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Lewis C, Fischer IC, Tsai J, Harpaz-Rotem I, Pietrzak RH. Barriers to Mental Health Care in US Military Veterans. Psychiatr Q 2024:10.1007/s11126-024-10078-7. [PMID: 38940875 DOI: 10.1007/s11126-024-10078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Military veterans often encounter multiple obstacles to mental health care, such as stigma, practical barriers (e.g., high cost), and negative beliefs about mental health care. To date, however, nationally representative data on the prevalence and key correlates of these barriers to care are lacking. Such data are critical to informing population-based efforts to reduce barriers and promote engagement in mental health treatment in this population. METHODS Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed 4,069 US veterans, 531 (weighted 15.0%) of whom screened positive for a mental disorder but never received mental health treatment. Multivariable logistic regression and relative importance analyses were conducted to identify key predisposing, enabling, and need-based factors associated with endorsement of stigma, instrumental barriers, and negative beliefs about mental health care. RESULTS A total 47.1% of veterans endorsed any barrier to care, with 38.7% endorsing instrumental barriers to care, 28.8% perceived stigma, and 22.0% negative beliefs about mental health care. Lower purpose in life, grit, and received social support were most consistently associated with these barriers to care. CONCLUSIONS Nearly half of US veterans with psychiatric need and no history of mental health treatment report barriers to care. Modifiable characteristics such as a low purpose in life, grit, and received support were associated with endorsement of these barriers. Results may help inform resource allocation, as well as prevention, psychoeducation, and treatment efforts to help reduce barriers and promote engagement with mental health services in this population.
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Affiliation(s)
- Connor Lewis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Ian C Fischer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Jack Tsai
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington, DC, USA
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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2
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Williams C. Achievement Goal Theory and Mindsets: Keys for Competency Development in Nursing. Nurse Educ 2024:00006223-990000000-00492. [PMID: 38936402 DOI: 10.1097/nne.0000000000001694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND Many nursing schools are transitioning to a competency-based model due to the increasing complexity of medical information, skills, task acuities, and cognitive overload. PROBLEM Nursing faculty may not be familiar with the synergy between achievement goal theory and the growth mindset (GM) model to prepare nursing students within a competency-based model effectively. APPROACH This article presents a persuasive argument for how integrating achievement goal theory and the GM model could effectively foster mastery goals essential for competency development. CONCLUSIONS Mastery goals, a component of the GM model, can be used as tangible indicators for assessing and evaluating competency development.
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Affiliation(s)
- Cheryl Williams
- Author Affiliation: School of Nursing, Salem State University, Salem, Massachusetts
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3
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Butler JM, Taft T, Taber P, Rutter E, Fix M, Baker A, Weir C, Nevers M, Classen D, Cosby K, Jones M, Chapman A, Jones BE. Pneumonia diagnosis performance in the emergency department: a mixed-methods study about clinicians' experiences and exploration of individual differences and response to diagnostic performance feedback. J Am Med Inform Assoc 2024; 31:1503-1513. [PMID: 38796835 PMCID: PMC11187426 DOI: 10.1093/jamia/ocae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/25/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES We sought to (1) characterize the process of diagnosing pneumonia in an emergency department (ED) and (2) examine clinician reactions to a clinician-facing diagnostic discordance feedback tool. MATERIALS AND METHODS We designed a diagnostic feedback tool, using electronic health record data from ED clinicians' patients to establish concordance or discordance between ED diagnosis, radiology reports, and hospital discharge diagnosis for pneumonia. We conducted semistructured interviews with 11 ED clinicians about pneumonia diagnosis and reactions to the feedback tool. We administered surveys measuring individual differences in mindset beliefs, comfort with feedback, and feedback tool usability. We qualitatively analyzed interview transcripts and descriptively analyzed survey data. RESULTS Thematic results revealed: (1) the diagnostic process for pneumonia in the ED is characterized by diagnostic uncertainty and may be secondary to goals to treat and dispose the patient; (2) clinician diagnostic self-evaluation is a fragmented, inconsistent process of case review and follow-up that a feedback tool could fill; (3) the feedback tool was described favorably, with task and normative feedback harnessing clinician values of high-quality patient care and personal excellence; and (4) strong reactions to diagnostic feedback varied from implicit trust to profound skepticism about the validity of the concordance metric. Survey results suggested a relationship between clinicians' individual differences in learning and failure beliefs, feedback experience, and usability ratings. DISCUSSION AND CONCLUSION Clinicians value feedback on pneumonia diagnoses. Our results highlight the importance of feedback about diagnostic performance and suggest directions for considering individual differences in feedback tool design and implementation.
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Affiliation(s)
- Jorie M Butler
- Department of Biomedical Informatics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
- Department of Internal Medicine, Division of Geriatrics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84132, United States
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT 84148, United States
- Geriatrics Research, Education, and Clinical Center (GRECC), VA Salt Lake City Health Care System, Salt Lake City, UT 84148, United States
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - Peter Taber
- Department of Biomedical Informatics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT 84148, United States
| | - Elizabeth Rutter
- Department of Emergency Medicine, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - Megan Fix
- Department of Emergency Medicine, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - Alden Baker
- Department of Family and Preventive Medicine, Division of Physician Assistant Studies, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - McKenna Nevers
- Department of Internal Medicine, Division of Epidemiology, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - David Classen
- Department of Internal Medicine, Division of Epidemiology, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - Karen Cosby
- Department of Emergency Medicine, Cook County Hospital, Rush Medical College, Chicago, IL 60612, United States
| | - Makoto Jones
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT 84148, United States
- Department of Internal Medicine, Division of Epidemiology, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - Alec Chapman
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - Barbara E Jones
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT 84148, United States
- Department of Internal Medicine, Division of Pulmonology, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
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Hsu D, Rassbach C, Leaming-Van Zandt K, Morrow A, Rubenstein J, Tatem A, Turner DA, Poitevien P, Barone MA. Competency based medical education and trust in the learning environment. Curr Probl Pediatr Adolesc Health Care 2024:101640. [PMID: 38876832 DOI: 10.1016/j.cppeds.2024.101640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Affiliation(s)
- Deborah Hsu
- Stanford University School of Medicine, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Palo Alto CA, United States.
| | - Carrie Rassbach
- Stanford University School of Medicine, Department of Pediatrics, Division of Hospital Medicine, Palo Alto CA, United States
| | - Katherine Leaming-Van Zandt
- Penn State College of Medicine, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Hershey PA, United States
| | - Asha Morrow
- Baylor College of Medicine, Department of Pediatrics, Division of Pediatric Emergency Medicine, Houston TX, United States
| | - Jared Rubenstein
- Baylor College of Medicine, Department of Pediatrics, Division of Palliative Care, Houston TX, United States
| | - Andria Tatem
- Eastern Virginia Medical School and Children's Hospital of the King's Daughters, Department of Pediatrics, Norfolk VA, United States
| | - David A Turner
- American Board of Pediatrics, Chapel Hill NC, United States
| | - Patricia Poitevien
- Brown University Warren Alpert Medical School and Hasbro Children's Hospital, Department of Pediatrics, Division of Pediatric Hospital Medicine, Providence RI, United States
| | - Michael A Barone
- Brown University Warren Alpert Medical School and Hasbro Children's Hospital, Department of Pediatrics, Division of Pediatric Hospital Medicine, Providence RI, United States
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Burke AE, Sklansky DJ, Haftel HM, Mitchell A, Mann KJ. Competency-based medical education and the education continuum: Establishing a framework for lifelong learning. Curr Probl Pediatr Adolesc Health Care 2024:101642. [PMID: 38851971 DOI: 10.1016/j.cppeds.2024.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Affiliation(s)
- Ann E Burke
- Wright State University Boonshoft School of Medicine and Dayton Children's Hospital.
| | - Daniel J Sklansky
- University of Wisconsin School of Medicine and Public Health and American Family Children's Hospital
| | - Hilary M Haftel
- American Academy of Pediatrics, Senior Vice President, Education
| | - Andrew Mitchell
- Wright State University Boonshoft School of Medicine and Dayton Children's Hospital
| | - Keith J Mann
- American Board of Pediatrics, Vice President for Continuing Certification
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Tibbetts Y, Himmelberger ZM, Barron KE, Speicher MR, Hulleman CS. Learning Mindsets and Well-Being and Ill-Being Among Osteopathic Medical Students. JAMA Netw Open 2024; 7:e2418090. [PMID: 38874920 PMCID: PMC11179131 DOI: 10.1001/jamanetworkopen.2024.18090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/20/2024] [Indexed: 06/15/2024] Open
Abstract
Importance Given the high rates of burnout and associated negative mental health outcomes (eg, depression, suicidal ideation, substance abuse) among medical students and physicians, it is imperative to identify strategies for supporting the future health workforce, particularly when considering trends indicating a future shortage of physicians. Understanding the associations of medical school students' learning mindsets (eg, growth mindset, purpose and relevance, and sense of belonging) with indicators of well-being (eg, flourishing) and ill-being (eg, burnout) could provide a foundation for future research to consider when attempting to combat the negative mental health trends among medical students and physicians. Objectives To understand the associations of medical school students' learning mindsets (ie, their beliefs about themselves as learners and their learning environment) with critical student health outcomes (ie, well-being and ill-being). Design, Setting, and Participants This survey study used a nationally representative sample of first-year osteopathic medical school students across the US who responded to a survey of learning mindsets as well as measures of well-being and ill-being in fall 2022. Data were analyzed from January to April 2024. Main Outcomes and Measures Learning mindsets were categorized as growth mindset, purpose and relevance, and sense of belonging. Well-being was categorized as flourishing and resilience, and ill-being was categorized as burnout and psychological symptoms. Outcomes were regressed on learning mindset and demographics variables, and interactions of demographic variables and learning mindsets were assessed. Results A total of 7839 students were surveyed, and 6622 students (mean [SD] age, 25.05 [3.20]; 3678 [55.5%] women) responded and were included in analyses. The 3 learning mindsets were significantly associated with flourishing (growth mindset: b = 0.34; 95% CI, 0.23 to 0.45; P < .001; purpose and relevance: b = 2.02; 95% CI, 1.83 to 2.20; P < .001; belonging uncertainty: b = -0.98; 95% CI, -1.08 to -0.89; P < .001) and resilience (growth mindset: b = 0.28; 95% CI, 0.17 to 0.40; P < .001; purpose and relevance: b = 1.62; 95% CI, 1.43 to 1.82; P < .001; belonging uncertainty: b = -1.50; 95% CI, -1.60 to -1.40; P < .001) well-being outcomes and burnout (growth mindset: b = -0.09; 95% CI, -0.11 to -0.07; P < .001; purpose and relevance: b = -0.29; 95% CI, -0.32 to -0.25; P < .001; belonging uncertainty: b = 0.28; 95% CI, 0.26 to 0.30; P < .001) and psychological symptoms (growth mindset: b = -0.22; 95% CI, -0.30 to -0.14; P < .001; purpose and relevance: b = -0.51; 95% CI, -0.64 to -0.38; P < .001; belonging uncertainty: b = 1.33; 95% CI, 1.27 to 1.40; P < .001) ill-being outcomes, even when controlling for important demographic characteristics (eg, race and ethnicity, gender identity, age). Furthermore, several significant interactions indicated that these learning mindsets may be particularly salient for students from historically marginalized communities: there was a significant interaction between growth mindset and race and ethnicity (b = 0.58; 95% CI, 0.08 to 1.09, P = .02), such that growth mindset was more strongly associated with flourishing among American Indian or Alaska Native, Black, Latine, or Native Hawaiian students. Conclusions and Relevance These findings suggest that identifying strategies for supporting students' learning mindsets may be an effective way to support medical student well-being and reduce ill-being, particularly among students from historically marginalized backgrounds.
