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Hoffman M, Dedow L, Boscamp J. Competency-based and less time-bound: a new approach to the macro-structure of a medical school curriculum. Med Educ Online 2024; 29:2343205. [PMID: 38626425 PMCID: PMC11022905 DOI: 10.1080/10872981.2024.2343205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 04/11/2024] [Indexed: 04/18/2024]
Abstract
Shifting to a competency-based (CBME) and not time-bound curricular structure is challenging in the undergraduate medical education (UME) setting for a number of reasons. There are few examples of broad scale CBME-driven interventions that make the UME program less time-bound. However, given the range of student ability and varying speed of acquisition of competencies, this is an area in need of focus. This paper describes a model that uses the macro structure of a UME program to make UME curricula less time-bound, and driven more by student competency acquisition and individual student goals. The 3 + 1 curricular model was derived from the mission of the school, and includes a 3-year core curriculum that all students complete and an individualized phase. Students have an 18 month individualized educational program that meets their developmental needs and their educational and professional goals. This is achieved through a highly structured advising system, including the creation of an Individualized Learning Plan, driven by specific goals and targeted Entrustable Professional Activities (EPA). Students who struggle in achieving core competencies can use individualized time to support competency development and EPA acquisition. For students who have mastered core competencies, options include obtaining a masters degree, clinical immersion, research, and community-based experiences. Students can also graduate after the 3-year core curriculum, and enter residency one year early. Structural approaches such as this may contribute to the norming of the developmental nature of medical education, and can advance culture and systems that support CBME implementation at the UME level.
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Affiliation(s)
- Miriam Hoffman
- Department of Family Medicine, Hackensack Meridian School of Medicine, Nutley, NJ, USA
- Office of Medical Education, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Lindsey Dedow
- Office of Student Affairs and Wellbeing, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Jeffrey Boscamp
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA
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Baboolal SO, Singaram VS. Implementation and Impact of an Adapted Digital Perioperative Competency-Building Tool to Enhance Teaching, Learning And Feedback in Postgraduate Competency-Based Medical Education. J Surg Educ 2024; 81:722-740. [PMID: 38492984 DOI: 10.1016/j.jsurg.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES The purpose of this educational intervention was to introduce, iteratively adapt, and implement a digital formative assessment tool in a surgical speciality. The study also evaluated the intervention's impact on perioperative teaching, learning, feedback, and surgical competency. DESIGN A participatory action research model with a mixed methods approach. SETTING This study was performed over 10 months in an institutional hospital in South Africa with a general surgery department. PARTICIPANTS Twelve supervising surgical trainers/faculty and 12 surgical trainees/residents consented to participate in the intervention. RESULTS The first 4 months of the intervention focused on relationship building, a multi-stakeholder contextual needs assessment and training sessions to support a shared mindset and shift in the teaching and learning culture. The final adapted perioperative competency-building tool comprised a 23-item assessment with four open-text answers (Table 1). Over the following 6-month period, 48 workplace-based competency-building perioperative evaluations were completed. Most trainees took less than 5 minutes to self-assess (67%) before most trainers (67%) took less than 5 minutes to give oral feedback to the trainee after the perioperative supervised learning encounter. On average, the digital tool took 6 minutes to complete during the bidirectional perioperative teaching and learning encounter with no negative impact on the operational flow. All trainers and trainees reported the training and implementation of the digital tool to be beneficial to teaching, learning, feedback, and the development of surgical competency. Analysis of the completed tools revealed several trainees showing evidence of progression in surgical competency for index procedures within the speciality. The focus groups and interviews also showed a change in the teaching and learning culture: more positively framed, frequent, structured, and specific feedback, improved accountability, and trainee-trainer perioperative readiness for teaching. Highlighted changes included the usefulness of trainee self-assessment before perioperative trainer feedback and the tool's value in improving competency to Kirkpatrick Level 4. CONCLUSION Implementing an adapted digital Workplace-Based Assessment (WBA) tool using a participatory action research model has proven successful in enhancing the effectiveness of supervised perioperative teaching and learning encounters. This approach has improved teaching and feedback practices, facilitated the development of surgical competency, and ultimately impacted the overall culture to Kirkpatrick level 4. Importantly, it has positively influenced the trainee-trainer relationship dynamic. Based on these positive outcomes, we recommend using this effective method and our relationship-centred framework for implementing formative competency-building tools in future studies. By doing so, larger-scale and successful implementation of Competency-Based Medical Education (CBME) could be achieved in various contexts. This approach can potentially enhance teaching and learning encounters, promote competency development, and improve the overall educational experience for surgical trainees and trainers.
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Affiliation(s)
- Sandika O Baboolal
- School of Clinical Medicine College of Health Sciences University of KwaZulu Natal 719 Umbilo Road, Umbilo Durban 4001 South Africa; Ophthalmology Department, Division of Surgery, James Paget University Hospital NHS Foundation Trust, United Kingdom.
| | - Veena S Singaram
- School of Clinical Medicine College of Health Sciences University of KwaZulu Natal 719 Umbilo Road, Umbilo Durban 4001 South Africa
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Bryant BH, Anderson SR, Brissette M, Childs JM, Gratzinger D, Johnson K, Powell DE, Zein-Eldin Powell S, Timmons CF, Chute D, Cummings TJ, Furlong MA, Hébert TM, Reeves HM, Rush D, Vitkovski T, McCloskey CB. National pilot of entrustable professional activities in pathology residency training. Acad Pathol 2024; 11:100110. [PMID: 38560425 PMCID: PMC10978478 DOI: 10.1016/j.acpath.2024.100110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/25/2023] [Accepted: 01/21/2024] [Indexed: 04/04/2024] Open
Abstract
Entrustable professional activities (EPAs) are observable clinical skills and/or procedures that have been introduced into medical education at the student and resident levels in most specialties to determine readiness to advance into residency or independent practice, respectively. This publication describes the process and outcomes of a pilot study looking at the feasibility of using two anatomic pathology and two clinical pathology EPAs in pathology residency in 6 pathology residency programs that volunteered for the study. Faculty development on EPAs and their assessment was provided to pilot program faculty, and EPA assessment tools were developed and used by the pilot programs. Pre- and post-study surveys were given to participating residents, faculty, and program directors to gauge baseline practices and to gather feedback on the EPA implementation experience. Results demonstrated overall good feasibility in implementing EPAs. Faculty acceptance of EPAs varied and was less than that of program directors. Residents reported a significant increase in the frequency with which faculty provided formative assessments that included specific examples of performance and specific ways to improve, as well as increased frequency with which faculty provided summative assessments that included specific ways to improve. EPAs offered the most benefit in setting clear expectations for performance of each task, for providing more specific feedback to residents, and in increasing Program director's understanding of resident strengths abilities and weaknesses.
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Affiliation(s)
- Bronwyn H. Bryant
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine, Burlington, VT, USA
| | - Scott R. Anderson
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine, Burlington, VT, USA
| | - Mark Brissette
- University of Colorado Anschutz Medical Campus, Department of Pathology, Aurora, CO, USA
| | - John M. Childs
- Geisinger Medical Center, Department of Pathology, Danville, PA, USA
| | - Dita Gratzinger
- Stanford University School of Medicine, Department of Pathology, Stanford, CA, USA
| | | | - Deborah E. Powell
- University of Minnesota Medical School, Department of Laboratory Medicine and Pathology, Minneapolis, MN, USA
| | | | - Charles F. Timmons
- UT Southwestern Medical Center, Department of Pathology, Dallas, TX, USA
| | - Deborah Chute
- Cleveland Clinic, Department of Pathology and Laboratory Medicine, Cleveland, OH, USA
| | | | - Mary A. Furlong
- Georgetown University School of Medicine, Department of Pathology and Laboratory Medicine, Washington, DC, USA
| | - Tiffany M. Hébert
- Montefiore Health System/Albert Einstein College of Medicine, Department of Pathology, Bronx, NY, USA
| | - Hollie M. Reeves
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Department of Pathology, Cleveland, OH, USA
| | - Demaretta Rush
- University of Arizona College of Medicine, Department of Pathology, Tucson, AZ, USA
| | - Taisia Vitkovski
- Zucker School of Medicine at Hofstra/Northwell Health, Department of Pathology and Laboratory Medicine, Hempstead, NY, USA
| | - Cindy B. McCloskey
- University of Oklahoma College of Medicine, Department of Pathology, Oklahoma City, OK, USA
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Abstract
In this critical narrative review, we challenge the belief that single-moment-in-time high-stakes examinations (SMITHSEx) are an essential component of contemporary specialist training. We explore the arguments both for and against SMITHSEx, examine potential alternatives, and discuss the barriers to change.SMITHSEx are viewed as the "gold standard" assessment of competence but focus excessively on knowledge assessment rather than capturing essential competencies required for safe and competent workplace performance. Contrary to popular belief, regulatory bodies do not mandate SMITHSEx in specialist training. Though acting as significant drivers of learning and professional identity formation, these attributes are not exclusive to SMITHSEx.Skills such as crisis management, procedural skills, professionalism, communication, collaboration, lifelong learning, reflection on practice, and judgement are often overlooked by SMITHSEx. Their inherent design raises questions about the validity and objectivity of SMITHSEx as a measure of workplace competence. They have a detrimental impact on trainee well-being, contributing to burnout and differential attainment.Alternatives to SMITHSEx include continuous low-stakes assessments throughout training, ongoing evaluation of competence in the workplace, and competency-based medical education (CBME) concepts. These aim to provide a more comprehensive and context-specific assessment of trainees' competence while also improving trainee welfare.Specialist training colleges should evolve from exam providers to holistic education sources. Assessments should emphasise essential practical knowledge over trivia, align with clinical practice, aid learning, and be part of a diverse toolkit. Eliminating SMITHSEx from specialist training will foster a competency-based approach, benefiting future medical professionals' well-being and success.
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Affiliation(s)
- Navdeep S Sidhu
- Department of Anaesthesiology, School of Medicine, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand
| | - Simon Fleming
- Department of Hand Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Kang EYN, Chi KY, Liao F, Liu CC, Lin CP, Chen TL, Tanaka P, Chen CY. Indigenizing and co-producing the ACGME anesthesiology milestone in Taiwan: a Delphi study and subgroup analysis. BMC Med Educ 2024; 24:154. [PMID: 38374112 PMCID: PMC10875863 DOI: 10.1186/s12909-024-05081-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND To implement the ACGME Anesthesiology Milestone Project in a non-North American context, a process of indigenization is essential. In this study, we aim to explore the differences in perspective toward the anesthesiology competencies among residents and junior and senior visiting staff members and co-produce a preliminary framework for the following nation-wide survey in Taiwan. METHODS The expert committee translation and Delphi technique were adopted to co-construct an indigenized draft of milestones. Descriptive analysis, chi-square testing, Pearson correlation testing, and repeated-measures analysis of variance in the general linear model were employed to calculate the F values and mean differences (MDs). RESULTS The translation committee included three experts and the consensus panel recruited 37 participants from four hospitals in Taiwan: 9 residents, 13 junior visiting staff members (JVSs), and 15 senior visiting staff members (SVSs). The consensus on the content of the 285 milestones was achieved after 271 minor and 6 major modifications in 3 rounds of the Delphi survey. Moreover, JVSs were more concerned regarding patient care than were both residents (MD = - 0.095, P < 0.001) and SVSs (MD = 0.075, P < 0.001). Residents were more concerned regarding practice-based learning improvement than were JVSs (MD = 0.081; P < 0.01); they also acknowledged professionalism more than JVSs (MD = 0.072; P < 0.05) and SVSs (MD = 0.12; P < 0.01). Finally, SVSs graded interpersonal and communication skills lower than both residents (MD = 0.068; P < 0.05) and JVSs (MD = 0.065; P < 0.05) did. CONCLUSIONS Most ACGME anesthesiology milestones are applicable and feasible in Taiwan. Incorporating residents' perspectives may bring insight and facilitate shared understanding to a new educational implementation. This study helped Taiwan generate a well-informed and indigenized draft of a competency-based framework for the following nation-wide Delphi survey.
