evaluation model. Six articles were based on the Accreditation Council for Graduate Medical Education criterion, although there was significant variability in content. The most common teaching method was role modeling with scenario- and case-based learning. A wide range of assessment methods for evaluating professionalism education were reported. The Kirkpatrick model was reported in one article as a method for program evaluation.

CONCLUSION

It is suggested that for a core surgical professionalism education program, developmental/instructional design model, aims and competencies, content, teaching methods, assessment methods, and program evaluation methods/models should be well defined, and the content should be comparable.

What supervisors say in their feedback: construction of CanMEDS roles in workplace settings

The CanMEDS framework has been widely adopted in residency education and feedback processes are guided by it. It is, however, only one of many influences on what is actually discussed in feedback. The sociohistorical culture of medicine and individual supervisors' contexts, experiences and beliefs are also influential. Our aim was to find how CanMEDS roles are constructed in feedback in a postgraduate curriculum-in-action. We applied a set of discourse analytic tools to written feedback from 591 feedback forms from 7 hospitals, including 3150 feedback comments in which 126 supervisors provided feedback to 120 residents after observing their performance in authentic settings. The role of Collaborator was constructed in two different ways: a cooperative discourse of equality with other workers and patients; and a discourse, which gave residents positions of power-delegating, asserting and 'taking a firm stance'. Efficiency-being fast and to the point emerged as an important attribute of physicians. Patients were seldom part of the discourses and, when they were, they were constructed as objects of communication and collaboration rather than partners. Although some of the discourses are in line with what might be expected, others were in striking contrast to the spirit of CanMEDS. This study's findings suggest that it takes more than a competency framework, evaluation instruments, and supervisor training to change the culture of workplaces. The impact on residents of training in such demanding, efficiency-focused clinical environments is an important topic for future research.

[Competency-based Neurosurgery Residency Programme]

A programme proposal for competency-based Neurosurgery training adapted to the specialization project is presented. This proposal has been developed by a group of neurosurgeons commissioned by the SENEC (Spanish Society of Neurosurgery) and could be modified to generate a final version that could come into force coinciding with the implementation of the specialization programme. This document aims to facilitate the test of the new programme included in the online version of our journal.

DURATION OF THE PROGRAMME

Total training period is 6 years; initial 2 years belong to the surgery specialization and remaining 4 years belong to core specialty period.

STRUCTURE OF THE PROGRAMME

It is a competency-based programmed based on the map used by the US Accreditation Council for Graduate Medical Education (ACGME) including the following domains of clinical competency: Medical knowledge, patient care, communication skills, professionalism, practice-based learning and improvement, health systems, interprofessional collaboration and professional and personal development. Subcompetencies map in the domains of Knowledge and Patient care (including surgical competencies) was adapted to the one proposed by AANS and CNS (annex 1 of the programme). A subcompetency map was also used for the specialization rotations.

INSTRUCTION METHODS

Resident's training is based on personal study (self-learning) supported by efficient use of information sources and supervised clinical practice, including bioethical instruction, clinical management, research and learning techniques.

EVALUATION METHODS

Resident evaluation proposal includes, among other instruments, theoretical knowledge tests, objective and structured evaluation of the level of clinical competency with real or standardised patients, global competency scales, 360-degree evaluation, clinical record audits, milestones for residents progress and self-assessment (annex 2). Besides, residents periodically assess the teaching commitment of the department's neurosurgeons and other professors participating in rotations, and annually assess the overall operation of the programme. Results of evaluations are registered, together with other relevant data, in the Resident's Book.

PROGRAMME'S NATIONAL COMMITTEE

The creation of a Programme Committee directly attached to the SENEC (National Commission) that, aside from generating a final version of the programme, monitors its implementation (level of adherence and operation in the different departments), assumes the creation of test banks and the centralized administration of knowledge tests (in the middle of the residency and/or at the end of it) and centralizes information collected by tutors that could be used for re-accreditation of the services, is proposed.

Charting a course for cardiac electrophysiology training in Canada: the vital role of fellows in advanced cardiovascular care

Canadian electrophysiology (EP) fellowship programs have evolved in an ad hoc fashion over 30 years. This evolution has occurred in many fields in medicine and is natural when innovators and pioneers attract research fellows who help change the status quo from predominantly research to a predominantly clinical application and focus. Fellows not only push their supervisors and their centres into new areas of inquiry but also function at the most advanced level to encourage and teach junior trainees and to provide examples of excellence to residents, medical students, and other health professionals. Funding for fellows has never been provided in the traditional way through the Ministry of Health or the Ministry of Advanced Education. Each Canadian centre has over the years found novel ways to fund fellowship programs, and many centres have used value-adds from procurement programs. These sources of funding are eroding as provincial government agencies are beginning to assume procurement responsibilities and local flexibility to fund fellowships is lost. In particular, provincial government agencies feel that valuable financial resources should be restricted to Canadian trainees only, despite the international consensus that fellowship is an essential time for advanced trainees to travel abroad to acquire a broad a range of experience, learn new techniques and approaches, make lifelong research connections, and hopefully return home with these skills and expertise. This article summarizes the long history of EP fellowship training in Canada, as well as EP fellowship experiences at home and abroad by Canadian electrophysiologists, in an attempt to contextualize these new realities.