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Affiliation(s)
- Yoi Tibbetts
- Motivate Lab, Harrisonburg, Virginia
- University of Virginia, Charlottesville
| | | | - Kenneth E. Barron
- Motivate Lab, Harrisonburg, Virginia
- James Madison University, Harrisonburg, Virginia
| | - Mark R. Speicher
- American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland
| | - Chris S. Hulleman
- Motivate Lab, Harrisonburg, Virginia
- University of Virginia, Charlottesville
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7
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Murry LT, Boyer JG, Catledge K, Gettig JP, Travlos DV, Zarembski D, Kiersma ME. The Intersection of Growth Mindset and Accreditation in Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100711. [PMID: 38723896 DOI: 10.1016/j.ajpe.2024.100711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES To describe existing growth mindset literature within pharmacy and health care education, describe how a growth mindset can be beneficial in the accreditation process, and propose potential ways to promote a growth mindset in faculty, preceptors, students, and staff within pharmacy education. FINDINGS To help pharmacy learners develop a growth mindset, existing literature emphasizes the need for a shift toward and aligning assessment with a growth mindset, helping to create self-directed adaptive learners, leading to health care providers who can adjust their practice to tackle expected and unexpected challenges throughout their careers. Strategies to create a culture of growth mindset identified include training faculty and learners on growth mindset and developing new assessments that track a learner's growth. Recommendations for pharmacy educators include encouraging educators to assess their own growth mindset and use a variety of teaching methods and provide feedback on learner effort that encourages the process of learning rather than focusing on individual attributes, traits, and results. SUMMARY Growth mindset intersects with accreditation standards for both professional degree programs and providers of continuing pharmacy education. Continuing professional development process is one way to encourage faculty, staff, and students to develop a growth mindset. While a growth mindset can have many positive impacts on pharmacy accreditation, it is essential to recognize that achieving and maintaining accreditation is a multifaceted process involving numerous factors. A growth mindset can positively influence pharmacy education accreditation by fostering a culture of continuous improvement, innovation, resilience, student-centeredness, data-driven decision-making, collaboration, and effective leadership.
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Affiliation(s)
- Logan T Murry
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | - J Gregory Boyer
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | | | - Jacob P Gettig
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | | | - Dawn Zarembski
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | - Mary E Kiersma
- Accreditation Council for Pharmacy Education, Chicago, IL, USA.
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Lanting K, Oudbier J, van den Aardwegh C, Arnold J, Ang W, Otto S, Horta TP, Verpooten L, Suurmond J. Community-based learning in medical education: A starting guide and lessons learned. MEDICAL TEACHER 2024:1-4. [PMID: 38733364 DOI: 10.1080/0142159x.2024.2351591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/01/2024] [Indexed: 05/13/2024]
Abstract
Community-based medical education (CBME) addresses real-world health problems and is characterized by its emphasis on reciprocity and collaboration with community stakeholders. Limited evidence shows that CBME is an effective learning strategy to care for underserved communities. However, medical schools and nursing schools struggle to implement CBME in their curriculum. In this article, we present four practical examples of CBME from medical and nursing schools in Belgium and the Netherlands. By taking the lessons learned derived from these practical examples into account, all students can have an authentic learning experience within the community, which empowers community members and increases their health.
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Affiliation(s)
- Katja Lanting
- School of Health, Saxion - Locatie Deventer, Deventer, Netherlands
| | | | | | | | - Winny Ang
- University of Antwerp, Wilrijk, Belgium
| | - Suzie Otto
- Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | | | | | - Jeanine Suurmond
- Public and Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
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9
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Braund H, Dalgarno N, O’Dell R, Taylor DR. Making assessment a team sport: a qualitative study of facilitated group feedback in internal medicine residency. CANADIAN MEDICAL EDUCATION JOURNAL 2024; 15:14-26. [PMID: 38827914 PMCID: PMC11139793 DOI: 10.36834/cmej.75250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Purpose Competency-based medical education relies on feedback from workplace-based assessment (WBA) to direct learning. Unfortunately, WBAs often lack rich narrative feedback and show bias towards Medical Expert aspects of care. Building on research examining interactive assessment approaches, the Queen's University Internal Medicine residency program introduced a facilitated, team-based assessment initiative ("Feedback Fridays") in July 2017, aimed at improving holistic assessment of resident performance on the inpatient medicine teaching units. In this study, we aim to explore how Feedback Fridays contributed to formative assessment of Internal Medicine residents within our current model of competency-based training. Method A total of 53 residents participated in facilitated, biweekly group assessment sessions during the 2017 and 2018 academic year. Each session was a 30-minute facilitated assessment discussion done with one inpatient team, which included medical students, residents, and their supervising attending. Feedback from the discussion was collected, summarized, and documented in narrative form in electronic WBA forms by the program's assessment officer for the residents. For research purposes, verbatim transcripts of feedback sessions were analyzed thematically. Results The researchers identified four major themes for feedback: communication, intra- and inter-personal awareness, leadership and teamwork, and learning opportunities. Although feedback related to a broad range of activities, it showed strong emphasis on competencies within the intrinsic CanMEDS roles. Additionally, a clear formative focus in the feedback was another important finding. Conclusions The introduction of facilitated team-based assessment in the Queen's Internal Medicine program filled an important gap in WBA by providing learners with detailed feedback across all CanMEDS roles and by providing constructive recommendations for identified areas for improvement.
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Affiliation(s)
- Heather Braund
- Office of Professional Development and Educational Scholarship, Ontario, Canada
- Faculty of Education, Queen’s University, Ontario, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Faculty of Health Sciences, Queen’s University, Ontario, Canada
| | - Rachel O’Dell
- Department of Internal Medicine, Faculty of Health Sciences, Queen’s University, Ontario, Canada
| | - David R Taylor
- Academy for Teachers and Educators, Department of Medicine, Queen’s University, Ontario, Canada
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Van Hecke A, Decoene E, Embo M, Beeckman D, Bergs J, Courtens A, Dancot J, Dobbels F, Goossens GA, Jacobs N, Van Achterberg T, Van Bogaert P, Van Durme T, Verhaeghe S, Vlaeyen E, Goossens E. Development of a competency framework for advanced practice nurses: A co-design process. J Adv Nurs 2024. [PMID: 38586883 DOI: 10.1111/jan.16174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/23/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
AIMS The aim of the study was to develop a comprehensive competency framework for advanced practice nurses in Belgium. DESIGN A co-design development process was conducted. METHODS This study consisted of two consecutive stages (November 2020-December 2021): (1) developing a competency framework for advanced practice nurses in Belgium by the research team, based on literature and (2) group discussions or interviews with and written feedback from key stakeholders. 11 group discussions and seven individual interviews were conducted with various stakeholder groups with a total of 117 participants. RESULTS A comprehensive competency framework containing 31 key competencies and 120 enabling competencies was developed based on the Canadian Medical Education Directions for Specialists Competency Framework. These competencies were grouped into seven roles: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator and health promoter. CONCLUSION The developed competency framework has resemblance to other international frameworks. This framework emphasized the independent role of the advanced practice nurse and provided guidance in a clear task division and delegation to other professionals. It can provide a solid foundation for delivering high-quality, patient-centred care by advanced practice nurses in the years to come. IMPLICATIONS FOR THE PROFESSION This competency framework can guide further development of advanced practice nursing education in Belgium and represents a starting point for future evaluation of its feasibility and usability in education and clinical practice. Advanced practice nurses and healthcare managers can also use the framework as an instrument for personal and professional development, performance appraisal, and further alignment of these function profiles in clinical practice. Finally, this framework can inform and guide policymakers towards legal recognition of advanced practice nursing in Belgium and inspire the development of advanced practice nursing profiles in countries where these profiles are still emerging. IMPACT What problem did the study address? The absence of a detailed competency framework for advanced practice nurses complicates legal recognition, role clarification and implementation in practice in Belgium. A rigorously developed competency framework could clarify which competencies to integrate in future advanced practice nursing education, mentorship programs and practice. What were the main findings? The competency framework outlined seven roles for advanced practice nurses: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator, and health promoter. Differentiation from other expert nursing profiles and clinical autonomy of advanced practice nurses were pivotal. Where and on whom will the research have impact? The comprehensive competency framework for advanced practice nurses and the collaborative methodology used can inspire other countries where these profiles are still emerging. The competency framework can be used as an instrument for role clarification, performance appraisals, continuous professional development, and professional (e-)portfolios. The competency framework can guide policymakers when establishing Belgian's legal framework for advanced practice nurses. REPORTING METHOD The authors have adhered to CONFERD-HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution in the design of the study. A patient advisory panel commented on the developed competency framework.