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Affiliation(s)
- Enoch Yi-No Kang
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Yu Chi
- Department of Medicine, Jacobi Medical Center, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Faith Liao
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chih-Chung Liu
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Pedro Tanaka
- Department of Anesthesia, Stanford University Medical School, Palo Alto, CA, USA
| | - Chien-Yu Chen
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Tu CY, Huang KM, Cheng CH, Lin WJ, Liu CH, Yang CW. Development, implementation, and evaluation of entrustable professional activities (EPAs) for medical radiation technologists in Taiwan: a nationwide experience. BMC Med Educ 2024; 24:95. [PMID: 38287396 PMCID: PMC10826224 DOI: 10.1186/s12909-024-05088-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/23/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Competency-based medical education (CBME) is an outcomes-oriented approach focused on developing competencies that translate into clinical practice. Entrustable professional activities (EPAs) bridge competency assessment and clinical performance by delineating essential day-to-day activities that can be entrusted to trainees. EPAs have been widely adopted internationally, but not yet implemented for medical radiation professionals in Taiwan. MATERIALS AND METHODS A nationwide consensus process engaged 97 experts in radiation technology education representing diagnostic radiography, radiation therapy, and nuclear medicine. Preliminary EPAs were developed through the focus group discussion and the modified Delphi method. The validity of these EPAs was evaluated using the QUEPA and EQual tools. RESULTS Through iterative consensus building, six core EPAs with 18 component observable practice activities (OPAs) in total were developed, encompassing routines specific to each radiation technology specialty. QUEPA and EQual questionnaire data verified these EPAs were valid, and of high quality for clinical teaching and evaluation. CONCLUSION The consensus development of tailored EPAs enables rigorous competency assessment during medical radiation technology education in Taiwan. Further expansion of EPAs and training of clinical staff could potentially enhance care quality by producing competent professionals.
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Affiliation(s)
- Chun-Yuan Tu
- Taiwan Association of Medical Radiation Technologists, Taipei, Taiwan
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Ming Huang
- Taiwan Association of Medical Radiation Technologists, Taipei, Taiwan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Hsueh Cheng
- Taiwan Association of Medical Radiation Technologists, Taipei, Taiwan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Jou Lin
- Taiwan Association of Medical Radiation Technologists, Taipei, Taiwan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Heng Liu
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department and Graduate Institute of Medical Education and Bioethics, College of Medicine, National Taiwan University, No. 1, Sec. 1, Ren'ai Rd., Zhongzheng Dist., Taipei, 100, Taiwan
| | - Chih-Wei Yang
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Department and Graduate Institute of Medical Education and Bioethics, College of Medicine, National Taiwan University, No. 1, Sec. 1, Ren'ai Rd., Zhongzheng Dist., Taipei, 100, Taiwan.
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Braund H, Patel V, Dalgarno N, Mann S. Exploring residents' perceptions of competency-based medical education across Canada: A national survey study. MedEdPublish (2016) 2024; 14:2. [PMID: 38487752 PMCID: PMC10933567 DOI: 10.12688/mep.19247.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 03/17/2024] Open
Abstract
Background: As competency-based medical education (CBME) is implemented across Canada, little is known about residents' perceptions of this model. This study examined how Canadian residents understand CBME and their lived experiences with implementation. Methods: We administered a survey in 2018 with Likert-type and open-ended questions to 375 residents across Canada, of whom 270 were from traditional programs ("pre-CBME") and 105 were in a CBME program. We used the Mann-Whitney test to examine differences across samples, and analyzed qualitative data thematically. Results: Three themes were identified across both groups: program outcome concerns, changes, and emotional responses. In relation to program concerns, both groups were concerned about the administrative burden, challenges with the assessment process, and feedback quality. Only pre-CBME residents were concerned about faculty engagement and buy-in. In terms of changes, both groups discussed a more formalized assessment process with mixed reactions. Residents in the pre-CBME sample reported greater concerns for faculty time constraints, assessment completion, and quality of learning experiences, whilst those in CBME programs reported being more proactive in their learning and greater selfreflection. Residents expressed strong emotional narrative responses including greater stress and frustration in a CBME environment. Conclusion: Findings demonstrate that residents have mixed feelings and experiences regarding CBME. Their positive experiences align with the aim of developing more self-directed learners. However, the concerns suggest the need to address specific shortcomings to increase buy-in, while the emotional responses associated with CBME may require a cultural shift within residency programs to guard against burnout.
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Affiliation(s)
- Heather Braund
- Professional Development & Educational Scholarship, Queen's University, Kingston, Ontario, K7L 1B9,, Canada
| | - Vivesh Patel
- Faculty of Health Sciences, Queen's University, Kingston, Ontario, K7L 2Y1, Canada
| | - Nancy Dalgarno
- Professional Development & Educational Scholarship, Queen's University, Kingston, Ontario, K7L 1B9,, Canada
| | - Steve Mann
- Department of Surgery, Queen's University, Kingston, Ontario, K7L 2V7, Canada
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Fisk D, Clendenning B, St John P, Francois J. Multi-stakeholder validation of entrustable professional activities for a family medicine care of the elderly residency program: A focus group study. Gerontol Geriatr Educ 2024; 45:12-25. [PMID: 36326195 DOI: 10.1080/02701960.2022.2130913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Entrustable Professional Activities (EPAs) have become widely used within Competency-Based Medical Education (CBME) for the training and evaluation of residents. Little is known about the effectiveness of incorporating multiple stakeholder groups in the validation of EPAs. Here, we seek to validate an EPA framework developed for the University of Manitoba Care of the Elderly Enhanced Skills program using online focus groups consisting of five stakeholder groups. Participants were recruited to take part in one of five online focus groups, one for each stakeholder group (physician faculty, residents, non-physician healthcare professionals, administrators/managers, and patients). Each group met one time for 90 minutes over ZOOM®. The themes arising from stakeholder feedback suggest that successful EPAs must neither be too specific nor too expansive in scope, clearly delineate appropriate means of evaluation, and indicate specific clinical settings in which each EPA should be evaluated. Cross-cutting themes included requiring trainees to collaborate with other professionals when it would optimize patient care, and preparing trainees to advocate for their patients' health (Advocacy). The present study demonstrates that multi-stakeholder analysis yields diverse feedback that can help make EPAs more clear, easier to use in evaluation, and more socially accountable.
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Affiliation(s)
- Derek Fisk
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ben Clendenning
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Philip St John
- Max Rady College of Medicine, Department of Internal Medicine, Section of Geriatric Medicine, Winnipeg, Manitoba, Canada
- University of Manitoba Centre on Aging, Winnipeg, Manitoba, Canada
| | - Jose Francois
- University of Manitoba Centre on Aging, Winnipeg, Manitoba, Canada
- Department of Family Medicine, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
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Schumacher DJ, Kinnear B, Carraccio C, Holmboe E, Busari JO, van der Vleuten C, Lingard L. Competency-based medical education: The spark to ignite healthcare's escape fire. Med Teach 2024; 46:140-146. [PMID: 37463405 DOI: 10.1080/0142159x.2023.2232097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
High-value care is what patients deserve and what healthcare professionals should deliver. However, it is not what happens much of the time. Quality improvement master Dr. Don Berwick argued more than two decades ago that American healthcare needs an escape fire, which is a new way of seeing and acting in a crisis situation. While coined in the U.S. context, the analogy applies in other Western healthcare contexts as well. Therefore, in this paper, the authors revisit Berwick's analogy, arguing that medical education can, and should, provide the spark for such an escape fire across the globe. They assert that medical education can achieve this by fully embracing competency-based medical education (CBME) as a way to place medicine's focus on the patient. CBME targets training outcomes that prepare graduates to optimize patient care. The authors use the escape fire analogy to argue that medical educators must drop long-held approaches and tools; treat CBME implementation as an adaptive challenge rather than a technical fix; demand genuine, rich discussions and engagement about the path forward; and, above all, center the patient in all they do.
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Affiliation(s)
- Daniel J Schumacher
- Pediatrics, Cincinnati Children's Hospital Medical Center and, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Benjamin Kinnear
- Pediatrics and Internal Medicine, Cincinnati Children's Hospital Medical Center and, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Carol Carraccio
- Vice President of Competency-Based Medical Education, American Board of Pediatrics, Chapel Hill, North Carolina, USA
| | - Eric Holmboe
- Milestones Development and Evaluation Officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois, USA
| | - Jamiu O Busari
- Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Cees van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Lorelei Lingard
- Department of Medicine, and Center for Education Research & Innovation, Schulich School of Medicine and Dentistry at Western University, London, Ontario, Canada
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Joshi MK. Novel teaching-learning and assessment tools to complement competency-based medical education in postgraduate training. Indian J Anaesth 2024; 68:11-16. [PMID: 38406330 PMCID: PMC10893807 DOI: 10.4103/ija.ija_1175_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/01/2024] [Accepted: 01/07/2024] [Indexed: 02/27/2024] Open
Abstract
Medical and educational techniques and approaches have evolved globally over the past few decades. The modern approach is more learner-centred, with a focus on the acquisition of skills. The recently implemented competency-based medical education (CBME) for the National Medical Commission (NMC) undergraduate course curriculum is also competency-based rather than an outcome-based traditional curriculum. It is vital to embrace innovative teaching-learning and educational strategies to achieve the aspiration of CBME. This article provides a list of some of the newer tools and their perceived advantages and challenges and serves as a guide for using these methods effectively to meet the objectives of CBME as proposed by the NMC. Virtual teaching, learning from digital resources, objective-structured practical and clinical examination, flipped classroom, case-based learning, serious gaming, simulation-based learning and learning from role-plays and portfolios emerged as novel instructional strategies.
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Affiliation(s)
- Mohit K. Joshi
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Baboolal SO, Singaram VS. Specialist training: workplace-based assessments impact on teaching, learning and feedback to support competency-based postgraduate programs. BMC Med Educ 2023; 23:941. [PMID: 38082397 PMCID: PMC10712152 DOI: 10.1186/s12909-023-04922-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Workplace-based assessments (WBAs) are part of a competency-based curriculum where training progression is dependent on the achievement of defined competencies in a real-world clinical environment. There is a significant literature gap on the impact of WBAs implemented in resource constrained countries and their contextual challenges. This study aimed to examine the use, impact, and educational context of WBAs in South African medical specialist training programs drawing on perspectives from both trainees and trainers to identify educational challenges and propose effective solutions. METHODS A mixed methods national electronic survey was conducted with specialist medical trainees and supervising trainers from all eight specialist training institutions in South Africa involving 16 specialities. The survey responses were voluntary and anonymous. The survey was closed after seven months when data saturation was achieved. Descriptive statistical analysis was performed using SPSS Version 27 (SPSS Inc, 2012, Chicago, IL) for the quantitative analysis. The thematic coding framework for the qualitative analysis was facilitated by NVivo Version 12 software. RESULTS There were 108 ethnically diverse supervising trainers and 248 specialist trainees' survey respondents. Across the 16 medical specialities, 45% of the respondents were using WBAs. Despite contextual resource and staff challenges, this study found that WBAs had a positive impact to Kirkpatrick level 2 in providing actionable feedback to improve competency. WBA users had a significantly higher rating for trainee supervision (p < 0.01), general quality of feedback on trainee competence (< 0.01) and the specialist training program (p = 0.03) compared to WBA non-users. They also had a higher rating for the assessment of the trainee as a professional (p < 0.01); scholar (p < 0.01); communicator (p < 0.01); collaborator (p = 0.001) and leader/manager (p < 0.001) based on the AfriMEDS competency framework. Racism, sexism and favouritism were challenges that negatively affected the training programs. CONCLUSION Overall, this study reports that the use of WBAs had a substantially favourable impact on teaching, learning, feedback and supports a competency-based approach to specialist training programs. Addressing the contextual concerns that negatively impact training; training the trainees and trainers about their relationship, roles and responsibilities; and focusing on a trainee-centred, inclusive and empowering teaching approach will help further enhance its effectiveness.