Developing gerontological competency: a curriculum approach

This study describes a competency-based educational approach to course development, implementation, and evaluation. The course model is presented, including its philosophical base. The authors hypothesized that student participation in a competency-based graduate gerontology course would increase their perceived competency level. Results indicate that students (N = 74 students; 2008-2011) rated their competency skill level as higher at posttest than at the pretest (paired t-tests, p < .01), as measured by the Geriatric Social Work Competency Scale II. In addition, pretest/posttest results on the Myths of Aging checklist and Expectations Regarding Aging survey supported increases of perceived knowledge of older adults at posttest (p < .01). This project illustrates the benefits of organizing and implementing competency-based curriculum so that students are better prepared to work with older adults when they graduate.

Demystifying the Millennial student: a reassessment in measures of character and engagement in professional education

The characteristic profile of Millennial Generation students, driving many educational reforms, can be challenged by research in a number of fields including cognition, learning style, neurology, and psychology. This evidence suggests that the current aggregate view of the Millennial student may be less than accurate. Statistics show that Millennial students are considerably diverse in backgrounds, personalities, and learning styles. Data are presented regarding technological predilection, multitasking, reading, critical thinking, professional behaviors, and learning styles, which indicate that students in the Millennial Generation may not be as homogenous in fundamental learning strategies and attitudes as is regularly proposed. Although their common character traits have implications for instruction, no available evidence demonstrates that these traits impact their fundamental process of learning. Many curricular strategies have been implemented to address alleged changes in the manner by which Millennial students learn. None has clearly shown superior outcomes in academic accomplishments or developing expertise for graduating students and concerns persist related to the successful engagement of Millennial students in the process of learning. Four factors for consideration in general curricular design are proposed to address student engagement and optimal knowledge acquisition for 21st century learners.

A proposed model for an optimal mentoring environment for medical residents: a literature review

PURPOSE

To develop a model of the optimal mentoring environment for medical residents. The authors propose that such an environment is a function of a relationship that rests upon a set of interactional foundations that allow a protégé to capitalize on the strengths of the mentor, and it facilitates behaviors that will enable the protégé to develop and internalize the requisite knowledge, skills, and attitudes (KSAs) as fully as possible.

METHOD

The authors searched the literature using Web of Science and Google Scholar in 2007-2008 to identify articles addressing the mentoring process and the context in which it occurs (mentoring environment), and the effect both have on KSA development. The authors distilled the attributes of a good mentor that were consistent across the 20 papers that met inclusion criteria and described good mentoring of residents or curricula for training mentors or residents.

RESULTS

The authors identified six interactional foundations that underlie the optimal mentoring relationship: emotional safety, support, protégé-centeredness, informality, responsiveness, and respect. These foundations enable protégés to engage in four key developmental behaviors: exercising independence, reflecting, extrapolating, and synthesizing.

CONCLUSIONS

This model identifies mentoring practices that empower protégés to engage in developmental behaviors that will help them become the best physicians possible. Educators may use this model to develop training tools to teach attendings how to create an optimal mentoring environment. Researchers can use the model to help guide their future investigations of mentoring in medicine.

Medical competence: the interplay between individual ability and the health care environment

Competency-based education in the health care professions has become a prominent approach to postgraduate training in Canada, the Netherlands, the United Kingdom, the United States, and many other countries. Competency frameworks devised at national and international levels have been well received, and in many cases mandated, by governing bodies. However, the teaching and assessment of competencies pose questions of practicality, validity, and reliability. In this article we propose that competence and competencies be approached in the context of the particular clinical environment, such that the assessment of competence is tied to a trainee's performance of essential clinical activities that define the profession. Competence is implicit in the eventual entrustment of trainees to perform these professional activities. Competencies and "entrustable professional activities" (EPAs) relate to each other as two dimensions of a grid in which each EPA can be mapped back to a number of competencies. This backward visioning from EPAs to competencies is proposed as a guide to curriculum planning and assessment. The authors discuss experiences with this conceptual model in research, curriculum development and learner assessment.

CanMEDS evaluation in Canadian postgraduate training programmes: tools used and programme director satisfaction

CONTEXT

The Royal College of Physicians and Surgeons of Canada (RCPSC) CanMEDS framework is being incorporated into specialty education worldwide. However, the literature on how to evaluate trainees in the CanMEDS competencies remains sparse.

OBJECTIVES

The goals of this study were to examine the assessment tools used and programme directors' perceptions of how well they evaluate performance of the CanMEDS roles in Canadian postgraduate training programmes.

METHODS

We conducted a web-based survey of programme directors of RCPSC-accredited training programmes. The survey consisted of two questions. Question 1 was designed to establish which assessment tools were used to assess each of the CanMEDS roles. Question 2 was intended to assess programme directors' perceived satisfaction with CanMEDS evaluation in their programmes.

RESULTS

A total of 149 of the eligible 280 programme directors participated in the survey. Programme directors used a variety of assessment tools to evaluate trainees in CanMEDS competencies. Programmes used more tools to evaluate the Medical Expert (mean = 4.03, standard deviation [SD] = 1.59) and Communicator (mean = 2.36, SD = 1.02) roles. Programme directors used the fewest tools for the Collaborator (mean = 1.75, SD = 1.10) and Manager (mean = 1.75, SD = 1.18) roles. More than 92% of the programmes used in-training evaluation reports to evaluate all the CanMEDS roles. Programme directors were satisfied with their evaluation of the Medical Expert role, but less so with assessment of the other CanMEDS competencies.

CONCLUSIONS

This study demonstrates that Canadian postgraduate training programmes use a variety of assessment tools to evaluate the CanMEDS competencies. Programme directors are neutral or concerned about how the CanMEDS roles other than that of Medical Expert are evaluated in their programmes. Further efforts are required to establish best practice in CanMEDS evaluation.