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Affiliation(s)
- Ann Van Hecke
- Department of Public Health and Primary Care, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Staff Member Centre of Expertise in Nursing, Ghent University Hospital, Ghent, Belgium
| | - Elsie Decoene
- Staff Member Centre of Expertise in Nursing, Ghent University Hospital, Ghent, Belgium
| | - Mieke Embo
- Department of Educational Studies, Faculty of Psychology and Educational Sciences and Expertise Network Health and Care, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Swedish Center for Skin and Wound Research (SCENTR), Nursing Science Unit, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Jochen Bergs
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
- Department of PXL-Healthcare, Center for Healthcare Innovation, PXL University of Applied Sciences and Arts, Hasselt, Belgium
| | | | - Jacinthe Dancot
- Nursing Department, Haute École Robert Schuman, Libramont, Belgium
- Public Health Sciences Department, University of Liège, Liège, Belgium
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Goddelieve Alice Goossens
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Nursing Center of Excellence, University Hospitals, Leuven, Belgium
| | - Noortje Jacobs
- Research Unit Health Promotion, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Theo Van Achterberg
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Peter Van Bogaert
- Center for Research and Innovation in Care, Department of Midwifery and Nursing Sciences, Antwerp University, Antwerp, Belgium
| | - Thérèse Van Durme
- Institute of Health and Society, UC Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ellen Vlaeyen
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Eva Goossens
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Center for Research and Innovation in Care, Department of Midwifery and Nursing Sciences, Antwerp University, Antwerp, Belgium
- Department of Patient Care, Antwerp University Hospital, Antwerp, Belgium
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Sibicky SL, Daugherty KK, Chen AMH, Rhoney D, Nawarskas J. Enabling Factors for the Implementation of Competency-Based Curricula in Colleges and Schools of Pharmacy. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100681. [PMID: 38460599 DOI: 10.1016/j.ajpe.2024.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 09/22/2023] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES To review the implementation drivers of competency-based pharmacy education (CBPE) and provide recommendations for enablers. FINDINGS Competency-based education is an emerging model in the health professions, focusing on time-variable competency development and achievement compared with a time-bound, course-based, traditional model. CBPE is an outcomes-based organized framework of competencies enabling pharmacists to meet health care and societal needs. However, challenges need to be recognized and overcome for the successful implementation of CBPE. Competency drivers include defining the competencies and roles of stakeholders, developing transparent learning trajectories and aligned assessments, and establishing lifetime development programs for stakeholders. Organization drivers include developing support systems for stakeholders; facilitating connections between all educational experiences; and having transparent assessment plans, policies, and procedures that align with core CBPE precepts, including the sustainability of time-variability. Leadership drivers include establishing growth mindset and facilitating a culture of connection between workplace and educational environments, program advocacy by institutional leaders, accepting failures as part of the process, shifting the organizational culture away from learner differentiation toward competence, and maintaining sufficient administrative capability to support CBPE. SUMMARY The successful implementation of CBPE involves enabling the competency, organization, and leadership drivers that will lead to program success. More research is needed in the areas of creation, implementation, and assessment of CBPE to determine success in this model. We have reviewed and provided recommendations to enable the drivers of successful implementation of CBPE.
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Affiliation(s)
- Stephanie L Sibicky
- Northeastern University School of Pharmacy and Pharmaceutical Sciences, Boston, MA, USA.
| | - Kimberly K Daugherty
- Sullivan University College of Pharmacy and Health Sciences, Louisville, KY, USA
| | - Aleda M H Chen
- Cedarville University School of Pharmacy, Cedarville, OH, USA
| | - Denise Rhoney
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - James Nawarskas
- University of New Mexico College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
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Sagin A, Balmer D, Musheno R, Olenik JM, Dingfield L, Bennett NL, Dine CJ. Lifelong Learning Indicators in Medical Students After a Novel Communication Skills Session. J Pain Symptom Manage 2024; 67:e367-e374. [PMID: 38244707 DOI: 10.1016/j.jpainsymman.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/22/2024]
Abstract
CONTEXT A growth mindset and mastery approach have gained attention as useful learning orientations in medical education, however few studies of interventions to foster these orientations exist. OBJECTIVES We sought to discover whether a communication skills session on delivering serious news could foster a communication growth mindset and/or a mastery approach in medical students. METHODS This was an interventional survey study of third-year medical students before and after a session on delivering serious news. Students were administered a communication mindset survey before and after the session; achievement goal and learning environment surveys were administered after the session. Chi-square tests were used to assess the difference in pre and post mindsets. Logistic regression was used to determine the odds of achieving a mastery approach with pre- and post-communication growth mindset as the independent variables. RESULTS Students' communication growth mindset increased from 79% (n = 186) before the intervention to 92% (n = 142) after the intervention. Achievement goal analysis demonstrated that 64% (n = 91) of students had a mastery approach, 14% (n = 20) had a performance approach and 22% (n = 32) had an avoidant approach. Ninety-nine percent (n = 151) felt the session provided a safe learning environment. The odds of having a mastery approach correlated with both pre and post-intervention growth mindset, with post-session growth mindset having the strongest correlation. CONCLUSIONS A novel communication skills session on delivering serious news fostered a communication growth mindset in third year medical students. Most students exhibited a mastery approach to learning; this approach was more likely when they had a growth mindset.
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Affiliation(s)
- Alana Sagin
- University of Pennsylvania's Perelman School of Medicine (A.S., D.B. R.M., J.M.O., L.D., N.L.B., C.J.D.), Philadelphia, Pennsylvania, USA.
| | - Dorene Balmer
- University of Pennsylvania's Perelman School of Medicine (A.S., D.B. R.M., J.M.O., L.D., N.L.B., C.J.D.), Philadelphia, Pennsylvania, USA
| | - Rosie Musheno
- University of Pennsylvania's Perelman School of Medicine (A.S., D.B. R.M., J.M.O., L.D., N.L.B., C.J.D.), Philadelphia, Pennsylvania, USA
| | - Jennifer M Olenik
- University of Pennsylvania's Perelman School of Medicine (A.S., D.B. R.M., J.M.O., L.D., N.L.B., C.J.D.), Philadelphia, Pennsylvania, USA
| | - Laura Dingfield
- University of Pennsylvania's Perelman School of Medicine (A.S., D.B. R.M., J.M.O., L.D., N.L.B., C.J.D.), Philadelphia, Pennsylvania, USA
| | - Nadia L Bennett
- University of Pennsylvania's Perelman School of Medicine (A.S., D.B. R.M., J.M.O., L.D., N.L.B., C.J.D.), Philadelphia, Pennsylvania, USA
| | - C Jessica Dine
- University of Pennsylvania's Perelman School of Medicine (A.S., D.B. R.M., J.M.O., L.D., N.L.B., C.J.D.), Philadelphia, Pennsylvania, USA
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Rajaragupathy S, Govindarajan S, Ponnusamy D. Study of mindset among learners and educators in an Indian medical school-A questionnaire-based survey. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:121. [PMID: 38726070 PMCID: PMC11081459 DOI: 10.4103/jehp.jehp_1661_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/25/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND Mindset varies along a spectrum of two extremes- fixed and growth. Individuals with growth mindset embrace new challenges readily and believe that intelligence is malleable. Mindset theory has gained focus as a principal underpinning value of health professions education, as it is aligned with the goals of competency-based education. The study aims to assess the mindset of health professional educators and learners. MATERIALS AND METHODS A cross-sectional questionnaire-based survey was conducted in a private medical college in South India. A pre-validated modified version of Dweck's (2000) Implicit Theories of Intelligence Questionnaire was administered to the study participants. Participants responded to 10 items using a four-point Likert scale, rating the degree to which they agreed or disagreed with each statement. The quantitative data were expressed in means and percentages. RESULTS A total of192 students and 25 faculty participated in the study. Among students, 45.8% (n = 88) had strong growth mindset, 42.1% (n = 81) had growth mindset with some fixed ideas, 10.9% (n = 21) had fixed mindset with some growth ideas, and 1% (n = 2) had strong fixed mindset. Among faculty 4% (n = 1) had fixed mindset with growth ideas, 44% (n = 11) had growth mindset with fixed ideas, and 52% (n = 13) had strong growth mindset. DISCUSSION In this study, educators and learners of a medical school were found to have predominantly growth mindset. Fostering growth mindset among stakeholders of health professions education is essential for effective teaching and learning in competency-based education.
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Affiliation(s)
- Sujatha Rajaragupathy
- Department of Biochemistry, PSG Institute of Medical Sciences and Research (PSGIMSR), Coimbatore, Tamil Nadu, India
| | - Sumitra Govindarajan
- Department of Biochemistry, PSG Institute of Medical Sciences and Research (PSGIMSR), Coimbatore, Tamil Nadu, India
| | - Deepika Ponnusamy
- Department of Biochemistry, PSG Institute of Medical Sciences and Research (PSGIMSR), Coimbatore, Tamil Nadu, India
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Frank JR, Karpinski J, Sherbino J, Snell LS, Atkinson A, Oswald A, Hall AK, Cooke L, Dojeiji S, Richardson D, Cheung WJ, Cavalcanti RB, Dalseg TR, Thoma B, Flynn L, Gofton W, Dudek N, Bhanji F, Wong BMF, Razack S, Anderson R, Dubois D, Boucher A, Gomes MM, Taber S, Gorman LJ, Fulford J, Naik V, Harris KA, St. Croix R, van Melle E. Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:201-223. [PMID: 38525203 PMCID: PMC10959143 DOI: 10.5334/pme.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/16/2024] [Indexed: 03/26/2024]
Abstract
Postgraduate medical education is an essential societal enterprise that prepares highly skilled physicians for the health workforce. In recent years, PGME systems have been criticized worldwide for problems with variable graduate abilities, concerns about patient safety, and issues with teaching and assessment methods. In response, competency based medical education approaches, with an emphasis on graduate outcomes, have been proposed as the direction for 21st century health profession education. However, there are few published models of large-scale implementation of these approaches. We describe the rationale and design for a national, time-variable competency-based multi-specialty system for postgraduate medical education called Competence by Design. Fourteen innovations were bundled to create this new system, using the Van Melle Core Components of competency based medical education as the basis for the transformation. The successful execution of this transformational training system shows competency based medical education can be implemented at scale. The lessons learned in the early implementation of Competence by Design can inform competency based medical education innovation efforts across professions worldwide.
