EMYWAY Workplace-Based Entrustable Professional Activities Assessments in Otolaryngology Residency Training: A Nationwide Experience

OBJECTIVE

To present workplace-based entrustable professional activities (EPAs) assessment data from the first 2 years of the EMYWAY platform in otolaryngology residency training in Taiwan.

STUDY DESIGN

Two-year cross-sectional study.

SETTING

Otolaryngology training programs.

METHODS

In 2020, the Taiwan Society of Otorhinolaryngology-Head and Neck Surgery (TSO-HNS) developed a workplace-based assessment (WBA) framework with 11 EPAs, integrating milestones to evaluate resident competency. In 2021, TSO-HNS piloted the EMYWAY platform for WBAs, which includes an EPA-based assessment workflow, coaching feedback, and a dashboard displaying residents' entrustment-supervision levels. Data are analyzed annually for accreditation and curriculum enhancement. This study reports on the pilot year and the first full-scale year of implementation.

RESULTS

Eleven programs participated in the pilot year. Subsequently, 362 faculty members and 274 resident physicians from 34 programs nationwide engaged with EMYWAY. In the full-scale year from August 2022 to July 2023, 9805 responses were recorded, primarily from surgical theaters (45.9%; 4502/9805) and third-year residents (23.8%; 2331/9805). The most frequently evaluated EPAs were "head and neck" (17.5%; 1716/9805), "sinonasal" (13.5%; 1324/9805), and "ear" (12.2%; 1193/9805), with task complexity increasing with resident seniority (P < .0001). A positive correlation was found between residents' self-assessments and faculty members' ratings (r = 0.531; P < .001). Over 98.2% of residents and 88.4% of faculty members provided substantial feedback (>10 words). Analysis of WBAs reported by training programs identified faculty development targets and teaching-intensive tasks.

CONCLUSION

EMYWAY effectively documents workplace learning and tracks resident competency progression. Continuous improvement of WBA quality is essential for advancing the competency-based medical education ecosystem.

Differences between resident self-assessments and faculty- assessments on Anesthesiology Milestones and associated factors: a cross-sectional study

BACKGROUND

Accurate self-assessment is crucial for the professional development of physicians. There has been sparse data on the accuracy of self-assessments on Anesthesiology Milestones. The aim of this study was to investigate the differences between resident self-assessments and faculty-assessments on Anesthesiology Milestones and the associated factors.

METHODS

This was a cross-sectional study conducted in a general tertiary university-affiliated hospital. We included anesthesia residents who were enrolled in the standardized residency training program in postgraduate year two and three at the time of the Milestone evaluation. We requested evaluations of competencies from both the Clinical Competency Committee faculty and the anesthesia residents themselves, utilizing the Chinese version of Anesthesiology Milestones in January 2023 and January 2024. The primary outcome was the differences between self- and faculty-assessments, calculated by subtracting the faculty-rated score from the self-rated score on each subcompetency.

RESULTS

A total of 46 and 42 residents were evaluated in year 2023 and 2024, respectively. The self-rated sum score was significantly higher than that rated by faculty [mean (standardized deviation): 120.39 (32.41) vs. 114.44 (23.71), P = 0.008 in paired t test] with an intraclass correlation coefficient of 0.55 [95% confidence interval (CI): 0.31 to 0.70]. The Bland-Altman plots revealed significant overestimation in patient care (bias 0.32, 95% CI: 0.05 to 0.60), practice-based learning and improvement (bias 0.45, 95% CI: 0.07 to 0.84), and professionalism (bias 0.37, 95% CI: 0.02 to 0.72). Ratings from residents with master's degrees (mean difference: -1.06, 95% CI: -1.80 to -0.32, P = 0.005) and doctorate degrees (mean difference: -1.14, 95% CI: -1.91 to -0.38, P = 0.003) were closer to the faculty-assessments than residents with bachelor's degrees. Compared with patient care, the differences between self- and faculty- rated scores were smaller in medical knowledge (mean difference: -0.18, 95% CI: -0.35 to -0.02, P = 0.031) and interpersonal and communication skills (mean difference: -0.41, 95% CI: -0.64 to -0.19, P < 0.001) in the generalized estimating equation logistic regression model.