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Affiliation(s)
- Sandika O Baboolal
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa.
- Ophthalmology Department, James Paget University Hospital, Great Yarmouth, UK.
| | - Veena S Singaram
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
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Jensen RM, Anand A, Kearse LE, Korndorffer JR. The domino effect: the impact of gender on operative self-efficacy. Surg Endosc 2023; 37:9461-9466. [PMID: 37697120 DOI: 10.1007/s00464-023-10378-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/30/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Studies suggest that there are key differences in operative experience based on a trainee's gender. A large-scale self-efficacy (SE) survey, distributed to general surgery residents after the American Board of Surgery In-Training Examination in 2020, found that female gender was associated with decreased SE in graduating PGY5 residents for all 4 laparoscopic procedures included on the survey (cholecystectomy, appendectomy, right hemicolectomy, and diagnostic laparoscopy). We sought to determine whether these differences were reflected at the case level when considering operative performance and supervision using an operative assessment tool (SIMPL OR). METHODS Supervision and performance data reported through the SIMPL OR platform for the same 4 laparoscopic procedures included in the SE survey were aggregated for residents who were PGY5s in 2020. Independent t-tests and multiple linear regression were used to determine the relationship between trainee gender and supervision/performance ratings. RESULTS For laparoscopic cases in aggregate (n = 2708), male residents rated their performance higher than females (3.57 vs. 3.26, p < 0.001, 1 = critical deficiency, 5 = exceptional performance) and reported less supervision (3.15 vs. 2.85, p < 0.001, 1 = show and tell, 4 = supervision only); similar findings were seen when looking at attending reports of resident supervision and performance. A multiple linear regression model showed that attending gender did not significantly predict resident-reported supervision or performance levels, while case complexity and trainee gender significantly affected both supervision and performance (p < 0.001). DISCUSSION Female residents perceive themselves to be less self-efficacious at core laparoscopic procedures compared to their male colleagues. Comparison to more case-specific data confirm that female residents receive more supervision and lower performance ratings. This may create a domino effect in which female residents receive less operative independence, preventing the opportunity to establish SE. Further research should identify opportunities to break this cycle and consider gender identity beyond the male/female construct.
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Affiliation(s)
- Rachel M Jensen
- Department of Surgery, Stanford University, Stanford, CA, USA.
| | - Ananya Anand
- Department of Surgery, Stanford University, Stanford, CA, USA
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Mathur M, Verma A, Mathur N, Kumar D, Meena JK, Nayak S, Gaiki V, Parmar P. Blueprint designing and validation for competency-based curriculum for theory assessment in community medicine. Med J Armed Forces India 2023; 79:S47-S53. [PMID: 38144616 PMCID: PMC10746729 DOI: 10.1016/j.mjafi.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/02/2021] [Indexed: 11/27/2022] Open
Abstract
Background Blueprint provides a base for assessment by assigning proportionate weightage to various content areas and helps the paper setter to construct a uniform and valid assessment. This study aimed to design and validate a blueprint for theory in Community Medicine as per the new curriculum for Medical Undergraduates in India. Methods Blueprint in community medicine was designed by assigning impact score (I) and frequency score (F) for the competencies. Blueprint was validated using the Content Validity Index (CVI), and inter-rater agreement for subject experts using Fleiss' kappa statistics was calculated. Feedback from faculty and students was obtained afterward to assess the postimplementation response. Results Blueprint was designed by an expert group where impact score and frequency score were assigned to 146 competencies in the theory of Community Medicine. In Delphi survey I, 63.2% of subject experts responded, while in Delphi survey II, a response rate of 58.3% was achieved. Value of the Fleiss' Kappa test for an inter-rater agreement was 0.68, i.e. "substantial agreement," while CVI among the raters came out to be 0.86, i.e. overall valid assessment. Feedback of faculty (n = 11) suggested that the blueprint was helpful and standardized the paper setting, whereas feedback from students (n = 138) depicted that it helped in preparing for exams, and they would recommend it to other students. Conclusion Validated blueprint by consensus of subject experts has impact score and frequency score along with topic-wise distribution of marks for the convenience of faculty and its utility is well proven among learners too.
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Affiliation(s)
- Medha Mathur
- Associate Professor (Community Medicine), Geetanjali Medical College & Hospital, Udaipur, Rajasthan, India
| | - Anjana Verma
- Associate Professor (General Medicine), Geetanjali Medical College & Hospital, Udaipur, Rajasthan, India
| | - Navgeet Mathur
- Associate Professor (General Medicine), Geetanjali Medical College & Hospital, Udaipur, Rajasthan, India
| | - Dewesh Kumar
- Assistant Professor (Community Medicine), Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Jitendra Kumar Meena
- Assistant Professor, Preventive Oncology, National Cancer Institute, Jhajjar, AIIMS, New Delhi, India
| | - Smrutiranjan Nayak
- Professor (Community Medicine), Kalinga Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Varun Gaiki
- Professor (Community Medicine), Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Piyushkumar Parmar
- Associate Professor (Community Medicine), Smt.B.K.Shah Medical Institute & Research Center, Piparia, Vadodara, Gujarat, India
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Carney PA, Sebok-Syer SS, Pusic MV, Gillespie CC, Westervelt M, Goldhamer MEJ. Using learning analytics in clinical competency committees: Increasing the impact of competency-based medical education. Med Educ Online 2023; 28:2178913. [PMID: 36821373 PMCID: PMC9970252 DOI: 10.1080/10872981.2023.2178913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Graduate medical education (GME) and Clinical Competency Committees (CCC) have been evolving to monitor trainee progression using competency-based medical education principles and outcomes, though evidence suggests CCCs fall short of this goal. Challenges include that evaluation data are often incomplete, insufficient, poorly aligned with performance, conflicting or of unknown quality, and CCCs struggle to organize, analyze, visualize, and integrate data elements across sources, collection methods, contexts, and time-periods, which makes advancement decisions difficult. Learning analytics have significant potential to improve competence committee decision making, yet their use is not yet commonplace. Learning analytics (LA) is the interpretation of multiple data sources gathered on trainees to assess academic progress, predict future performance, and identify potential issues to be addressed with feedback and individualized learning plans. What distinguishes LA from other educational approaches is systematic data collection and advanced digital interpretation and visualization to inform educational systems. These data are necessary to: 1) fully understand educational contexts and guide improvements; 2) advance proficiency among stakeholders to make ethical and accurate summative decisions; and 3) clearly communicate methods, findings, and actionable recommendations for a range of educational stakeholders. The ACGME released the third edition CCC Guidebook for Programs in 2020 and the 2021 Milestones 2.0 supplement of the Journal of Graduate Medical Education (JGME Supplement) presented important papers that describe evaluation and implementation features of effective CCCs. Principles of LA underpin national GME outcomes data and training across specialties; however, little guidance currently exists on how GME programs can use LA to improve the CCC process. Here we outline recommendations for implementing learning analytics for supporting decision making on trainee progress in two areas: 1) Data Quality and Decision Making, and 2) Educator Development.
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Affiliation(s)
- Patricia A. Carney
- Professor of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | | | | | - Marjorie Westervelt
- Director of Assessment, Evaluation and Scholarship, University of California, Davis, CA, USA
| | - Mary Ellen J. Goldhamer
- Medicine, Harvard Medical School, Massachusetts General Hospital, and Mass General Brigham, Boston, MA, USA
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Curtis C, Kassam A, Lord J, Cooke LJ. Competence committees decision-making; an interplay of data, group orientation, and intangible impressions. BMC Med Educ 2023; 23:748. [PMID: 37817152 PMCID: PMC10565978 DOI: 10.1186/s12909-023-04693-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 09/16/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND The implementation of competency-based medical education and utilization of competence committees (CC) represents a paradigm shift in residency education. This qualitative study aimed to explore the methods used by two operational CC and their members to make decisions about progression and competence of their residents. METHODS An instrumental case study methodology was used to study the CC of two postgraduate training programs. Transcripts from observed CC meetings, member interviews, and guiding documents were analyzed using a constructivist grounded theory approach to reveal themes explaining the decision-making process. RESULTS Our study found that the CC followed a process that began within a social decision schema model and evolved to a discussion that invoked social influence theory, shared mental models, and social judgment scheme to clarify the points of contention. We identified that the CC decision-making was at risk of bias, primarily influenced by the group composition, the group orientation and individual members' mindset, as well as their personal experiences with the trainees. CONCLUSIONS Increased awareness of the sources of bias in CC functioning and familiarity with the CC role in competency-based medical education would enable committees to provide valuable feedback to all trainees regardless of their trajectory.
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Affiliation(s)
- Colleen Curtis
- Department of Pediatrics, University of Calgary, 28 Oki Dr. NW, Calgary, AB, T3B 6A8, Canada.
| | - Aliya Kassam
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Jason Lord
- Departments of Emergency Medicine and Critical Care Medicine, University of Calgary, Calgary, Canada
| | - Lara J Cooke
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
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Wong L, Chung AD, Rogoza C, Kwan BYM. Peering Into the Future: A First Look at the CBME Transition to Practice Stage in Diagnostic Radiology. Acad Radiol 2023; 30:2406-2417. [PMID: 37453881 DOI: 10.1016/j.acra.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023]
Abstract
RATIONALE AND OBJECTIVES Queen's University (Kingston, ON, Canada) adopted a competency-based medical education (CBME) curriculum for Diagnostic Radiology residency training in an accelerated manner in 2017, with the curriculum comprised of four stages of training. This article focuses on the final stage (Transition to Practice), during which assessment methods of the new national curriculum (implemented in July 2022) were piloted. This study aims to highlight the challenges and opportunities associated with the implementation of CBME in Diagnostic Radiology training and specific considerations for programs undergoing this curricular transition. MATERIALS AND METHODS Ethics approval was provided by the affiliated hospital Research Ethics Board. All relevant electronic assessments pertaining to all trainees who had completed the Transition to Practice stage (n = 3) were collated, deidentified, analyzed, and presented in tabulated format. RESULTS A total of 39 evaluations completed by 13 assessors were assessed, with an average time of 3 minutes and 6 seconds to complete an assessment form. Also, 95% of evaluations were rated as entrustments. However, no residents met the minimum number of required entrustments for all five stage-specific Entrustable Professional Activities. These 39 evaluations included 219 milestone rating scores, with 86% rated as "achieved." Following review by the residency program Competence Committee, all three residents were promoted from the Transition to Practice stage. CONCLUSION Challenges in CBME implementation include the number and quality of resident assessments. Strategies for success may include providing clear guidelines and training for both faculty and residents, early identification and intervention, and adopting a holistic evaluation strategy. CBME has the potential to enhance medical education quality by emphasizing learner progress toward competency and providing personalized feedback and support.
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Affiliation(s)
- Laura Wong
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, ON K7L 2V7, Canada (L.W., A.C., C.R., B.K.); Queen's University, Faculty of Health Sciences, Kingston, ON, Canada (L.W., A.C., C.R., B.K.)
| | - Andrew D Chung
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, ON K7L 2V7, Canada (L.W., A.C., C.R., B.K.); Queen's University, Faculty of Health Sciences, Kingston, ON, Canada (L.W., A.C., C.R., B.K.)
| | - Christina Rogoza
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, ON K7L 2V7, Canada (L.W., A.C., C.R., B.K.); Queen's University, Faculty of Health Sciences, Kingston, ON, Canada (L.W., A.C., C.R., B.K.)
| | - Benjamin Y M Kwan
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, ON K7L 2V7, Canada (L.W., A.C., C.R., B.K.); Queen's University, Faculty of Health Sciences, Kingston, ON, Canada (L.W., A.C., C.R., B.K.).