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Affiliation(s)
- Jason R. Frank
- Centre for Innovation in Medical Education and Professor, Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Jolanta Karpinski
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Competency Based Medical Education, University of Ottawa, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | | | - Linda S. Snell
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Medicine and Health Sciences Education, McGill University, Montreal, QC, Canada
| | - Adelle Atkinson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Competency Based Medical Education, University of Alberta, Edmonton, AB, Canada
| | - Andrew K. Hall
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lara Cooke
- Division of Neurology, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan Dojeiji
- Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada
| | - Denyse Richardson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, ON, Canada
| | - Warren J. Cheung
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rodrigo B. Cavalcanti
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- HoPingKong Centre, University Health Network, Toronto, ON, Canada
| | - Timothy R. Dalseg
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Brent Thoma
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Leslie Flynn
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Departments of Psychiatry and Family Medicine, and Co-Director Master of Health Sciences Education, Queen’s University, Kingston, ON, Canada
| | - Wade Gofton
- Department of Surgery (Division of Orthopedic Surgery), The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Nancy Dudek
- Department of Medicine (Division of Physical Medicine & Rehabilitation) and The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Farhan Bhanji
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Brian M.-F. Wong
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Canada
| | - Saleem Razack
- Centre for Health Education Scholarship, University of British Columbia and BC Children’s Hospital, Vancouver, BC, Canada
| | - Robert Anderson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Daniel Dubois
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrée Boucher
- Department of Medicine (Division of Endocrinology), Universitéde Montréal, Montréal, QC, Canada
| | - Marcio M. Gomes
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sarah Taber
- Office of Standards and Assessment, Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Lisa J. Gorman
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Jane Fulford
- Canadian Internet Registration Authority, Canada
| | - Viren Naik
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- Medical Council of Canada, Ottawa, ON, Canada
| | - Kenneth A. Harris
- Royal College of Physicians and Surgeons of Canada, Canada
- Emeritus, Western University, Canada
| | - Rhonda St. Croix
- Learning and Connecting at the Royal College of Physicians and Surgeons of Canada, Canada
| | - Elaine van Melle
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Family Medicine, Queen’s University, Kingston, ON, Canada
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Memari M, Gavinski K, Norman MK. Beware False Growth Mindset: Building Growth Mindset in Medical Education Is Essential but Complicated. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:261-265. [PMID: 37643577 DOI: 10.1097/acm.0000000000005448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
ABSTRACT Mindset theory aims to explain how learners' beliefs about intelligence and learning affect how they perceive effort, react to failure, and respond to feedback in challenging learning contexts. Mindset theory distinguishes between growth mindset (the belief that human capacities can be developed over time) and fixed mindset (the belief that human capacities are inherent and unchangeable). Efforts to develop growth mindset in learners have shown a wide range of benefits, including positive effects on students' resilience, commitment to lifelong learning, and persistence in a field of study, with notable impacts on learners who are struggling, learners from minoritized groups, and women in scientific fields. In recent years, mindset theory interventions have caught the interest of medical educators hoping to engage learners as partners in their own learning and progression to competence. Educators hoping to apply this theory to educational programs and learner-teacher interactions in ways that promote growth mindsets would benefit from awareness of the concept of false growth mindset , a term coined by Carol Dweck to refer to common pitfalls in the theory's application. In this article, the authors highlight important findings from mindset interventions in medical education, identify common pitfalls of false growth mindset in the context of medical learners, and offer suggestions for how educators and institutions can better instigate changes to promote growth mindsets within medical education.
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de Heer MH, Driessen EW, Teunissen PW, Scheele F. Lessons learned spanning 17 years of experience with three consecutive nationwide competency based medical education training plans. Front Med (Lausanne) 2024; 11:1339857. [PMID: 38455473 PMCID: PMC10917951 DOI: 10.3389/fmed.2024.1339857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Curricula for postgraduate medical education have transformed since the introduction of competency based medical education (CBME). Postgraduate training plans offer broader training with different competencies and an outcome-based approach, in addition to the medical technical aspects of training. However, CBME also has its challenges. Over the past years, critical views have been shared on the potential drawbacks of CBME, such as assessment burden and conflicts with practicality in the workplace. Recent studies identified a need for a better understanding of how the evolving concept of CBME has been translated to curriculum design and implemented in the practice of postgraduate training. The aim of this study was to describe the development of CBME translations to curriculum design, based on three consecutive postgraduate training programs spanning 17 years. Method We performed a document analysis of three consecutive Dutch gynecology and obstetrics training plans that were implemented in 2005, 2013, and 2021. We used template analysis to identify changes over time. Results Over time, CBME-based curriculum design changed in several domains. Assessment changed from a model with a focus on summative decision to one with an emphasis on formative, low-stakes assessments aimed at supporting learning. The training plans evolved in parallel to evolving educational insights, e.g., by placing increasing emphasis on personal development. The curricula focused on a competency-based concept by introducing training modules and personalized authorization based on feedback rather than on a set duration of internships. There was increasing freedom in personalized training trajectories in the training plans, together with increasing trust towards the resident. Conclusion The way CBME was translated into training plans has evolved in the course of 17 years of experience with CMBE-based education. The main areas of change were the structure of the training plans, which became increasingly open, the degree to which learning outcomes were mandatory or not, and the way these outcomes were assessed.
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Affiliation(s)
- Merel H. de Heer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, Amsterdam, Netherlands
| | - Erik W. Driessen
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands
| | - Pim W. Teunissen
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands
- Department of Obstetrics and Gynecology, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Fedde Scheele
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, Amsterdam, Netherlands
- Athena Institute, Faculty of Science, VU, Amsterdam, Netherlands
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Hall AK, Oswald A, Frank JR, Dalseg T, Cheung WJ, Cooke L, Gorman L, Brzezina S, Selvaratnam S, Wagner N, Hamstra SJ, Van Melle E. Evaluating Competence by Design as a Large System Change Initiative: Readiness, Fidelity, and Outcomes. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:95-107. [PMID: 38343556 PMCID: PMC10854467 DOI: 10.5334/pme.962] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/17/2023] [Indexed: 02/15/2024]
Abstract
Program evaluation is an essential, but often neglected, activity in any transformational educational change. Competence by Design was a large-scale change initiative to implement a competency-based time-variable educational system in Canadian postgraduate medical education. A program evaluation strategy was an integral part of the build and implementation plan for CBD from the beginning, providing insights into implementation progress, challenges, unexpected outcomes, and impact. The Competence by Design program evaluation strategy was built upon a logic model and three pillars of evaluation: readiness to implement, fidelity and integrity of implementation, and outcomes of implementation. The program evaluation strategy harvested from both internally driven studies and those performed by partners and invested others. A dashboard for the program evaluation strategy was created to transparently display a real-time view of Competence by Design implementation and facilitate continuous adaptation and improvement. The findings of the program evaluation for Competence by Design drove changes to all aspects of the Competence by Design implementation, aided engagement of partners, supported change management, and deepened our understanding of the journey required for transformational educational change in a complex national postgraduate medical education system. The program evaluation strategy for Competence by Design provides a framework for program evaluation for any large-scale change in health professions education.
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Affiliation(s)
- Andrew K. Hall
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jason R. Frank
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tim Dalseg
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Warren J. Cheung
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lara Cooke
- Neurology, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lisa Gorman
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Stacey Brzezina
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | | | - Natalie Wagner
- Queen’s Health Sciences Office of Professional Development and Educational Scholarship, Queen’s University, Kingston, ON, Canada
| | - Stanley J. Hamstra
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Milestones Research and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, IL, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elaine Van Melle
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Family Medicine, Queen’s University, Kingston, ON, Canada
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Oswald A, Dubois D, Snell L, Anderson R, Karpinski J, Hall AK, Frank JR, Cheung WJ. Implementing Competence Committees on a National Scale: Design and Lessons Learned. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:56-67. [PMID: 38343555 PMCID: PMC10854462 DOI: 10.5334/pme.961] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/03/2023] [Indexed: 02/15/2024]
Abstract
Competence committees (CCs) are a recent innovation to improve assessment decision-making in health professions education. CCs enable a group of trained, dedicated educators to review a portfolio of observations about a learner's progress toward competence and make systematic assessment decisions. CCs are aligned with competency based medical education (CBME) and programmatic assessment. While there is an emerging literature on CCs, little has been published on their system-wide implementation. National-scale implementation of CCs is complex, owing to the culture change that underlies this shift in assessment paradigm and the logistics and skills needed to enable it. We present the Royal College of Physicians and Surgeons of Canada's experience implementing a national CC model, the challenges the Royal College faced, and some strategies to address them. With large scale CC implementation, managing the tension between standardization and flexibility is a fundamental issue that needs to be anticipated and addressed, with careful consideration of individual program needs, resources, and engagement of invested groups. If implementation is to take place in a wide variety of contexts, an approach that uses multiple engagement and communication strategies to allow for local adaptations is needed. Large-scale implementation of CCs, like any transformative initiative, does not occur at a single point but is an evolutionary process requiring both upfront resources and ongoing support. As such, it is important to consider embedding a plan for program evaluation at the outset. We hope these shared lessons will be of value to other educators who are considering a large-scale CBME CC implementation.
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Affiliation(s)
- Anna Oswald
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Competency Based Medical Education, University of Alberta, Edmonton, AB, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- 8-130 Clinical Sciences building, 11350-83 Avenue, Edmonton, AB, Canada
| | - Daniel Dubois
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Linda Snell
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Institute of Health Sciences Education and Department of Medicine, McGill University, Montreal, QC, Canada
| | - Robert Anderson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Jolanta Karpinski
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrew K. Hall
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Dept. of Emergency Medicine, University of Ottawa, Canada
| | - Jason R. Frank
- Centre for Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Canada
| | - Warren J. Cheung
- Dept. of Emergency Medicine, University of Ottawa, Canada
- Royal College of Physicians and Surgeons of Canada, 1053 Carling Avenue, Rm F660, Ottawa, Canada
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Montgomery MW, Petersen EM, Weinstein AR, Curren C, Hufmeyer K, Kisielewski M, Krupat E, Osman NY. Moving Beyond the Dichotomous Assessment of Professionalism in the Internal Medicine Clerkship: Results of a National Survey of Clerkship Directors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:208-214. [PMID: 37369066 DOI: 10.1097/acm.0000000000005308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
PURPOSE This study examines how internal medicine clerkship faculty and leadership conceptualize professionalism and professional behaviors and attitudes, identifies whether and how faculty use metrics to assess professionalism and factor it into clerkship grades, and describes barriers that prevent faculty from feeling prepared to support the development of professional behaviors in students. METHOD The Clerkship Directors in Internal Medicine opened a call for thematic survey section proposals to its physician-faculty members, blind-reviewed all submissions, and selected 4 based on internal medicine clinical clerkship training experience relevance. The survey launched on October 5 and closed on December 7, 2021. Data were analyzed using descriptive statistics. RESULTS Of 137 core clerkship directors (CDs) at Liaison Committee on Medical Education-accredited medical schools, 103 (75.2%) responded to the survey. Of 102 respondents (1 nonrespondent), 84 (82.4%) identified professional behavior lapses in involvement and 60 (58.8%) identified introspection lapses. Of 103 respondents, 97 (94.2%) reported that their clerkships ask clinical faculty and residents to formally evaluate professionalism, and 64 (62.1%) reported that they factor professionalism assessments into final clerkship grades. CDs reported multiple barriers to addressing professionalism directly with students, including logistical barriers, professionalism assessment subjectivity concerns, and the possible adverse effect of an unprofessional label for students. CONCLUSIONS Professionalism assessment and remediation in medical education currently center on a deficit model that seeks to identify and remediate professionalism lapses, rather than a developmental model that seeks to nurture growth. This dichotomous characterization of behaviors as professional or unprofessional limits assessment and can adversely affect the learning environment. The authors propose a shift to a developmental model that considers professionalism as a continuous process parallel to the acquisition of clinical skills and medical knowledge.