CONCLUSIONS

This study revealed that residents tended to overestimate themselves, emphasizing the need to improve the accuracy of Milestones self-assessment. The differences between self- and faculty-assessments were associated with residents' degrees and domains of competency.

Leadership Training Curriculum for Otolaryngology-Head and Neck Surgery Residents: A Scoping Review

OBJECTIVE

Otolaryngologists take on various leadership roles throughout their daily practice, but specific training focused on leadership development during otolaryngology-head and neck surgery (OHNS) residency is not well-defined. This project explores the current state of leadership curricula for OHNS residents.

DATA SOURCES

Google Scholar, Embase, PubMed, and MedEdPORTAL.

REVIEW METHODS

A scoping review was performed on English-language, full-text, peer-reviewed articles that describe leadership curricula for OHNS residents. Investigators reviewed curriculum settings, content, delivery methods, and assessment; curriculum effectiveness was evaluated using Kirkpatrick effectiveness scores and article quality was assessed using the Best Evidence in Medical Education (BEME) index.

CONCLUSION

Three thousand four hundred sixteen articles met search criteria, 198 articles were included for full-text review, and 4 articles met inclusion criteria. Curriculum content and delivery methods were diverse. Curriculum cadence ranged from 2-day immersion trainings to year-long longitudinal programs. Only one of the included studies utilized a needs assessment to inform curriculum development. Two articles achieved Kirkpatrick effectiveness scores of 2, indicating changes in the attitudes or perceptions among participants and a quality measure of 3, indicating clear conclusions drawn from the results.

IMPLICATIONS FOR PRACTICE

The current state of leadership training in OHNS residency is limited and nonuniform. These data align with descriptions of leadership training in other surgical residencies which are reported as heterogenous and lacking in effectiveness. This review highlights the need for standardized leadership training for OHNS residents. The high-quality leadership development initiatives within graduate medical education are reviewed to inform future directions for effective curriculum development and assessment.

Communication skills in psychiatry for undergraduate students: A scoping review

Communication skills are paramount in all areas of medicine but particularly in psychiatry due to the challenges posed by mental health patients and the essential role of communication from diagnosis to treatment. Despite the prevalence of psychiatric disorders in different medical specialties, particularly in primary care settings, communication skills in psychiatry and their training are not well studied and are often not included in the undergraduate medical curriculum. Our paper explores the relevance of teaching communication competencies in psychiatry for undergraduate medical students. Our work focused on reviewing the methods for teaching communication skills to undergraduate students in Psychiatry. Eleven studies were selected to be included in this review. We found considerable heterogeneity among methods for teaching communication skills but also some common elements such as the use of simulated patients and providing feedback. This review has identified two models: the Calgary-Cambridge interview model and the Kolb cycle-based model. However, most studies still lack a theoretical background model. We believe that the inclusion of communication skills training in medical curricula is fundamental to teaching medical students general communication skills but also specific training on establishing adequate communication with psychiatric patients. However, more research is needed to determine the best method for training but also regarding its translation to patient care and cost-effectiveness.

The Art of Teaching, Training, and Putting the Scalpel in Residents' Hands

Surgical education is under tremendous pressure due to ever-increasing medical knowledge and demands on trainees' time. They must continually learn more in less time due to work hour limitations, regulations, and electronic medical record demands. Surgical training must become more efficient. There is an unprecedented array of education and training opportunities for resident preparation. The preparation for each case has to be maximal. Preoperative, intraoperative, and postoperative simulation and discussions improve the educational benefit of the trainee experience. For the teaching surgeon, putting a scalpel in residents' hands requires patience, knowledge, judgment, and a leap of faith in the resident.

The Clinical Competency Committee in Adult Cardiothoracic Anesthesiology-Perspectives From Program Directors Around the United States

The clinical competency committee offers a fellowship program a structured approach to assess the clinical performance of each trainee in a comprehensive fashion This special article examines the structure and function of this important committee in detail. Furthermore, the strategies for the optimal functioning of this committee are also discussed as a way to enhance the overall quality of the fellowship program.