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Costello LL, Cho DD, Daniel RC, Dida J, Pritchard J, Pardhan K. Emergency medicine resident perceptions of simulation-based training and assessment in competence by design. CAN J EMERG MED 2023; 25:828-835. [PMID: 37665550 DOI: 10.1007/s43678-023-00577-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES With the launch of competence by design (CBD) in emergency medicine (EM) in Canada, there are growing recommendations on the use of simulation for the training and assessment of residents. Many of these recommendations have been suggested by educational leaders and often exclude the resident stakeholder. This study sought to explore their experiences and perceptions of simulation in CBD. METHODS Qualitative data were collected from November 2020 to May 2021 at McMaster University and the University of Toronto after receiving ethics approval from both sites. Eligible participants included EM residents who were interviewed by a trained interviewer using a semi-structured interview guide. All interviews were recorded, transcribed, coded, and collapsed into themes. Data analysis was guided by constructivist grounded theory. RESULTS A total of seventeen residents participated. Thematic analysis revealed three major themes: 1) impact of CBD on resident views of simulation; 2) simulation's role in obtaining entrustable professional activities (EPAs) and filling educational gaps; and 3) conflicting feelings on the use of high-stakes simulation-based assessment in CBD. CONCLUSIONS EM residents strongly support using simulation in CBD and acknowledge its ability to bridge educational gaps and fulfill specific EPAs. However, this study suggests some unintended consequences of CBD and conflicting views around simulation-based assessment that challenge resident perceptions of simulation as a safe learning space. As CBD evolves, educational leaders should consider these impacts when making future curricular changes or recommendations.
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Affiliation(s)
- Lorne L Costello
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Dennis D Cho
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
| | - Ryan C Daniel
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Joana Dida
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jodie Pritchard
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Kaif Pardhan
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Felicelli C, Gama A, Chornenkyy Y, Choy B, Blanco LZ, Novo JE. From principles to practice: Implementation of entrustable professional activities (EPAs) for surgical pathology residency education in a large academic hospital. Acad Pathol 2023; 10:100097. [PMID: 38025045 PMCID: PMC10679497 DOI: 10.1016/j.acpath.2023.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/29/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
Over the past decade, competency-based medical education (CBME) has gained momentum in the United States to develop trainees into independent and confident physicians by the end of their training. Entrustable professional activities (EPAs) are an established methodology for assessing trainee development through an outcomes-driven rather than a time-based model. While EPAs have been utilized as an assessment tool for CBME in Europe and Canada, their validation and implementation in some medical specialties has occurred more recently in the United States. Pediatrics was the first specialty in the US to conduct a large-scale UME-GME pilot. Pathology Residency EPAs were published in 2018; however, implementation in training programs has been slow. We have piloted EPAs in our residency program's surgical pathology rotation and propose a unique set of 4 surgical pathology EPAs to track trainee preparedness for independent practice.
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Affiliation(s)
| | - Alcino Gama
- Corresponding author. Northwestern University Feinberg School of Medicine, Department of Pathology, 303 E. Chicago Ave. Ward 3-140 W127, Chicago, IL 60611, USA.
| | - Yevgen Chornenkyy
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bonnie Choy
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Luis Z. Blanco
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jorge E. Novo
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Harvey A, Paget M, McLaughlin K, Busche K, Touchie C, Naugler C, Desy J. How much is enough? Proposing achievement thresholds for core EPAs of graduating medical students in Canada. Med Teach 2023; 45:1054-1060. [PMID: 37262177 DOI: 10.1080/0142159x.2023.2215910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The transition towards Competency-Based Medical Education at the Cumming School of Medicine was accelerated by the reduced clinical time caused by the COVID-19 pandemic. The purpose of this study was to define a standard protocol for setting Entrustable Professional Activity (EPA) achievement thresholds and examine their feasibility within the clinical clerkship. METHODS Achievement thresholds for each of the 12 AFMC EPAs for graduating Canadian medical students were set by using sequential rounds of revision by three consecutive groups of stakeholders and evaluation experts. Structured communication was guided by a modified Delphi technique. The feasibility/consequence models of these EPAs were then assessed by tracking their completion by the graduating class of 2021. RESULTS The threshold-setting process resulted in set EPA achievement levels ranging from 1 to 8 across the 12 AFMC EPAs. Estimates were stable after the first round for 9 of 12 EPAs. 96.27% of EPAs were successfully completed by clerkship students despite the shortened clinical period. Feasibility was predicted by the slowing rate of EPA accumulation overtime during the clerkship. CONCLUSION The process described led to consensus on EPA achievement thresholds. Successful completion of the assigned thresholds was feasible within the shortened clerkship.[Box: see text].
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Affiliation(s)
- Adrian Harvey
- Departments of Surgery & Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Paget
- Director of Academic Technologies, Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin McLaughlin
- Department of Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Busche
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Claire Touchie
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher Naugler
- Departments of Pathology & Laboratory Medicine, Community Health Sciences and Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Janeve Desy
- Clinical Assistant Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Greenfield J, Qua K, Prayson RA, Bierer SB. "It Changed How I Think"-Impact of Programmatic Assessment Upon Practicing Physicians: A Qualitative Study. Med Sci Educ 2023; 33:963-974. [PMID: 37546195 PMCID: PMC10403454 DOI: 10.1007/s40670-023-01829-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/08/2023]
Abstract
Programmatic assessment is a systematic approach used to document and assess learner performance. It offers learners frequent formative feedback from a variety of contexts and uses both high- and low-stakes assessments to determine student progress. Existing research has explored learner and faculty perceptions of programmatic assessment, reporting favorable impact on faculty understanding of the importance of assessment stakes and feedback to learners while students report the ability to establish and navigate towards goals and reflect on their performance. The Cleveland Clinic Lerner College of Medicine (CCLCM) of Case Western Reserve University adopted programmatic assessment methods at its inception. With more than 18 years' experience with programmatic assessment and a portfolio-based assessment system, CCLCM is well-positioned to explore its graduates' perceptions of their programmatic assessment experiences during and after medical school. In 2020, the investigators interviewed 26 of the 339 physician graduates. Participants were purposefully sampled to represent multiple class cohorts (2009-2019), clinical specialties, and practice locations. The investigators analyzed interview transcripts using thematic analysis informed by the frameworks of self-determination theory and professional identity formation. The authors identified themes and support each with participant quotes from the interviews. Based on findings, the investigators compiled a series of recommendations for other institutions who have already or plan to incorporate elements of programmatic assessment into their curricula. The authors concluded by discussing future directions for research and additional avenues of inquiry.
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Affiliation(s)
- Jessica Greenfield
- University of Virginia School of Medicine, Room 2008A Pinn Hall, Box 800866, Charlottesville, VA 22908-0366 USA
| | - Kelli Qua
- Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - Richard A. Prayson
- Department of Anatomic Pathology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH USA
| | - S. Beth Bierer
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
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Laverdure M, Gomez-Garibello C, Snell L. Residents as Medical Coaches. J Surg Educ 2023; 80:1067-1074. [PMID: 37271599 DOI: 10.1016/j.jsurg.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES With the recent implementation of Competency-based Medical Education (CBME) and emphasis on direct observation of learners, there is an increased interest in the concept of clinical coaching. While there is considerable literature on the role of attending physicians as coaches, little data is available on the role of residents as coaches, and residents' perceptions about effective coaching. We aimed to identify distinct characteristics of residents' coaching, to examine residents' perceptions on what they valued most in clinical coaches, and to explore trainees' ideas about how to optimize this role. DESIGN We performed an exploratory qualitative study, using 45 minutes semi-structured interviews. We did a thematic analysis of the interview transcripts using both inductive and deductive coding. PARTICIPANTS We invited and interviewed 5 surgical and 5 nonsurgical residents, and 3 surgical and 3 nonsurgical attending staff. Residents were recruited from all post graduate levels and from a variety of programs. SETTING Our study was done in a large tertiary teaching hospital. RESULTS Residents perceived that they have a significant role as coaches for junior learners, different from the attending's role. The proximity between the coach and the coaches leads to a different supervisor-learner rapport. This was of benefit as learners described feeling more comfortable making mistakes and seeking feedback, which potentiates effective coaching. Residents reported feeling that it was easier to coach their recently-acquired skills as the subtleties of the tasks and the troubleshooting were fresher in memory. Residents expressed appreciating a coach who values autonomy and does not intervene except when patient safety is at risk. Strategies identified to further optimize residents' role as coaches include placing coaching as a priority, ensuring dedicated time, and offering teaching sessions on coaching. CONCLUSIONS Residents have distinct roles as coaches, driven by their recent experience being coached and as near peers. More research is needed to evaluate concrete measures to optimize residents' role as coaches and to improve their coaching skills.
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Affiliation(s)
- Morgane Laverdure
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
| | | | - Linda Snell
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
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Zhou Y, Wieringa TH, Brouwer J, Diemers AD, Bos NA. Challenges to acquire similar learning outcomes across four parallel thematic learning communities in a medical undergraduate curriculum. BMC Med Educ 2023; 23:349. [PMID: 37202782 DOI: 10.1186/s12909-023-04341-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND To train physicians who are able to meet the evolving requirements from health care, the University of Groningen Medical Center adopted in 2014 a new curriculum named G2020. This curriculum combines thematic learning communities with competency-based medical education and Problem-based learning. In the learning community program, different learning tasks were used to train general competencies. The challenge of this program was whether students acquire similar levels of learning outcomes within the different variations of the program. METHOD We used the assessment results of three cohorts for the first two bachelor years. We used progress tests and written tests to analyze knowledge development, and the assessment results of seven competencies to analyze competence development. Concerning knowledge, we used the cumulative deviation method to compare progress tests and used the Kruskal-Wallis H test to compare written test scores between programs. Descriptive statistics are used to present all assessments of the students' competencies. RESULTS We observed similarly high passing rates both for competency and knowledge assessments in all programs. However, we did observe some differences. The two programs that focused more on competencies development underperformed the other two programs on knowledge assessment but outperformed on competencies assessment. CONCLUSION This study indicates that it is possible to train students in different learning programs within one curriculum while having similar learning outcomes. There are however some differences in obtained levels between the different programs. The new curriculum still needs to improve by balancing variations in the programs and comparability of assessments across the programs.
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Affiliation(s)
- Yan Zhou
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
- Center for Education Development and Research in Health Professions (CEDAR), LEARN, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas H Wieringa
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Jasperina Brouwer
- Educational Sciences, Faculty Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Agnes D Diemers
- Center for Education Development and Research in Health Professions (CEDAR), LEARN, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nicolaas A Bos
- Center for Education Development and Research in Health Professions (CEDAR), LEARN, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Wenckebach Institute for Education and Training, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O.Box 30.001, 9700 RB, Groningen, The Netherlands.
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Chin M, Pack R, Cristancho S. "A whole other competence story": exploring faculty perspectives on the process of workplace-based assessment of entrustable professional activities. Adv Health Sci Educ Theory Pract 2023; 28:369-385. [PMID: 35997910 DOI: 10.1007/s10459-022-10156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/07/2022] [Indexed: 05/11/2023]
Abstract
The centrality of entrustable professional activities (EPAs) in competency-based medical education (CBME) is predicated on the assumption that low-stakes, high-frequency workplace-based assessments used in a programmatic approach will result in accurate and defensible judgments of competence. While there have been conversations in the literature regarding the potential of this approach, only recently has the conversation begun to explore the actual experiences of clinical faculty in this process. The purpose of this qualitative study was to explore the process of EPA assessment for faculty in everyday practice. We conducted 18 semi-structured interviews with Anesthesia faculty at a Canadian academic center. Participants were asked to describe how they engage in EPA assessment in daily practice and the factors they considered. Interviews were audio-recorded, transcribed, and analysed using the constant comparative method of grounded theory. Participants in this study perceived two sources of tension in the EPA assessment process that influenced their scoring on official forms: the potential constraints of the assessment forms and the potential consequences of their assessment outcome. This was particularly salient in circumstances of uncertainty regarding the learner's level of competence. Ultimately, EPA assessment in CBME may be experienced as higher-stakes by faculty than officially recognized due to these tensions, suggesting a layer of discomfort and burden in the process that may potentially interfere with the goal of assessment for learning. Acknowledging and understanding the nature of this burden and identifying strategies to mitigate it are critical to achieving the assessment goals of CBME.