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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 MEDICAL EDUCATION 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] [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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21
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Caretta-Weyer HA, Smirnova A, Barone MA, Frank JR, Hernandez-Boussard T, Levinson D, Lombarts KMJMH, Lomis KD, Martini A, Schumacher DJ, Turner DA, Schuh A. The Next Era of Assessment: Building a Trustworthy Assessment System. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:12-23. [PMID: 38274558 PMCID: PMC10809864 DOI: 10.5334/pme.1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Assessment in medical education has evolved through a sequence of eras each centering on distinct views and values. These eras include measurement (e.g., knowledge exams, objective structured clinical examinations), then judgments (e.g., workplace-based assessments, entrustable professional activities), and most recently systems or programmatic assessment, where over time multiple types and sources of data are collected and combined by competency committees to ensure individual learners are ready to progress to the next stage in their training. Significantly less attention has been paid to the social context of assessment, which has led to an overall erosion of trust in assessment by a variety of stakeholders including learners and frontline assessors. To meaningfully move forward, the authors assert that the reestablishment of trust should be foundational to the next era of assessment. In our actions and interventions, it is imperative that medical education leaders address and build trust in assessment at a systems level. To that end, the authors first review tenets on the social contextualization of assessment and its linkage to trust and discuss consequences should the current state of low trust continue. The authors then posit that trusting and trustworthy relationships can exist at individual as well as organizational and systems levels. Finally, the authors propose a framework to build trust at multiple levels in a future assessment system; one that invites and supports professional and human growth and has the potential to position assessment as a fundamental component of renegotiating the social contract between medical education and the health of the public.
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Affiliation(s)
- Holly A. Caretta-Weyer
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Alina Smirnova
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
- Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A. Barone
- NBME, Philadelphia, Pennsylvania, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jason R. Frank
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, CA
| | | | - Dana Levinson
- Josiah Macy Jr Foundation, Philadelphia, Pennsylvania, USA
| | - Kiki M. J. M. H. Lombarts
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, NL
- Amsterdam Public Health research institute, Amsterdam, NL
| | - Kimberly D. Lomis
- Undergraduate Medical Education Innovations, American Medical Association, Chicago, Illinois, USA
| | - Abigail Martini
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Daniel J. Schumacher
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David A. Turner
- American Board of Pediatrics, Chapel Hill, North Carolina, USA
| | - Abigail Schuh
- Division of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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22
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Daugherty KK, Chen A, Churchwell MD, Jarrett JB, Kleppinger EL, Meyer S, Nawarskas J, Sibicky SL, Stowe CD, Rhoney DH. Competency-based pharmacy education definition: What components need to be defined to implement it? AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100624. [PMID: 37952584 DOI: 10.1016/j.ajpe.2023.100624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES This study aimed to define the essential elements in the proposed competency-based pharmacy education (CBPE) definition, provide the key defining components of each essential element on the basis of educational theory and evidence, and define how the essential elements meet the identified needs for CBPE. METHODS best-practice integrative review was conducted as part of the work of the American Association of Colleges of Pharmacy CBPE Task Force to define the essential elements in the CBPE definition and how these elements fit with the need for CBPE. The definition was compared with other published competency-based education definitions across K-12, higher education, medical education, and veterinary education. Task Force members then met to develop a consensus on the core components of the 5 essential elements in the definition. Next, the Task Force evaluated the fit of CBPE by matching the identified needs, discussed in detail elsewhere, across each of the stakeholder perspectives with the core components of the 5 essential elements in the derived definition of CBPE. FINDINGS Upon review of the proposed CBPE definition, the Task Force identified 5 essential elements. These elements include the following: meeting health care and societal needs, outcomes-based curricular model, de-emphasized time, learner-centered culture, and authentic teaching and learning strategies aligned to assessments. SUMMARY This article helps to establish a common language for CBPE by defining the essential elements of the core components of the definition, and provides a starting point for further exploration of CBPE.
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Affiliation(s)
- Kimberly K Daugherty
- Sullivan University College of Pharmacy and Health Sciences, Louisville, KY, USA
| | - Aleda Chen
- Cedarville University, School of Pharmacy, Cedarville, OH, USA
| | - Marianne D Churchwell
- University of Toledo, College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA
| | - Jennie B Jarrett
- University of Illinois Chicago, College of Pharmacy, Department of Pharmacy Practice, Chicago, IL, USA
| | | | | | - James Nawarskas
- University of New Mexico, College of Pharmacy, Albuquerque, NM, USA
| | - Stephanie L Sibicky
- Northeastern University, School of Pharmacy and Pharmaceutical Sciences, Boston, MA, USA
| | - Cindy D Stowe
- University of Arkansas for Medical Sciences, College of Pharmacy, Little Rock, AR, USA
| | - Denise H Rhoney
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA.
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23
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Ten Cate O, Khursigara-Slattery N, Cruess RL, Hamstra SJ, Steinert Y, Sternszus R. Medical competence as a multilayered construct. MEDICAL EDUCATION 2024; 58:93-104. [PMID: 37455291 DOI: 10.1111/medu.15162] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/31/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The conceptualisation of medical competence is central to its use in competency-based medical education. Calls for 'fixed standards' with 'flexible pathways', recommended in recent reports, require competence to be well defined. Making competence explicit and measurable has, however, been difficult, in part due to a tension between the need for standardisation and the acknowledgment that medical professionals must also be valued as unique individuals. To address these conflicting demands, a multilayered conceptualisation of competence is proposed, with implications for the definition of standards and approaches to assessment. THE MODEL Three layers are elaborated. This first is a core layer of canonical knowledge and skill, 'that, which every professional should possess', independent of the context of practice. The second layer is context-dependent knowledge, skill, and attitude, visible through practice in health care. The third layer of personalised competence includes personal skills, interests, habits and convictions, integrated with one's personality. This layer, discussed with reference to Vygotsky's concept of Perezhivanie, cognitive load theory, self-determination theory and Maslow's 'self-actualisation', may be regarded as the art of medicine. We propose that fully matured professional competence requires all three layers, but that the assessment of each layer is different. IMPLICATIONS The assessment of canonical knowledge and skills (Layer 1) can be approached with classical psychometric conditions, that is, similar tests, circumstances and criteria for all. Context-dependent medical competence (Layer 2) must be assessed differently, because conditions of assessment across candidates cannot be standardised. Here, multiple sources of information must be merged and intersubjective expert agreement should ground decisions about progression and level of clinical autonomy of trainees. Competence as the art of medicine (Layer 3) cannot be standardised and should not be assessed with the purpose of permission to practice. The pursuit of personal excellence in this level, however, can be recognised and rewarded.
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Affiliation(s)
- Olle Ten Cate
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Richard L Cruess
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Stanley J Hamstra
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Yvonne Steinert
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Robert Sternszus
- Department of Pediatrics, Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
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24
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Tillotson CV, Becetti I, Hwu K, Page L, Krishnan S, Stafford D, Stanley T, Vuguin P, Barker JM. Pediatric Endocrinology Milestones 2.0-guide to their implementation. BMC MEDICAL EDUCATION 2023; 23:985. [PMID: 38124091 PMCID: PMC10734147 DOI: 10.1186/s12909-023-04862-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
Abstract
The Milestones were initiated by the Accreditation Council for Graduate Medical Education (ACGME) to provide a framework for monitoring a trainee's progression throughout residency/fellowship. The Milestones describe stepwise skill progression through six core domains of clinical competency: Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Practice-based Learning and Improvement, Professionalism, and Systems-based Practice. Since their introduction in 2013, several barriers to implementation have emerged. Thus, the ACGME launched the Milestones 2.0 project to develop updated specialty-specific milestones. The Pediatric Endocrinology Milestones 2.0 project aimed to improve upon Milestones 1.0 by addressing common limitations, providing resources for faculty to easily incorporate milestones into their assessment of trainees, and adding sub-competencies in health disparities, patient safety, and physician well-being.This paper reviews the development of the Pediatric Endocrinology Milestones 2.0 including the major changes from Milestones 1.0, development of the Supplemental Guide, and how Milestones 2.0 can be applied at the program level. Although use of the Milestones are required only for ACGME programs, the tools provided in Milestones 2.0 are applicable to fellowship programs worldwide.
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Affiliation(s)
- Cara V Tillotson
- Pediatric Endocrinology, New York Presbyterian - Columbia University Medical Center, 622 West 168th street, PH 17 West, Room 307, New York, NY, 10032, USA
| | - Imen Becetti
- Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine Hwu
- Pediatric Endocrinology, Baylor College of Medicine, Houston, TX, USA
| | - Laura Page
- Pediatric Endocrinology, Duke University School of Medicine, Durham, NC, USA
| | - Sowmya Krishnan
- Pediatric Endocrinology, The University of Texas Southwesteren Medical Center, Dallas, TX, USA
| | - Dianne Stafford
- Pediatric Endocrinology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Takara Stanley
- Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| | - Patricia Vuguin
- Pediatric Endocrinology, New York Presbyterian - Columbia University Medical Center, 622 West 168th street, PH 17 West, Room 307, New York, NY, 10032, USA
| | - Jennifer M Barker
- Pediatric Endocrinology, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
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25
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Gerken AT, Beckmann DL, Stoklosa JB, Vestal HS. Teaching to Teach Using Vulnerability: A Novel Approach to Clinician-Educator Programs for Trainees. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:672-675. [PMID: 37548857 DOI: 10.1007/s40596-023-01838-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
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26
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Somerville SG, Harrison NM, Lewis SA. Twelve tips for the pre-brief to promote psychological safety in simulation-based education. MEDICAL TEACHER 2023; 45:1349-1356. [PMID: 37210674 DOI: 10.1080/0142159x.2023.2214305] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
It is recognised that simulation-based education can be stressful, and this can impact negatively on learning. A fundamental aspect of facilitating simulation is creating a safe educational environment. Edmondson's seminal work on creating psychological safety among interpersonal teams has been embraced by the healthcare simulation community. Psychological safety is an underpinning philosophy for creating simulation experiences in which learners can develop within a stimulating and challenging yet supportive social atmosphere. Through careful design and thoughtful delivery, the introductory phase of simulation, the pre-briefing, can effectively prepare learners for simulation, reduce learner anxiety, and promote psychological safety, to enhance learning experiences. These twelve tips provide guidance for conducting a pre-brief and promoting a psychologically safe environment for simulation-based education.
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Affiliation(s)
| | - Neil Malcolm Harrison
- Clinical Skills Centre, Dundee Institute for Healthcare Simulation, School of Medicine, University of Dundee, Dundee, Scotland
| | - Steven Anthony Lewis
- Clinical Skills Centre, Dundee Institute for Healthcare Simulation, School of Medicine, University of Dundee, Dundee, Scotland
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27
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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. MEDICAL EDUCATION 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] [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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28
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Szulewski A, Braund H, Dagnone DJ, McEwen L, Dalgarno N, Schultz KW, Hall AK. The Assessment Burden in Competency-Based Medical Education: How Programs Are Adapting. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1261-1267. [PMID: 37343164 DOI: 10.1097/acm.0000000000005305] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Residents and faculty have described a burden of assessment related to the implementation of competency-based medical education (CBME), which may undermine its benefits. Although this concerning signal has been identified, little has been done to identify adaptations to address this problem. Grounded in an analysis of an early Canadian pan-institutional CBME adopter's experience, this article describes postgraduate programs' adaptations related to the challenges of assessment in CBME. From June 2019-September 2022, 8 residency programs underwent a standardized Rapid Evaluation guided by the Core Components Framework (CCF). Sixty interviews and 18 focus groups were held with invested partners. Transcripts were analyzed abductively using CCF, and ideal implementation was compared with enacted implementation. These findings were then shared back with program leaders, adaptations were subsequently developed, and technical reports were generated for each program. Researchers reviewed the technical reports to identify themes related to the burden of assessment with a subsequent focus on identifying adaptations across programs. Three themes were identified: (1) disparate mental models of assessment processes in CBME, (2) challenges in workplace-based assessment processes, and (3) challenges in performance review and decision making. Theme 1 included entrustment interpretation and lack of shared mindset for performance standards. Adaptations included revising entrustment scales, faculty development, and formalizing resident membership. Theme 2 involved direct observation, timeliness of assessment completion, and feedback quality. Adaptations included alternative assessment strategies beyond entrustable professional activity forms and proactive assessment planning. Theme 3 related to resident data monitoring and competence committee decision making. Adaptations included adding resident representatives to the competence committee and assessment platform enhancements. These adaptations represent responses to the concerning signal of significant burden of assessment within CBME being experienced broadly. The authors hope other programs may learn from their institution's experience and navigate the CBME-related assessment burden their invested partners may be facing.
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Affiliation(s)
- Adam Szulewski
- A. Szulewski is associate professor, Departments of Emergency Medicine and Psychology, and educational scholarship lead, Postgraduate Medical Education, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0002-3076-6221
| | - Heather Braund
- H. Braund is associate director of scholarship and simulation education, Office of Professional Development and Educational Scholarship, and assistant (adjunct) professor, Department of Biomedical and Molecular Sciences and School of Medicine, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0002-9749-7193
| | - Damon J Dagnone
- D.J. Dagnone is associate professor, Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0001-6963-7948
| | - Laura McEwen
- L. McEwen is director of assessment and evaluation of postgraduate medical education and assistant professor, Department of Pediatrics, Postgraduate Medical Education, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0003-2457-5311
| | - Nancy Dalgarno
- N. Dalgarno is director of education scholarship, Office of Professional Development and Educational Scholarship, and assistant professor (adjunct), Department of Biomedical and Molecular Sciences and Master of Health Professions Education, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0001-7932-9949
| | - Karen W Schultz
- K.W. Schultz is professor, Department of Family Medicine, and associate dean of postgraduate medical education, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0003-0208-3981
| | - Andrew K Hall
- A.K. Hall is associate professor and vice chair of education, Department of Emergency Medicine, University of Ottawa, and clinician educator, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada; ORCID: https://orcid.org/0000-0003-1227-5397
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29
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Sawicki JG, Richards BF, Schwartz A, Balmer D. Measuring the Learning Orientation Fostered by Pediatric Residency Programs With the Graduate Medical Education Learning Environment Inventory Instrument. Acad Pediatr 2023; 23:1288-1294. [PMID: 36997151 DOI: 10.1016/j.acap.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Mastery learning orientation, conceptualized as a growth mindset, can be beneficial to learners in medical education and is supported by a program...s learning environment. Currently, there are no instruments which reliably assess the learning orientation of a graduate medical education program...s learning environment. OBJECTIVE To explore the reliability and validity of the Graduate Medical Education Learning Environment Inventory (GME-LEI). METHODS Leaders of the Education in Pediatrics Across the Continuum (EPAC) project revised Krupat...s Educational Climate Inventory to create the GME-LEI. We investigated the GME-LEI...s reliability and validity through confirmatory factor and parallel factor analyses and calculated Cronbach...s alpha for each subscale. We compared mean subscale scores between residents in traditional programs and the EPAC project. As EPAC is known to foster a mastery-focused learning orientation, we hypothesized differences detected between resident groups would strengthen the instrument...s validity. RESULTS One hundred and twenty-seven pediatric residents completed the GME-LEI. The final 3-factor model was an acceptable fit to the data, and Cronbach...s alpha for each subscale was acceptable (Centrality: 0.87; Stress: 0.73; Support: 0.77). Mean scores on each subscale varied by program type (EPAC vs traditional) with EPAC residents reporting statistically significant higher scores in the Centrality of Learning subscale (2.03, SD 0.30, vs 1.79, SD 0.42; P.ß=.ß.023; scale of 1...4). CONCLUSIONS The GME-LEI reliably measures 3 distinct aspects of the GME learning environment with respect to learning orientation. The GME-LEI may be used to help programs better monitor the learning environment and make changes to support mastery-oriented learning.
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Affiliation(s)
- Jonathan G Sawicki
- Department of Pediatrics (JG Sawicki and BF Richards), University of Utah School of Medicine, Salt Lake City; Division of Pediatric Hospital Medicine (JG Sawicki), Primary Children...s Hospital.
| | - Boyd F Richards
- Department of Pediatrics (JG Sawicki and BF Richards), University of Utah School of Medicine, Salt Lake City.
| | - Alan Schwartz
- Department of Pediatrics (A Schwartz), University of Illinois College of Medicine.
| | - Dorene Balmer
- Department of Pediatrics (D Balmer), University of Pennsylvania School of Medicine.
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30
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Holmboe ES, Osman NY, Murphy CM, Kogan JR. The Urgency of Now: Rethinking and Improving Assessment Practices in Medical Education Programs. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S37-S49. [PMID: 37071705 DOI: 10.1097/acm.0000000000005251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Assessment is essential to professional development. Assessment provides the information needed to give feedback, support coaching and the creation of individualized learning plans, inform progress decisions, determine appropriate supervision levels, and, most importantly, help ensure patients and families receive high-quality, safe care in the training environment. While the introduction of competency-based medical education has catalyzed advances in assessment, much work remains to be done. First, becoming a physician (or other health professional) is primarily a developmental process, and assessment programs must be designed using a developmental and growth mindset. Second, medical education programs must have integrated programs of assessment that address the interconnected domains of implicit, explicit and structural bias. Third, improving programs of assessment will require a systems-thinking approach. In this paper, the authors first address these overarching issues as key principles that must be embraced so that training programs may optimize assessment to ensure all learners achieve desired medical education outcomes. The authors then explore specific needs in assessment and provide suggestions to improve assessment practices. This paper is by no means inclusive of all medical education assessment challenges or possible solutions. However, there is a wealth of current assessment research and practice that medical education programs can use to improve educational outcomes and help reduce the harmful effects of bias. The authors' goal is to help improve and guide innovation in assessment by catalyzing further conversations.
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Affiliation(s)
- Eric S Holmboe
- E.S. Holmboe is chief, Research, Milestones Development and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-0108-6021
| | - Nora Y Osman
- N.Y. Osman is associate professor of medicine, Harvard Medical School, and director of undergraduate medical education, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts; ORCID: https://orcid.org/0000-0003-3542-1262
| | - Christina M Murphy
- C.M. Murphy is a fourth-year medical student and president, Medical Student Government at Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-3966-5264
| | - Jennifer R Kogan
- J.R. Kogan is associate dean, Student Success and Professional Development, and professor of medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0001-8426-9506
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31
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Kinnear B, Santen SA, Kelleher M, Martini A, Ferris S, Edje L, Warm EJ, Schumacher DJ. How Does TIMELESS Training Impact Resident Motivation for Learning, Assessment, and Feedback? Evaluating a Competency-Based Time-Variable Training Pilot. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:828-835. [PMID: 36656286 DOI: 10.1097/acm.0000000000005147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE As competency-based medical education has become the predominant graduate medical education training model, interest in time-variable training has grown. Despite multiple competency-based time-variable training (CBTVT) pilots ongoing in the United States, little is known about how this training approach impacts learners. The authors aim to explore how their CBTVT pilot program impacted resident motivation for learning, assessment, and feedback. METHOD The authors performed a qualitative educational case study on the Transitioning in Internal Medicine Education Leveraging Entrustment Scores Synthesis (TIMELESS) program at the University of Cincinnati from October 2020 through March 2022. Semistructured interviews were conducted with TIMELESS residents (n = 9) approximately every 6 months to capture experiences over time. The authors used inductive thematic analysis to develop themes and compared their findings with existing theories of learner motivation. RESULTS The authors developed 2 themes: TIMELESS had variable effects on residents' motivation for learning and TIMELESS increased resident engagement with and awareness of the program of assessment. Participants reported increased motivation to learn and seek assessment, though some felt a tension between performance (e.g., advancement through the residency program) and growth (e.g., improvement as a physician). Participants became more aware of the quality of assessments they received, in part due to TIMELESS increasing the perceived stakes of assessment, and reported being more deliberate when assessing other residents. CONCLUSIONS Resident motivation for learning, assessment, and feedback was impacted in ways that the authors contextualize using current theories of learner motivation (i.e., goal orientation theory and attribution theory). Future research should investigate how interventions, such as coaching, guided learner reflection, or various CBTVT implementation strategies, can help keep learners oriented toward mastery learning rather than toward performance.