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Affiliation(s)
- Melissa Chin
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
| | - Rachael Pack
- Center for Education Research and Innovation, University of Western Ontario, London, ON, Canada
| | - Sayra Cristancho
- Center for Education Research and Innovation, University of Western Ontario, London, ON, Canada
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Yilmaz Y, Chan MK, Richardson D, Atkinson A, Bassilious E, Snell L, Chan TM. Defining new roles and competencies for administrative staff and faculty in the age of competency-based medical education. Med Teach 2023; 45:395-403. [PMID: 36471921 DOI: 10.1080/0142159x.2022.2136517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE These authors sought to define the new roles and competencies required of administrative staff and faculty in the age of CBME. METHOD A modified Delphi process was used to define the new CBME roles and competencies needed by faculty and administrative staff. We invited international experts in CBME (volunteers from the ICBME Collaborative email list), as well as faculty members and trainees identified via social media to help us determine the new competencies required of faculty and administrative staff in the CBME era. RESULTS Thirteen new roles were identified. The faculty-specific roles were: National Leader/Facilitator in CBME; Institutional/University lead for CBME; Assessment Process & Systems Designer; Local CBME Leads; CBME-specific Faculty Developers or Trainers; Competence Committee Chair; Competence Committee Faculty Member; Faculty Academic Coach/Advisor or Support Person; Frontline Assessor; Frontline Coach. The staff-specific roles were: Information Technology Lead; CBME Analytics/Data Support; Competence Committee Administrative Assistant. CONCLUSIONS The authors present a new set of faculty and staff roles that are relevant to the CBME context. While some of these new roles may be incorporated into existing roles, it may be prudent to examine how best to ensure that all of them are supported within all CBME contexts in some manner.
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Affiliation(s)
- Yusuf Yilmaz
- McMaster Education Research, Innovation, and Theory (MERIT), and Office of Continuing Professional Development, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Medical Education, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ming-Ka Chan
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Denyse Richardson
- Department of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Adelle Atkinson
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Ereny Bassilious
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Linda Snell
- Medicine and Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Teresa M Chan
- McMaster Education Research, Innovation, and Theory (MERIT), and Office of Continuing Professional Development, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Divisions of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Canada
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25
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Brodmann Maeder M. [La formation médicale continue en Suisse - un récit]. Praxis (Bern 1994) 2023; 112:292-296. [PMID: 37042403 DOI: 10.1024/1661-8157/a004002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Postgraduate Medical Education in Switzerland - A Narrative Abstract: Medical education has to respond to new challenges such as digitalisation, increase of chronic and complex diseases, economisation. The concept of Competency-Based Medical Education (CBME) has been implemented in undergraduate education in Switzerland. Postgraduate medical education has undergone a fundamental reformation, among other things with the development of Entrustable Professional Activities (EPAs), the adaptation of training programmes or "Teach the Teachers" classes. For the associated cultural change to be successful, the commitment of the professional societies, the training institutions, the hospitals is needed, but also the support of the health and education policy is of utmost importance.
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Cadieux M, McKinley SK, Odewade N, Riva-Cambrin J, Phitayakorn R. Neurosurgeons' Perspectives on Vascular Entrustable Professional Activities. Can J Neurol Sci 2023; 50:287-9. [PMID: 35190007 DOI: 10.1017/cjn.2021.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article discusses subspecialty Canadian neurosurgeons' perceptions of entrustable professional activities (EPAs) assessments and variabilities prior to the implementation of the Competence by Design (CBD) system in Canada. Vascular neurosurgeons were asked to reflect on how they would evaluate and give feedback to neurosurgery residents concerning the EPA "Performing surgery for patients with an intracranial aneurysm." Interviews were transcribed and analyzed using a deductive approach. Themes were derived from these interviews and reflected on the subjectivity and biases present in the EPA assessment forms. Indeed, faculty may require more training in the transitioning to a CBD evaluation system.
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27
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Baenziger K, Chan M, Colman S. Coaching in Postgraduate Competency-Based Medical Education: a Qualitative Exploration of Three Models. Acad Psychiatry 2023; 47:10-17. [PMID: 35501473 PMCID: PMC9060402 DOI: 10.1007/s40596-022-01628-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE As postgraduate medical education increasingly transitions to competency-based models, there is a growing need for faculty to help residents process increasing amounts of assessment data. It has been recommended that a designated resident advisor or coach take on this faculty role, but the literature surrounding coaching in medical education is sparse. The authors evaluated the implementation of different coaching models in a postgraduate psychiatry program to identify drivers and barriers to effective coaching. METHODS The authors conducted semi-structured interviews in September 2019 with focus groups of residents and faculty to understand their experiences of coaching under different models. They identified major themes through a qualitative analysis of the transcribed focus groups, which took place from September to December 2020. RESULTS The authors identified four key themes associated with the implementation of coaching within a competency-based framework, namely role ambiguity, educational alliance, the "idealized coach," and burden. CONCLUSIONS While these findings highlight the barriers that can interfere with effective coaching, particularly in the context of widespread curriculum change, they also illuminate opportunities for the coaching role moving forward. Thus, they offer valuable guidance for present and upcoming competency-based programs as they implement coaching and seek to optimize the learning experience for residents.
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Affiliation(s)
- Kaitlin Baenziger
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Malcolm Chan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Colman
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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28
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Safavi AH, Sienna J, Strang BK, Hann C. Competency-Based Medical Education in Canadian Radiation Oncology Residency Training: an Institutional Implementation Pilot Study. J Cancer Educ 2023; 38:274-284. [PMID: 34859361 DOI: 10.1007/s13187-021-02112-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 06/13/2023]
Abstract
Canadian radiation oncology (RO) residency programs transitioned to a competency-based medical education (CBME) training model named Competence by Design (CBD) in July 2019. Prior to this, CBD was piloted in a single RO training program to characterize assessment completion and challenges of implementation. Six residents and seven staff participated in a mixed-methods study and were oriented to CBD. Four Entrustable Professional Activities were assessed over a 4-week-long block and documented using online assessment forms. Anonymized assessments were analyzed to characterize completion. Post-pilot surveys were completed by 4/6 residents and 5/7 staff. Semi-structured post-pilot focus groups were conducted with all residents. Assessments were requested and documented on a weekly basis. Narrative comments were found in 68.1% of assessments, of which 26.7% described specific examples of observed competence or recommendations for improvement. Three of five staff believed that assessments have a negative impact on clinical workflow. Three themes were identified: (1) direct observation is the most challenging aspect of CBD to implement; (2) feedback content can be improved; and (3) staff attitude, clinical workflow, and inaccessibility of assessment forms are the primary barriers to completing assessments. This study demonstrates that CBD assessments can be completed regularly in an outpatient radiation oncology setting and that implementation challenges include improving feedback quality, promoting direct observation, and continuing faculty development to improve perceptions of this assessment model. Further study is required to identify best practices and expectations for the discipline in the era of CBME.
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Affiliation(s)
- Amir H Safavi
- Department of Radiation Oncology, University of Toronto, 700 University Ave 7th Floor, Toronto, Ontario, M5G 2M9, Canada
| | - Julianna Sienna
- Department of Oncology, Juravinski Cancer Centre, McMaster University, 699 Concession Street 3rd Floor, Hamilton, ON, L8V 5C2, Canada
| | - Barbara K Strang
- Department of Oncology, Juravinski Cancer Centre, McMaster University, 699 Concession Street 3rd Floor, Hamilton, ON, L8V 5C2, Canada
| | - Crystal Hann
- Department of Oncology, Juravinski Cancer Centre, McMaster University, 699 Concession Street 3rd Floor, Hamilton, ON, L8V 5C2, Canada.
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Hamza DM, Hauer KE, Oswald A, van Melle E, Ladak Z, Zuna I, Assefa ME, Pelletier GN, Sebastianski M, Keto-Lambert D, Ross S. Making sense of competency-based medical education (CBME) literary conversations: A BEME scoping review: BEME Guide No. 78. Med Teach 2023:1-14. [PMID: 36668992 DOI: 10.1080/0142159x.2023.2168525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Competency-based medical education (CBME) received increased attention in the early 2000s by educators, clinicians, and policy makers as a way to address concerns about physician preparedness and patient safety in a rapidly changing healthcare environment. Opinions and perspectives around this shift in medical education vary and, to date, a systematic search and synthesis of the literature has yet to be undertaken. The aim of this scoping review is to present a comprehensive map of the literary conversations surrounding CBME. METHODS Twelve different databases were searched from database inception up until 29 April 2020. Literary conversations were extracted into the following categories: perceived advantages, perceived disadvantages, challenges/uncertainties/skepticism, and recommendations related to CBME. RESULTS Of the 5757 identified records, 387 were included in this review. Through thematic analysis, eight themes were identified in the literary conversations about CBME: credibility, application, community influence, learner impact, assessment, educational developments, organizational structures, and societal impacts of CBME. Content analysis supported the development of a heat map that provides a visual illustration of the frequency of these literary conversations over time. CONCLUSIONS This review serves two purposes for the medical education research community. First, this review acts as a comprehensive historical record of the shifting perceptions of CBME as the construct was introduced and adopted by many groups in the medical education global community over time. Second, this review consolidates the many literary conversations about CBME that followed the initial proposal for this approach. These findings can facilitate understanding of CBME for multiple audiences both within and outside of the medical education research community.
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Affiliation(s)
- Deena M Hamza
- Postgraduate Medical Education, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Karen E Hauer
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Anna Oswald
- Postgraduate Medical Education, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Elaine van Melle
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | - Zeenat Ladak
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Ines Zuna
- Undergraduate Medical Education, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Mekdes E Assefa
- Global Health, School of Public Health, University of Alberta, Edmonton, Canada
| | - Gabrielle N Pelletier
- Department of Educational Psychology, School and Clinical Child Psychology, University of Alberta, Edmonton, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, Canada
| | - Diana Keto-Lambert
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, Canada
| | - Shelley Ross
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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El Hage S, Chahine MN, Sayde G, Daaboul M, El Masri J, Salameh P. Competencies required for graduated physicians: the integration of Englander's common taxonomy in a validated scale for the assessment of competency acquiring in undergraduate medical education. Ir J Med Sci 2023; 192:499-507. [PMID: 35244872 PMCID: PMC8895106 DOI: 10.1007/s11845-022-02962-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Competency-based medical education has been emerging as a new educational model for learning. The development of medical education in Middle Eastern countries lacks basic literature in the area of medical education, particularly competency-based medical education (CBME). AIM Our objective is to validate a brief/rapid scale that informs us on the current perception of the acquiring of competencies of medical students and graduates from the Lebanese University, Lebanon. METHODS A survey containing the Englander's common taxonomy for medical competencies-a set of 57 items-was distributed to medical students and graduates from the Lebanese University. Three parameters were used for the validation of this scale: construct validity using the principal component analysis technique, internal reliability using Cronbach alpha, and convergent validity using Pearson correlation. RESULTS A total of 377 participants responded to the survey. Factor analysis, using Varimax rotation, showed appropriate loading of domains; loadings varied between 0.648 and 0.899. Construct validity showed for all competencies loaded appropriately in their respective domains; loadings ranged between 0.656 and 0.913. Cronbach alpha values were very good to excellent (0.868 to 0.932). Pearson correlation coefficients showed a good correlation with the total score and varied between 0.739 and 0.893 (p < 0.0001). CONCLUSION The Englander's common taxonomy scale is valid and reliable among Lebanese medical students and could be used for concise assessment of current and past medical education in faculties among Lebanese medical students. Using such scales can be used in assessing the improvement of medical education towards CBME.