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Affiliation(s)
- Benjamin Kinnear
- B. Kinnear is associate professor of internal medicine and pediatrics, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0003-0052-4130
| | - Sally A Santen
- S.A. Santen is professor of emergency medicine, Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, and University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-8327-8002
| | - Matthew Kelleher
- M. Kelleher is assistant professor of internal medicine and pediatrics, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6400-1745
| | - Abigail Martini
- A. Martini is a clinical research coordinator with emergency medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sarah Ferris
- S. Ferris is a research administrator, Clinical Trials Unit, Michigan Medicine Research, University of Michigan, Ann Arbor, Michigan
| | - Louito Edje
- L. Edje is professor of family and community medicine, Departments of Medical Education and of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Eric J Warm
- E.J. Warm is professor of internal medicine and program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6088-2434
| | - Daniel J Schumacher
- D.J. Schumacher is professor of pediatrics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0001-5507-8452
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Williams SR, Sebok-Syer SS, Caretta-Weyer H, Katznelson L, Dohn AM, Park YS, Gisondi MA, Tekian A. Patient handoffs and multi-specialty trainee perspectives across an institution: informing recommendations for health systems and an expanded conceptual framework for handoffs. BMC MEDICAL EDUCATION 2023; 23:434. [PMID: 37312085 PMCID: PMC10262514 DOI: 10.1186/s12909-023-04355-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/12/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Safe and effective physician-to-physician patient handoffs are integral to patient safety. Unfortunately, poor handoffs continue to be a major cause of medical errors. Developing a better understanding of challenges faced by health care providers is critical to address this continued patient safety threat. This study addresses the gap in the literature exploring broad, cross-specialty trainee perspectives around handoffs and provides a set of trainee-informed recommendations for both training programs and institutions. METHODS Using a constructivist paradigm, the authors conducted a concurrent/embedded mixed method study to investigate trainees' experiences with patient handoffs across Stanford University Hospital, a large academic medical center. The authors designed and administered a survey instrument including Likert-style and open-ended questions to solicit information about trainee experiences from multiple specialties. The authors performed a thematic analysis of open-ended responses. RESULTS 687/1138 (60.4%) of residents and fellows responded to the survey, representing 46 training programs and over 30 specialties. There was wide variability in handoff content and process, most notably code status not being consistently mentioned a third of the time for patients who were not full code. Supervision and feedback about handoffs were inconsistently provided. Trainees identified multiple health-systems level issues that complicated handoffs and suggested solutions to these threats. Our thematic analysis identified five important aspects of handoffs: (1) handoff elements, (2) health-systems-level factors, (3) impact of the handoff, (4) agency (duty), and (5) blame and shame. CONCLUSIONS Health systems, interpersonal, and intrapersonal issues affect handoff communication. The authors propose an expanded theoretical framework for effective patient handoffs and provide a set of trainee-informed recommendations for training programs and sponsoring institutions. Cultural and health-systems issues must be prioritized and addressed, as an undercurrent of blame and shame permeates the clinical environment.
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Affiliation(s)
- Sarah R Williams
- Department of Emergency Medicine, Stanford University School of Medicine, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, USA.
| | - Stefanie S Sebok-Syer
- Department of Emergency Medicine, Stanford University School of Medicine, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, USA
| | - Holly Caretta-Weyer
- Department of Emergency Medicine, Stanford University School of Medicine, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, USA
| | - Laurence Katznelson
- Departments of Neurosurgery and Medicine, Stanford University School of Medicine, Stanford, USA
- Graduate Medical Education, Stanford University School of Medicine and Stanford Health Care, Stanford, USA
| | - Ann M Dohn
- Graduate Medical Education, Stanford University School of Medicine and Stanford Health Care, Stanford, USA
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, USA
| | - Michael A Gisondi
- Department of Emergency Medicine, Stanford University School of Medicine, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, USA
| | - Ara Tekian
- Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, USA
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Guttin T, McKay T, Light TP, Wise LN, Baillie S. Growth Mindset in Veterinary Educators: An International Survey. JOURNAL OF VETERINARY MEDICAL EDUCATION 2023:e20220128. [PMID: 37229549 DOI: 10.3138/jvme-2022-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Carol Dweck's mindset theory describes whether an individual believes that attributes, like intelligence or morality, can be honed (growth mindset) or are innate (fixed mindset). An educator's mindset impacts their approach to teaching, students' learning, participation in faculty development, and wellbeing. Mindset can affect faculty members' openness to curricular change, making the study of veterinary educator mindset timely and salient, as competency-based education is spurring curricular change worldwide. The purpose of this study was to examine the mindsets of veterinary educators internationally. A survey, consisting of demographic questions and mindset items (based on previously published scales), was distributed electronically to veterinary educators internationally, at universities where English is the primary instruction medium. Mindset was evaluated for the following traits: intelligence, clinical reasoning, compassion, and morality. Scale validation, descriptive statistics, and associations to demographic variables were evaluated. Four hundred and forty-six complete surveys were received. Overall, the study population demonstrated predominantly growth mindsets for all traits, higher than population averages, with some variation by trait. There was a small effect on years teaching towards growth mindset. No other associations were found. Veterinary educators internationally who participated in this study demonstrated higher rates of growth mindset than the general population. In other fields, a growth mindset in educators has had implications for faculty wellbeing, teaching and assessment practices, participation in faculty development, and openness to curricular change. Further research is needed in veterinary education to evaluate the implications of these high rates of growth mindset.
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Affiliation(s)
- Talia Guttin
- St. George's University School of Veterinary Medicine, True Blue, Grenada, West Indies
| | - Todd McKay
- Department of Educational Services at St. George's University, True Blue, Grenada, West Indies
| | - Tracy Penny Light
- Department of Educational Services at St. George's University, True Blue, Grenada, West Indies
| | - Lauren Nicki Wise
- St. George's University School of Veterinary Medicine, True Blue, Grenada, West Indies
| | - Sarah Baillie
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol BS40 5DU UK
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Schafer KR, Sood L, King CJ, Alexandraki I, Aronowitz P, Cohen M, Chretien K, Pahwa A, Shen E, Williams D, Hauer KE. The Grade Debate: Evidence, Knowledge Gaps, and Perspectives on Clerkship Assessment Across the UME to GME Continuum. Am J Med 2023; 136:394-398. [PMID: 36632923 DOI: 10.1016/j.amjmed.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/03/2023] [Indexed: 01/10/2023]
Affiliation(s)
- Katherine R Schafer
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Lonika Sood
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Christopher J King
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
| | | | | | - Margot Cohen
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Amit Pahwa
- Johns Hopkins University School of Medicine, Baltimore, Md
| | - E Shen
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Donna Williams
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
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Santen SA, Hemphill RR. Embracing our responsibility to ensure trainee competency. AEM EDUCATION AND TRAINING 2023; 7:e10863. [PMID: 37013132 PMCID: PMC10066499 DOI: 10.1002/aet2.10863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Sally A. Santen
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Virginia Commonwealth University School of MedicineRichmondVirginiaUSA
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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. MEDICAL TEACHER 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] [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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Waters HM, Oswald A, Constantin E, Thoma B, Dagnone JD. Physician Humanism in CanMEDS 2025. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:13-17. [PMID: 36998505 PMCID: PMC10042789 DOI: 10.36834/cmej.75536] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Heather M Waters
- Department of Family Medicine, McMaster University, Ontario, Canada
| | - Anna Oswald
- Department of Medicine, University of Alberta, Alberta, Canada
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
| | | | - Brent Thoma
- University of Saskatchewan, Saskatchewan, Canada
| | - J Damon Dagnone
- Department of Emergency Medicine, Queen’s University, Ontario, Canada
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Hall J, Atkinson A, Chan MK, Tourian L, Thoma B, Pattani R. The Clinical Learning Environment in CanMEDS 2025. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:41-45. [PMID: 36998502 PMCID: PMC10042790 DOI: 10.36834/cmej.75537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Jena Hall
- University of Calgary, Alberta, Canada
| | | | | | | | - Brent Thoma
- University of Saskatchewan, Saskatchewan, Canada
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Toubassi D, Schenker C, Roberts M, Forte M. Professional identity formation: linking meaning to well-being. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:305-318. [PMID: 35913664 PMCID: PMC9341156 DOI: 10.1007/s10459-022-10146-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
Trainee distress and burnout continue to be serious concerns for educational programs in medicine, prompting the implementation of numerous interventions. Although an expansive body of literature suggests that the experience of meaning at work is critical to professional wellbeing, relatively little attention has been paid to how this might be leveraged in the educational milieu. We propose that professional identity formation (PIF), the process by which trainees come to not only attain competence, but additionally to "think, act and feel" like physicians, affords us a unique opportunity to ground trainees in the meaningfulness of their work. Using the widely accepted tri-partite model of meaning, we outline how this process can contribute to wellbeing. We suggest strategies to optimize the influence of PIF on wellbeing, offering curricular suggestions, as well as ideas regarding the respective roles of communities of practice, teachers, and formative educational experiences. Collectively, these encourage trainees to act as intentional agents in the making of their novel professional selves, anchoring them to the meaningfulness of their work, and supporting their short and long-term wellbeing.
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Affiliation(s)
- Diana Toubassi
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
- University Health Network - Toronto Western FHT, 440 Bathurst Street - Suite 300, Toronto, ON, M5T 2S6, Canada.
| | - Carly Schenker
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Roberts
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Milena Forte
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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A Novel Framework for Routine Versus Critical Communication in Surgical Education-Don't Take It Personally. J Am Acad Orthop Surg 2023; 31:115-121. [PMID: 36656272 DOI: 10.5435/jaaos-d-22-00912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/11/2022] [Indexed: 01/20/2023] Open
Abstract
Despite their impressive academic track records and mastery of controlled classroom-based didactic learning, many orthopaedic surgery residents struggle to adjust from learning in the classroom environment in medical school to learning in the operating room as surgical residents. Instead of learning in lectures, surgical residents take on a more apprenticeship-based role with the goal of mastering technical skills in an experiential learning environment. Yet, no framework has been explicitly described in the literature to help learners make this transition. Consequently, we feel there is a need to clearly define the different learning environments and modes of communication, such that the residents can better understand how information is acquired and retained as well as how feedback is delivered in the operating room compared with more traditional spaces (eg, medical school classroom). The objectives of this summary are to (1) identify the major differences between learning in the classroom environment and the operating room and (2) introduce the concept of routine versus critical communication. We hope that by better defining the new learning environment with an emphasis on communication styles that may be encountered in this setting, learners can more easily make the transition from high-performing academicians to high-performing surgeons.
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Hauer KE, Williams PM, Byerley JS, Swails JL, Barone MA. Blue Skies With Clouds: Envisioning the Future Ideal State and Identifying Ongoing Tensions in the UME-GME Transition. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:162-170. [PMID: 35947473 DOI: 10.1097/acm.0000000000004920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The transition from medical school to residency in the United States consumes large amounts of time for students and educators in undergraduate and graduate medical education (UME, GME), and it is costly for both students and institutions. Attempts to improve the residency application and Match processes have been insufficient to counteract the very large number of applications to programs. To address these challenges, the Coalition for Physician Accountability charged the Undergraduate Medical Education to Graduate Medical Education Review Committee (UGRC) with crafting recommendations to improve the system for the UME-GME transition. To guide this work, the UGRC defined and sought stakeholder input on a "blue-skies" ideal state of this transition. The ideal state views the transition as a system to support a continuum of professional development and learning, thus serving learners, educators, and the public, and engendering trust among them. It also supports the well-being of learners and educators, promotes diversity, and minimizes bias. This manuscript uses polarity thinking to analyze 3 persistent key tensions in the system that require ongoing management. First, the formative purpose of assessment for learning and growth is at odds with the use of assessment data for ranking and sorting candidates. Second, the function of residents as learners can conflict with their role as workers contributing service to health care systems. Third, the current residency Match process can position the desire for individual choice-among students and their programs-against the workforce needs of the profession and the public. This Scholarly Perspective presents strategies to balance the upsides and downsides inherent to these tensions. By articulating the ideal state of the UME-GME transition and anticipating tensions, educators and educational organizations can be better positioned to implement UGRC recommendations to improve the transition system.