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Affiliation(s)
- Said El Hage
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - Liban), Beirut, Lebanon
| | - Mirna N Chahine
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
- Basic Sciences Department, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
- Foundation-Medical Research Institutes (F-MRI®), Beirut, Lebanon / Geneva, Switzerland
| | - Georgio Sayde
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Michael Daaboul
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Jad El Masri
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon.
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.
| | - Pascale Salameh
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
- INSPECT-LB (Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - Liban), Beirut, Lebanon
- University of Nicosia Medical School, Nicosia, Cyprus
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31
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Kraft KH. Advancements in Surgical Performance Evaluation and Feedback. Curr Urol Rep 2023; 24:11-15. [PMID: 36394773 DOI: 10.1007/s11934-022-01134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE OF REVIEW How today's urology trainees acquire surgical skills has changed dramatically due to multiple forces placing strain on the graduate medical education mission. The development of workplace-based assessments that deliver feedback while capturing performance data has led to a paradigm shift toward individualized learning. RECENT FINDINGS Delivering feedback that drives surgical skill development requires the educator to provide a meaningful assessment of the learner after an operative experience. Workplace-based assessment involves direct observation of routine clinical practice and has become a central component of competency-based medical education. Urology has the chance to fully embrace competency-based medical education, employing robust feedback mechanisms and workplace-based assessments. We must first define what it means to be a proficient urologist and design an assessment system that captures this collective sentiment. This can only be done through effective engagement and collaboration with stakeholders across our specialty.
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Affiliation(s)
- Kate H Kraft
- Department of Urology, University of Michigan, 1500 E. Medical Center Drive, SPC 5330, Ann Arbor, MI, 48105, USA.
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Kuehl SE, Spicer JO. Using entrustable professional activities to better prepare students for their postgraduate medical training: A medical student's perspective. Perspect Med Educ 2022; 11:359-364. [PMID: 36441351 PMCID: PMC9743878 DOI: 10.1007/s40037-022-00731-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
THE PROBLEM Medical students graduate underprepared for postgraduate medical training despite years of classroom and clinical training. In this article, a medical student shares her personal perspectives on three factors contributing to this problem in undergraduate medical education: students' peripheral roles in the clinical environment impede learning, students receive inadequate feedback, and assessments do not measure desired learning outcomes. A SOLUTION The authors describe how using entrustable professional activities (EPAs) could address these issues and promote students' clinical engagement by clarifying their roles, providing them with frequent and actionable feedback, and aligning their assessments with authentic work. These factors combined with grading schemes rewarding improvement could contribute to a growth mindset that reprioritizes clinical skill acquisition. The authors explore how medical schools have begun implementing the EPA framework, highlight insights from these efforts, and describe barriers that must be addressed. THE FUTURE Incorporating EPAs into medical school curricula could better prepare students for postgraduate training while also alleviating issues that contribute to student burnout by defining students' roles, improving feedback, and aligning assessments with desired learning outcomes.
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Affiliation(s)
- Sarah E Kuehl
- Emory University School of Medicine and Goizueta Business School, Atlanta, GA, USA.
| | - Jennifer O Spicer
- J. Willis Hurst Internal Medicine Residency Program, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Chen Q, Li M, Wu N, Peng X, Tang G, Cheng H, Hu L, Yang B, Liao Z. A survey of resident physicians' perceptions of competency-based education in standardized resident training in China: a preliminary study. BMC Med Educ 2022; 22:801. [PMID: 36397045 PMCID: PMC9673373 DOI: 10.1186/s12909-022-03863-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Understanding resident physicians' perceptions of competency-based medical education(CBME) may help improve approaches for implementing such education in standardized resident training (SRT). We conducted surveys of residents in China to identify their perceptions of CBME and determine the degree to which such education impacts their career plans. METHODS Questionnaire contained a total of 24 questions, which were answered using multiple choice or yes/no, was distributed to residents who were undergoing SRT, regardless of specialty, at 7 accredited training bases located across six provinces of China. The survey aimed to investigate residents' reasons for participating in SRT, perceptions of CBME, interest in receiving CBME-associated courses, and attitudes towards CBME. RESULTS Overall, 441 residents completed the questionnaire.17.7% (78/441) responded "no clear objective" before the participated in SRT. Only 3.9% (17/441) fully understood the objectives, training contents, and assessment system of the current "competency-based" standardized training program for residents in China. Residents ranked clinical skills and patient care, interpersonal communication, and professionalism, as the three most important competencies. Most were interested in the CBME residency programs. 90.7% felt that implementing CBME could help them clarify their professional direction and improve their career planning. CONCLUSION Residents had positive perceptions of the incorporation of CBME into SRT. Administrators, educational leaders, and clinical faculty should seek to further publicize and increase the popularity of CBME.
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Affiliation(s)
- Qi Chen
- Department of Anesthesiology, Chongqing University Cancer Hospital, 400030, Chongqing, PR China
| | - Ming Li
- Health management center, the First Affiliated Hospital, Army Military Medical University, 400038, Chongqing, PR China
| | - Na Wu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, 400038, Chongqing, PR China
| | - Xue Peng
- Department of Gastroenterology, the Second Affiliated Hospital, Army Military Medical University, 400037, Chongqing, PR China
| | - GuangMin Tang
- Center of Infectious diseases, West China Hospital, 610041, ChenDu, PR China
| | - Heng Cheng
- Department of Gastroenterology, the First Affiliated Hospital, Medical and Pharmaceutical College, 401331, Chongqing, PR China
| | - LiuLing Hu
- Department of Gastroenterology, Chongqing University Cancer Hospital, 400030, Chongqing, PR China
| | - Bin Yang
- Department of Anesthesiology, the First Affiliated Hospital, XiaMen University, 361003, FuJian, PR China.
| | - ZhongLi Liao
- Department of Gastroenterology, Chongqing University Cancer Hospital, 400030, Chongqing, PR China.
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Schneider AR, Sharma T, Bhattacharya A, Brown A. Exploring the relationship between social accountability and competency-based medical education: A narrative review. Med Teach 2022; 44:1283-1289. [PMID: 35793268 DOI: 10.1080/0142159x.2022.2093702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Social accountability (SA), a quintessential goal of medical education, has been discussed as a precipitant for the transition toward competency-based medical education (CBME). However, the relationship between SA and CBME remains unclear. A narrative review was conducted to systematically explore the relationship between SA and CBME as described in the literature. METHODS Electronic databases, select journals, and medical education organizations were systematically searched. 363 titles and abstracts were screened and 147 full texts were reviewed. The salient text was extracted from 36 records, which were then inductively coded before narrative synthesis and interpretation. RESULTS The relationship between SA and CBME was described in three manners: (1) CBME as a natural driver of SA where CBME was perceived to be inherently socially accountable, (2) CBME as an opportunistic mechanism for actively changing medical training to better meet standards of SA, and (3) CBME as a tool to measure SA relating to measurable outcomes data provided by CBME. CONCLUSION CBME has theoretical potential to assist programs in becoming more socially accountable if the communities they serve are considered key stakeholders in the design, implementation, and evaluation. A paucity of evidence remains which provides empirical evidence of SA within programs that have implemented CBME.
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Affiliation(s)
| | - Tejeswin Sharma
- Cumming School of Medicine-Undergraduate Medical Education, University of Calgary, Calgary, Canada
| | - Anindita Bhattacharya
- Cumming School of Medicine-Undergraduate Medical Education, University of Calgary, Calgary, Canada
| | - Allison Brown
- Department of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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35
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Garber AM, Ferris AH, Vu TR. The Importance of Adding Discernment to the Acting Internship - A Necessary Shift in Culture Toward Competency-Based Metrics. Am J Med 2022; 135:1137-1141. [PMID: 35688261 DOI: 10.1016/j.amjmed.2022.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/31/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Adam M Garber
- Department of Internal Medicine, Internal Medicine and School of Medicine Acting Internship Director, Virginia Commonwealth University School of Medicine, Richmond.
| | - Allison H Ferris
- Department of Medicine, Internal Medicine Residency Program Director, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - T Robert Vu
- Department of Medicine, Internal Medicine Acting Internship Director, Indiana University School of Medicine, Indianapolis
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36
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Hanson MN, Pryor AD, Jeyarajah DR, Minter RM, Mattar SG, Scott DJ, Brunt LM, Cummings M, Vassiliou M, Feldman LS. Implementation of entrustable professional activities into fellowship council accredited programs: a pilot project. Surg Endosc 2022; 37:3191-3200. [PMID: 35974253 PMCID: PMC9381155 DOI: 10.1007/s00464-022-09502-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/23/2022] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The Fellowship Council (FC) is transitioning to a competency-based medical education (CBME) model, including the introduction of Entrustable Professional Activities (EPAs) for training and assessment of Fellows. This study describes the implementation process employed by the FC during a ten-month pilot project and presents data regarding feasibility and perceived value. METHODS The FC coordinated the development of EPAs in collaboration with the sponsoring societies for Advanced GI/MIS, Bariatrics, Foregut, Endoscopy and Hepatopancreaticobiliary (HPB) fellowships encompassing the preoperative, intraoperative, and postoperative phases of care for key competencies. Fifteen accredited fellowship programs participated in this project. The assessments were collected through a unique platform on the FC website. Programs were asked to convene a Clinical Competency Committee (CCC) on a quarterly basis. The pilot group met monthly to support and improve the process. An exit survey evaluated the perceived value of EPAs. RESULTS The 15 participating programs included 18 fellows and 106 faculty. A total of 655 assessments were initiated with 429 (65%) completed. The average (SD) number of EPAs completed for each fellow was 24(18); range 0-72. Intraoperative EPAs were preferentially completed (71%). The average(SD) time for both the fellow and faculty to complete an EPA was 27(78) hours. Engagement increased from 39% of fellows completing at least one EPA in September to 72% in December and declining to 50% in May. Entrustment level increased from 6% of EPAs evaluated as "Practice Ready" in September to 75% in June. The exit survey was returned by 63% of faculty and 72% of fellows. Overall, 46% of fellows and 74% of program directors recommended full-scale implementation of the EPA framework. CONCLUSION A competency-based assessment framework was developed by the FC and piloted in several programs. Participation was variable and required ongoing strategies to address barriers. The pilot project has prepared the FC to introduce CBME across all FC training programs.
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Affiliation(s)
- Melissa N Hanson
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, H3A 0G4, Canada
| | - Aurora D Pryor
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY, 11794, USA
| | - D Rohan Jeyarajah
- Department of Surgery, TCU School of Medicine and Methodist Richardson Medical Center, Richardson, TX, 75082, USA
| | - Rebecca M Minter
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Samer G Mattar
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Daniel J Scott
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - L Michael Brunt
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | | | - Melina Vassiliou
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, H3A 0G4, Canada
| | - Liane S Feldman
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada. .,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, H3A 0G4, Canada.
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Thomson B, O'Halloran H, Wu L, Gauthier S, Taylor D. Transition to practice curriculum for general internal medicine physicians: scoping review and Canadian national survey. BMC Med Educ 2022; 22:609. [PMID: 35945567 PMCID: PMC9361703 DOI: 10.1186/s12909-022-03673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/29/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND There remains a paucity of evidence for curricula for the transition to practice (TTP) stage of Competence by Design internal medicine (IM) training programs. Current entrustable professional activities are based on expert consensus rather than robust subspecialty-specific needs assessment. METHODS A scoping review was completed to identify studies with TTP focus. A national survey was conducted to identify transition experiences for general internal medicine physicians. Results were assessed by grounded theory analysis to identify core topics for TTP curricula. RESULTS Neither scoping review nor national survey identified TTP topics related to the CanMEDS Medical Expert role. Scoping Review: 41 relevant studies were identified. Most (97.6%) were from North America. The most common study types were observational (survey) or curriculum (13/41 31.7% for each). Only two studies were exclusively in IM, and the most common subspecialty studied was surgical (13/41, 31.7%). The most common TTP topics were mentorship, billing and coding, practice management, negotiating contract and job, and financial aspects of practice. National Survey: There were 44 respondents, with the majority (25/44, 56.8%) having completed an IM subspecialty fellowship. Most (38/44) completed medical school in Canada, and most were from academic practice settings (33/44, 75.0%). The most common TTP topics were billing and coding, personal financial planning, practice management, work-life balance and mentorship. Grounded Theory Analysis: There were six themes that encompassed all TTP topics from the scoping review and national survey, being (i) building a career, (ii) continuing professional development, (iii) expectations of the profession, (iv) practice management, (v) Life, health and well-being and (vi) clinical skills. Curriculum competencies and resources for curriculum development were provided. CONCLUSIONS This study identifies topics critical for curricula development for IM transition to practice. Further research is required to evaluate effectiveness of curricula including topics and themes developed from this scoping review and national survey.
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Affiliation(s)
- Benjamin Thomson
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada.
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Heather O'Halloran
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada
| | - Luke Wu
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada
| | - Stephen Gauthier
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada
| | - David Taylor
- Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada
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St-Onge C, Boileau E, Langevin S, Nguyen LHP, Drescher O, Bergeron L, Thomas A. Stakeholders' perception on the implementation of Developmental Progress Assessment: using the Theoretical Domains Framework to document behavioral determinants. Adv Health Sci Educ Theory Pract 2022; 27:735-759. [PMID: 35624332 DOI: 10.1007/s10459-022-10119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The widespread implementation of longitudinal assessment (LA) to document trainees' progression to independent practice rests more on speculative rather than evidence-based benefits. We aimed to document stakeholders' knowledge of- and attitudes towards LA, and identify how the supports and barriers can help or hinder the uptake and sustainable use of LA. METHODS We interviewed representatives from four stakeholder groups involved in LA. The interview protocols were based on the Theoretical Domains Framework (TDF), which contains a total of 14 behaviour change determinants. Two team members coded the interviews deductively to the TDF, with a third resolving differences in coding. The qualitative data analysis was completed with iterative consultations and discussions with team members until consensus was achieved. Saliency analysis was used to identify dominant domains. RESULTS Forty-one individuals participated in the study. Three dominant domains were identified. Participants perceive that LA has more positive than negative consequences and requires substantial ressources. All the elements and characteristics of LA are present in our data, with differences between stakeholders. CONCLUSION Going forward, we could develop and implement tailored and theory driven interventions to promote a shared understanding of LA, and maintain potential positive outcomes while reducing negative ones. Furthermore, ressources to support LA implementation need to be addressed to facilitate its uptake.
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Affiliation(s)
- Christina St-Onge
- Université de Sherbrooke, Christina St-Onge, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
| | - Elisabeth Boileau
- Université de Sherbrooke, Christina St-Onge, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Serge Langevin
- Université de Sherbrooke, Christina St-Onge, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | | | | | - Linda Bergeron
- Université de Sherbrooke, Christina St-Onge, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
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Cheung WJ, Hall AK, Skutovich A, Brzezina S, Dalseg TR, Oswald A, Cooke LJ, Van Melle E, Hamstra SJ, Frank JR. Ready, set, go! Evaluating readiness to implement competency-based medical education. Med Teach 2022; 44:886-892. [PMID: 36083123 DOI: 10.1080/0142159x.2022.2041585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Organizational readiness is critical for successful implementation of an innovation. We evaluated program readiness to implement Competence by Design (CBD), a model of Competency-Based Medical Education (CBME), among Canadian postgraduate training programs. METHODS A survey of program directors was distributed 1 month prior to CBD implementation in 2019. Questions were informed by the R = MC2 framework of organizational readiness and addressed: program motivation, general capacity for change, and innovation-specific capacity. An overall readiness score was calculated. An ANOVA was conducted to compare overall readiness between disciplines. RESULTS Survey response rate was 42% (n = 79). The mean overall readiness score was 74% (30-98%). There was no difference in scores between disciplines. The majority of respondents agreed that successful implementation of CBD was a priority (74%), and that their leadership (94%) and faculty and residents (87%) were supportive of change. Fewer perceived that CBD was a move in the right direction (58%) and that implementation was a manageable change (53%). Curriculum mapping, competence committees and programmatic assessment activities were completed by >90% of programs, while <50% had engaged off-service disciplines. CONCLUSION Our study highlights important areas where programs excelled in their preparation for CBD, as well as common challenges that serve as targets for future intervention to improve program readiness for CBD implementation.
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Affiliation(s)
- Warren J Cheung
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| | - Andrew K Hall
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| | | | - Stacey Brzezina
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| | - Timothy R Dalseg
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lara J Cooke
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Elaine Van Melle
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Stanley J Hamstra
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Milestones Research and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jason R Frank
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
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Schrewe B, Martimianakis MA. Re-thinking "I"dentity in medical education: genealogy and the possibilities of being and becoming. Adv Health Sci Educ Theory Pract 2022; 27:847-861. [PMID: 35122588 DOI: 10.1007/s10459-022-10095-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 01/23/2022] [Indexed: 06/14/2023]
Abstract
Professional identity formation has emerged as a key topic for medical education research, with contributions from perspectives of psychological development and socialization opening up needed conversations in the field. Yet mainstream training practices may have the unintended effects of educating for a physician typology that may be too narrow to account for the complexity of learners' personal identities. Alternative approaches, such as Foucauldian genealogy, offer ways to empirically investigate how the legitimate contours of being and becoming have come to be as they are, how they shape professional identities, and to which degree their borders may be made more inclusive. Drawing upon an example of the contemporary practice of competency-based medical education in the Canadian context, this paper considers how genealogy's methodological tools of critical distancing, the dispositif, and problematization may help reveal how educational practices shape the identities of physicians-in-training in ways both intended and unintended. From this perspective it becomes apparent that any attempt to explore professional identity is incomplete without also considering that a trainee's evolving sense of self is inexorably bound up with forces of knowledge, power, and ethics that shape them into becoming certain kinds of physician subjects rather than others. In mapping this terrain, a genealogical approach determines how we reached the now in which we find ourselves and how we might transform it, such that we may shift the possibilities afforded to health professionals to establish professional identities aligned with their personal identities in ways that maximize inclusivity and minimize marginalization.
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Affiliation(s)
- Brett Schrewe
- Department of Pediatrics, The University of British Columbia, Victoria, BC, Canada.
- Centre for Health Education Scholarship, P. A. Woodward Instructional Resources Centre (IRC), 429-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
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Rachul C, Collins B, Chan MK, Srinivasan G, Hamilton J. Rivalries for attention: insights from a realist evaluation of a postgraduate competency-based medical education implementation in Canada. BMC Med Educ 2022; 22:583. [PMID: 35906632 PMCID: PMC9336173 DOI: 10.1186/s12909-022-03661-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Implementing competency-based medical education (CBME) in post-graduate medical education (PGME) is a complex process that requires multiple systemic changes in a complex system that is simultaneously engaged in multiple initiatives. These initiatives often compete for attention during the implementation of CBME and produce unintended and unanticipated consequences. Understanding the impact of this context is necessary for evaluating the effectiveness of CBME. The purpose of the study was to identify factors, such as contexts and processes, that contribute to the implementation of CBME. METHODS We conducted a realist evaluation using data collected from 15 programs through focus groups with residents (2 groups, n = 16) and faculty (one group, n = 8), and semi-structured interviews with program directors (n = 18), and program administrators (n = 12) from 2018 to 2021. Data were analyzed using a template analysis based on a coding framework that was developed from a sample of transcripts, the context-mechanism-outcomes framework for realist evaluations, and the core components of CBME. RESULTS The findings demonstrate that simultaneous initiatives in the academic health sciences system creates a key context for CBME implementation - rivalries for attention - and specifically, the introduction of curricular management systems (CMS) concurrent to, but separate from, the implementation of CBME. This context influenced participants' participation, communication, and adaptation during CBME implementation, which led to change fatigue and unmet expectations for the collection and use of assessment data. CONCLUSIONS Rival initiatives, such as the concurrent implementation of a new CMS, can have an impact on how programs implement CBME and greatly affect the outcomes of CBME. Mitigating the effects of rivals for attention with flexibility, clear communication, and training can facilitate effective implementation of CBME.
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Affiliation(s)
- Christen Rachul
- Office of Innovation and Scholarship in Medical Education, Max Rady College of Medicine, University of Manitoba, S204, Medical Services Building, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada.
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
| | - Benjamin Collins
- Department of Anthropology, University of Manitoba, Winnipeg, Canada
| | - Ming-Ka Chan
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Ganesh Srinivasan
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Joanne Hamilton
- Office of Innovation and Scholarship in Medical Education, Max Rady College of Medicine, University of Manitoba, S204, Medical Services Building, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada
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Cheung WJ, Wagner N, Frank JR, Oswald A, Van Melle E, Skutovich A, Dalseg TR, Cooke LJ, Hall AK. Implementation of competence committees during the transition to CBME in Canada: A national fidelity-focused evaluation. Med Teach 2022; 44:781-789. [PMID: 35199617 DOI: 10.1080/0142159x.2022.2041191] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE This study evaluated the fidelity of competence committee (CC) implementation in Canadian postgraduate specialist training programs during the transition to competency-based medical education (CBME). METHODS A national survey of CC chairs was distributed to all CBME training programs in November 2019. Survey questions were derived from guiding documents published by the Royal College of Physicians and Surgeons of Canada reflecting intended processes and design. RESULTS Response rate was 39% (113/293) with representation from all eligible disciplines. Committee size ranged from 3 to 20 members, 42% of programs included external members, and 20% included a resident representative. Most programs (72%) reported that a primary review and synthesis of resident assessment data occurs prior to the meeting, with some data reviewed collectively during meetings. When determining entrustable professional activity (EPA) achievement, most programs followed the national specialty guidelines closely with some exceptions (53%). Documented concerns about professionalism, EPA narrative comments, and EPA entrustment scores were most highly weighted when determining resident progress decisions. CONCLUSIONS Heterogeneity in CC implementation likely reflects local adaptations, but may also explain some of the variable challenges faced by programs during the transition to CBME. Our results offer educational leaders important fidelity data that can help inform the larger evaluation and transformation of CBME.
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Affiliation(s)
- Warren J Cheung
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | - Natalie Wagner
- Office of Professional Development & Educational Scholarship and Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Canada
| | - Jason R Frank
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Elaine Van Melle
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Family Medicine, Queen's University, Kingston, Canada
| | | | - Timothy R Dalseg
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Canada
| | - Lara J Cooke
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Andrew K Hall
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
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Parsons AS, Mark K, Martindale JR, Bray MJ, Smith RP, Bradley E, Gusic M. Concordance of Narrative Comments with Supervision Ratings Provided During Entrustable Professional Activity Assessments. J Gen Intern Med 2022; 37:2200-7. [PMID: 35710663 DOI: 10.1007/s11606-022-07509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Use of EPA-based entrustment-supervision ratings to determine a learner's readiness to assume patient care responsibilities is expanding. OBJECTIVE In this study, we investigate the correlation between narrative comments and supervision ratings assigned during ad hoc assessments of medical students' performance of EPA tasks. DESIGN Data from assessments completed for students enrolled in the clerkship phase over 2 academic years were used to extract a stratified random sample of 100 narrative comments for review by an expert panel. PARTICIPANTS A review panel, comprised of faculty with specific expertise related to their roles within the EPA program, provided a "gold standard" supervision rating using the comments provided by the original assessor. MAIN MEASURES Interrater reliability (IRR) between members of review panel and correlation coefficients (CC) between expert ratings and supervision ratings from original assessors. KEY RESULTS IRR among members of the expert panel ranged from .536 for comments associated with focused history taking to .833 for complete physical exam. CC (Kendall's correlation coefficient W) between panel members' assignment of supervision ratings and the ratings provided by the original assessors for history taking, physical examination, and oral presentation comments were .668, .697, and .735 respectively. The supervision ratings of the expert panel had the highest degree of correlation with ratings provided during assessments done by master assessors, faculty trained to assess students across clinical contexts. Correlation between supervision ratings provided with the narrative comments at the time of observation and supervision ratings assigned by the expert panel differed by clinical discipline, perhaps reflecting the value placed on, and perhaps the comfort level with, assessment of the task in a given specialty. CONCLUSIONS To realize the full educational and catalytic effect of EPA assessments, assessors must apply established performance expectations and provide high-quality narrative comments aligned with the criteria.
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Sheng WH, Ho YL, Jenq CC, Chuang CL, Chen CY, Tsai MJ, Yang YS, Wu MS, Chang SC. Longitudinal assessment of milestone development among internal medicine residents in Taiwan. J Formos Med Assoc 2022; 121:2281-2287. [PMID: 35725679 DOI: 10.1016/j.jfma.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/PURPOSE The Accreditation Council for Graduate Medical Education (ACGME) milestones have been implemented in residency training worldwide. We investigated the development of individual competency in first-year residents (R1) and second-year postgraduate students (PGY2) who received internal medicine training in Taiwan. METHODS A multicenter observational cohort study was conducted to evaluate the competency-based milestone evaluation designed by the Taiwan Society of Internal Medicine in 2019. The evaluation was based on the ACGME-accredited milestone ratings. Periodic evaluation of milestone achievements of R1 and PGY2, who entered the internal medicine residency training at six medical centers, was performed. Each resident was evaluated every 3 months. RESULTS Among the 98 R1 enrolled in 2019, substantial improvement in sub-competencies, including skill in performing procedures (Patient Care 4), clinical knowledge (Medical Knowledge 1), knowledge of diagnostic testing and procedures (Medical Knowledge 2), and identify impact the cost of health care and practices cost-effective care (Systems Based Practice 3) during the two years of training. Among the 107 R1 and 46 PGY2 enrolled in 2020, no significant difference in baseline milestone ratings was observed. However, the milestone assessments of R1 in 2020 showed improvement in nearly all sub-competencies compared with the stationary status of PGY2 in 2020. CONCLUSION We demonstrate the application of ACGME-based accredited milestone ratings to target the educational goals of internal medicine residency training in Taiwan. Differences in milestone ratings between different PGY training systems exist. The long-term impact of performance among different PGY training systems requires further investigation.
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Affiliation(s)
- Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Yi-Lwun Ho
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Chang-Chyi Jenq
- Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chiao-Lin Chuang
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei City, Taiwan
| | - Chiung-Yu Chen
- College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Ju Tsai
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Sun Yang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan.
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Klapheke M, Abrams MP, Cubero M, Zhu X. Aligning Medical Student Workplace-Based Assessments with Entrustable Professional Activities and the RIME Model in a Psychiatry Clerkship. Acad Psychiatry 2022; 46:283-288. [PMID: 35288865 DOI: 10.1007/s40596-022-01614-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The authors piloted use of workplace-based assessments of students during the psychiatry clerkship utilizing both entrustable professional activities (EPAs) and the reporter, interpreter, manager, and educator (RIME) model. METHODS After supervising clinicians conducted assessments of medical students (N=109) during the psychiatry clerkship using a supervisory scale aligned with both EPA and RIME models, each student received individualized formative feedback. Students were then surveyed on the usefulness of this feedback, and participating faculty/residents were surveyed on the ease of completion of the supervisory scale. RESULTS Students' mean skill profile suggested they no longer needed direct supervision on EPA1 and EPA6. Mean scores on other studied EPAs suggested students were well on their way toward performing these EPAs without direct supervision. Students had mean RIME scores that exceeded the suggested levels identified for a Reporter to start clerkships, for an Interpreter to start clerkships, and for a Manager to transition to the fourth year. Close to half of the students found the feedback helpful in their development as a clinician but most felt their performance should not be shared with residency program directors, either before or after the Match. Almost all responding preceptors felt the supervisory ratings were easy to complete. CONCLUSIONS This pilot RIME/EPA framework served as a successful step toward a more competency-based medical education in the psychiatry clerkship with relatively little additional faculty time commitment by using workplace-based assessments already in place and a supervisory scale based on EPAs and RIME.
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Affiliation(s)
| | | | | | - Xiang Zhu
- University of Central Florida, Orlando, FL, USA
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Ross S, Pirraglia C, Aquilina AM, Zulla R. Effective competency-based medical education requires learning environments that promote a mastery goal orientation: A narrative review. Med Teach 2022; 44:527-534. [PMID: 34807798 DOI: 10.1080/0142159x.2021.2004307] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Competency-based medical education (CBME) emphasizes the need for learners to be central to their own learning and to take an active role in learning. This approach has a dual aim: to encourage learners to actively engage in their own learning, and to push learners to develop learning strategies that will prepare them for lifelong learning. This review paper proposes a theoretical bridge between CBME and lifelong learning and puts forth the argument that in order for CBME programs to produce the physicians truly needed in our society now and in the future, learning environments must be intentionally designed to foster mastery goal orientations and to support the development of adaptive self-regulated learning skills and behaviours. MATERIALS AND METHODS This narrative literature review incorporated results of searches conducted by a subject librarian in PsycInfo and MedLine. Articles were also identified through reference lists of identified papers to capture older key citations. Analysis of the literature used a constructivist epistemological approach to develop an integrative description of the interaction of achievement goal orientation, self-regulated learning, learning environment, and lifelong learning. RESULTS Findings from achievement goal theory research support the assumption that adoption of a mastery goal orientation facilitates the use of adaptive learning behaviours, such as those described in self-regulated learning theory. Adaptive self-regulated learning strategies, in turn, facilitate effective lifelong learning. The authors offer evidence for how learning environments influence goal orientations and self-regulated learning, and propose that CBME programs intentionally plan for such learning environments. Finally, the authors offer specific suggestions and examples for how learning environments can be designed or adjusted to support adoption of a mastery goal orientation and use of self-regulated learning behaviours and strategies to help support development of adaptive lifelong learners.
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Affiliation(s)
- Shelley Ross
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | | | | | - Rosslynn Zulla
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
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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? Med Teach 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Weissenbacher A, Bolz R, Stehr SN, Hempel G. Development and consensus of entrustable professional activities for final-year medical students in anaesthesiology. BMC Anesthesiol 2022; 22:128. [PMID: 35488205 PMCID: PMC9052481 DOI: 10.1186/s12871-022-01668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background The transfer of classic concepts of competency-based medical education into clinical practice has been proven to be difficult in the past, being described as partially fragmented, misleading and inadequate. At the beginning of training, novice doctors commonly feel overwhelmed, overloaded and exposed to extreme time pressure. The discrepancy between expected and actual clinical competence of doctors at the start of their speciality training jeopardizes patient safety. The framework of Entrustable Professional Activities (EPAs) is a promising instrument to effectively integrate competency-based training into clinical practice and may help to close this gap and consequently to improve patient safety. Methods For anaesthesiology, we developed 5 EPAs for final-year medical students. The EPAs comprised the following seven categories: 1. Title, 2. Specifications, 3. Limitations, 4. Competency domains, 5. Knowledge, abilities and skills, professional attitudes, 6. Assessment and 7. Entrustment. Based on a modified, online-based Delphi study, we further developed and refined these EPAs. Education experts were recruited from the alumni network of the Master of Medical Education (MME) degree course from the University of Heidelberg, Germany. Results 28 data sets were evaluated in three Delphi rounds. 82% of study participants had previous experience with EPAs. Qualitative and quantitative data formed the basis during the iterative process and resulted in complete descriptions of 5 EPAs for final-year medical students in anaesthesiology. Conclusions Our study including the associated description of 5 EPAs represent a further step and starting point for EPA-based curricula in medical training in Germany linking undergraduate training, to residency training and continuous medical education. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01668-8.
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Affiliation(s)
- Andreas Weissenbacher
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Centre, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Robert Bolz
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Centre, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Sebastian N Stehr
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Centre, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Gunther Hempel
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Centre, Liebigstrasse 20, 04103, Leipzig, Germany.
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Hassan IS, AbdulKareem AK, Alrabee NHK, Mansour SF, Fadlelmoula SA, Elhassan EAA, Abdelgadir MM, Mohamed MA, Adam SA, Bedawi FO, Yousif MEA, Ahmed RA, Kashif TA. A Systems Thinking approach for the creation of effective competency-based medical education programs. Pan Afr Med J 2022; 41:203. [PMID: 35685098 PMCID: PMC9146597 DOI: 10.11604/pamj.2022.41.203.28896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/04/2022] [Indexed: 11/11/2022] Open
Abstract
Successful and sustainable implementation of Competency-based Medical Education (CBME) programs is a significant and daunting challenge facing medical education worldwide. Our manuscript endorses for the first time, Systems Thinking as a concept for transforming and redesigning CBME programs employing the full 7-system elements as advocated by the Biomatrix Systems Theory. The majority of internationally recommended actions and processes for such an endeavor are highlighted, each within its system element. New innovative ideas such as having competency-structured clinical training activities as well as re-writing medical textbooks following a novel competency-based roadmap for their disease monographs etc. are also highlighted. Furthermore, the need for innovative partnerships as well as novel medical rotations that may facilitate the creation of "master clinicians" are also stressed.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sarah Ali Adam
- Al Tababa Competency-based Training Unit, Khartoum, Sudan
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Herath JC. Firsthand Experience in Graduating Three Cohorts of Forensic Pathologists Trained With Competency by Design (CBD) Curriculum. Acad Forensic Pathol 2022; 11:196-207. [PMID: 35003451 DOI: 10.1177/19253621211063104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/02/2021] [Indexed: 11/17/2022]
Abstract
Introduction The University of Toronto experienced graduating three cohorts of forensic pathologists trained with Competency by Design (CBD) curriculum. We achieved this as a result of multiyear development of Entrustable Professional Activities (EPAs), Required Training Experience (RTEs), and Specialty Competency Requirements (SCRs) by the Royal College of Physicians and Surgeons of Canada's Forensic Pathology Speciality Committee, the Ontario Forensic Pathology Service, and the University of Toronto. Method Our academic year is comprised of 13 blocks. We divided the 13-block period into 4 stages to map all the EPAs and RTEs. The first stage, Transition to Discipline, is 1 block, the second stage, Foundation of Discipline, consists of 3 blocks; the third stage, Core of Discipline, consists of 6 blocks, and the final fourth stage, Transition to Practice, consists of 3 blocks. Board-certified faculty members in Forensic Pathology with more than five years of experience supervised the trainees. We graduated 5 Canadian and 4 international trainees at the end of the third cycle of CBD-based training program. Conclusion Using the Royal College Speciality Committee blueprint, the University of Toronto started in 2016 planning the CBD curriculum in the forensic pathology training program. By the end of June 2021, we graduated nine trainees from our CBD-based Forensic Pathology training program. We are training the fourth cohort, and they will be graduating at the end of June 2022. This article aims to share our firsthand experiencing in CBD training in forensic pathology.
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