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Affiliation(s)
- Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-8812-4045
| | - Pamela M Williams
- P.M. Williams is associate dean for student affairs and professor, Department of Family Medicine, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, Maryland
| | - Julie S Byerley
- J.S. Byerley was interim dean, University of North Carolina Adams School of Dentistry, and professor of pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, at the time of writing and is now president and dean, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Jennifer L Swails
- J.L. Swails is residency program director, codirector of interprofessional education, and associate professor, Department of Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas; ORCID: http://orcid.org/0000-0002-6102-831X
| | - Michael A Barone
- M.A. Barone is vice president, competency-based assessment, NBME, Philadelphia, Pennsylvania, and adjunct associate professor of pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: http://orcid.org/0000-0002-4724-784X
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Swails JL, Angus S, Barone MA, Bienstock J, Burk-Rafel J, Roett MA, Hauer KE. The Undergraduate to Graduate Medical Education Transition as a Systems Problem: A Root Cause Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:180-187. [PMID: 36538695 DOI: 10.1097/acm.0000000000005065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The transition from undergraduate medical education (UME) to graduate medical education (GME) constitutes a complex system with important implications for learner progression and patient safety. The transition is currently dysfunctional, requiring students and residency programs to spend significant time, money, and energy on the process. Applications and interviews continue to increase despite stable match rates. Although many in the medical community acknowledge the problems with the UME-GME transition and learners have called for prompt action to address these concerns, the underlying causes are complex and have defied easy fixes. This article describes the work of the Coalition for Physician Accountability's Undergraduate Medical Education to Graduate Medical Education Review Committee (UGRC) to apply a quality improvement approach and systems thinking to explore the underlying causes of dysfunction in the UME-GME transition. The UGRC performed a root cause analysis using the 5 whys and an Ishikawa (or fishbone) diagram to deeply explore problems in the UME-GME transition. The root causes of problems identified include culture, costs and limited resources, bias, systems, lack of standards, and lack of alignment. Using the principles of systems thinking (components, connections, and purpose), the UGRC considered interactions among the root causes and developed recommendations to improve the UME-GME transition. Several of the UGRC's recommendations stemming from this work are explained. Sustained monitoring will be necessary to ensure interventions move the process forward to better serve applicants, programs, and the public good.
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Affiliation(s)
- Jennifer L Swails
- J.L. Swails is residency program director, codirector of interprofessional education, and associate professor, Department of Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas; ORCID: http://orcid.org/0000-0002-6102-831X
| | - Steven Angus
- S. Angus is designated institutional official, vice-chair for education, and professor, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Michael A Barone
- M.A. Barone is vice president of competency-based assessment, NBME, Philadelphia, Pennsylvania, and adjunct associate professor of pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica Bienstock
- J. Bienstock is professor of gynecology and obstetrics, associate dean for graduate medical education, and designated institutional official, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jesse Burk-Rafel
- J. Burk-Rafel is assistant professor of medicine and assistant director of UME-GME innovation, Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, New York
| | - Michelle A Roett
- M.A. Roett is professor and chair, Department of Family Medicine, Georgetown University Medicine Center, and clinical chief of family medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
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Puri A, Memari M, Sottile EM, Snydman LK, Lee WW, Bonnema RA, Jones D, Nandiwada DR. Changing the Assessment Paradigm: Promoting a Growth Mindset Across the Medical Education Continuum. Am J Med 2023; 136:207-212. [PMID: 36441037 DOI: 10.1016/j.amjmed.2022.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/18/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Aditi Puri
- Department of Internal Medicine, MacNeal Hospital, Loyola University Health System, North Riverside, Ill.
| | - Milad Memari
- Division of General Internal Medicine University of Pittsburgh Medical Center, Pa
| | - Elisa M Sottile
- Division of General Internal Medicine, University of Florida College of Medicine - Jacksonville
| | - Laura K Snydman
- Division of General Internal Medicine, Tufts Medical Center, Boston, Mass
| | - Wei Wei Lee
- Section of General Internal Medicine, University of Chicago Pritzker School of Medicine, Ill
| | - Rachel A Bonnema
- Division of General Internal Medicine, University of Texas Southwestern School of Medicine, Dallas
| | - Danielle Jones
- Division of General Internal Medicine, Emory University of Medicine, Atlanta, Ga
| | - D Rani Nandiwada
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
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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. PERSPECTIVES ON MEDICAL EDUCATION 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] [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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Dace W, Purdy E, Brazil V. Wearing hats and blending boundaries: harmonising professional identities for clinician simulation educators. Adv Simul (Lond) 2022; 7:35. [PMID: 36303245 PMCID: PMC9615167 DOI: 10.1186/s41077-022-00229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
Many clinicians working in healthcare simulation struggle with competing dual identities of clinician and educator, whilst those who harmonise these identities are observed to be highly effective teachers and clinicians. Professional identity formation (PIF) theories offer a conceptual framework for considering this dilemma. However, many clinician simulation educators lack practical guidance for translating these theories and are unable to develop or align their dual identities. An unusual experience involving the first author’s suspension of disbelief as a simulation facilitator sparked a novel reflection on his dual identity as a clinician and as a simulation educator. He re-framed his clinician and simulation ‘hats’ as cooperative and fluid rather than competing and compartmentalised. He recognised that these dual identities could flow between clinical and simulation environments through leaky ‘blended boundaries’ rather than being restricted by environmental demarcations. This personal story is shared and reflected upon to offer a practical ‘hats and boundaries’ model. Experimenting with the model in both clinical and simulation workplaces presents opportunities for PIF and alignment of dual identities. The model may help other clinician simulation educators navigate the complexities of merging their dual identities.
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Affiliation(s)
- William Dace
- Gold Coast University Hospital Emergency Department, Southport, Queensland, Australia.
| | - Eve Purdy
- Gold Coast University Hospital Emergency Department, Southport, Queensland, Australia.,Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Victoria Brazil
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
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Mindfulness–based positive transformative leadership development for health organisations. Leadersh Health Serv (Bradf Engl) 2022. [DOI: 10.1108/lhs-04-2022-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Positive transformative leadership development practices in health care are perhaps the most important pathway that, collectively, can be pursued while heading towards a post-corona virus disease 2019 world, and race towards 2030. As a practitioner paper, based on front line and leadership experience, this study aims to argue that we need transformational leaders who will go beyond knowing to practice and implementation. While the findings from research is presented from different organisations and companies, they all have something in common – people. Hence, important lessons can be extrapolated to health-related organisations in the future.
Design/methodology/approach
The approach is based on practical research findings based on the literature. The approach uses real practical examples from companies and organisations to demonstrate the need for a new, radical way forward.
Findings
The findings from the literature clearly indicate that mindfulness-based transformative leadership development program is a worthwhile investment for decision-makers and organisations. A new transformative leader for the future of health care needs to be developed with care with investment in that development.
Research limitations/implications
Implications of this paper show that health-care organisations need to begin this journey. There is a paucity in the literature to demonstrate the implementation of mindfulness-based transformative leadership development programs.
Practical implications
Organisations of the future face even greater challenges brought about by intelligent technology, new pandemics and even tighter government regulation. The time to prepare for such eventualities is now. This is not a choice but an imperative for organisations to know what to do rather than react with regret.
Originality/value
There is a paucity in the health-care literature that tracks, measures, and reports on the long-term results of a mindfulness-based transformative leadership development program. This needs to be addressed, and health care should be a leader in the field of mindfulness and transformative leadership of the future.
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Pincavage AT, Osman NY, Alexandraki I, Ismail NJ, Levine DL, Onumah CM, Lai CJ. AAIM Recommendations to Promote Equity in the Clerkship Clinical Learning Environment. Am J Med 2022; 135:1021-1028. [PMID: 35504324 DOI: 10.1016/j.amjmed.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Nora Y Osman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Irene Alexandraki
- Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso
| | - Nadia J Ismail
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Diane L Levine
- Department of Medicine, Wayne State University School of Medicine, Detroit, Mich
| | - Chavon M Onumah
- Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Cindy J Lai
- Department of Medicine, University of California, San Francisco, School of Medicine
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Kealey A, Naik VN. Competency-Based Medical Training in Anesthesiology: Has It Delivered on the Promise of Better Education? Anesth Analg 2022; 135:223-229. [PMID: 35839492 DOI: 10.1213/ane.0000000000006091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Alayne Kealey
- From the Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Viren N Naik
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Chan TM, Dowling S, Tastad K, Chin A, Thoma B. Integrating training, practice, and reflection within a new model for Canadian medical licensure: a concept paper prepared for the Medical Council of Canada. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:68-81. [PMID: 36091730 PMCID: PMC9441128 DOI: 10.36834/cmej.73717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In 2020 the Medical Council of Canada created a task force to make recommendations on the modernization of its practices for granting licensure to medical trainees. This task force solicited papers on this topic from subject matter experts. As outlined within this Concept Paper, our proposal would shift licensure away from the traditional focus on high-stakes summative exams in a way that integrates training, clinical practice, and reflection. Specifically, we propose a model of graduated licensure that would have three stages including: a trainee license for trainees that have demonstrated adequate medical knowledge to begin training as a closely supervised resident, a transition to practice license for trainees that have compiled a reflective educational portfolio demonstrating the clinical competence required to begin independent practice with limitations and support, and a fully independent license for unsupervised practice for attendings that have demonstrated competence through a reflective portfolio of clinical analytics. This proposal was reviewed by a diverse group of 30 trainees, practitioners, and administrators in medical education. Their feedback was analyzed and summarized to provide an overview of the likely reception that this proposal would receive from the medical education community.
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Affiliation(s)
- Teresa M Chan
- Division of Emergency Medicine, Department of Medicine, Faculty of Health Sciences, McMaster University
- Division of Education & Innovation, Department of Medicine
- Faculty of Health Sciences, McMaster University; McMaster Education Research, Innovation, and Theory (MERIT) program
- Office of Continuing Professional Development; Faculty of Health Sciences, McMaster University
| | - Shawn Dowling
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary
| | - Kara Tastad
- Royal College Emergency Medicine Training Program, University of Toronto
| | - Alvin Chin
- Division of Emergency Medicine, Department of Medicine, Faculty of Health Sciences, McMaster University
| | - Brent Thoma
- Department of Emergency Medicine, University of Saskatchewan
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Swails JL, Gadgil MA, Goodrum H, Gupta R, Rahbar MH, Bernstam EV. Role of faculty characteristics in failing to fail in clinical clerkships. MEDICAL EDUCATION 2022; 56:634-640. [PMID: 34983083 DOI: 10.1111/medu.14725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In the context of competency-based medical education, poor student performance must be accurately documented to allow learners to improve and to protect the public. However, faculty may be reluctant to provide evaluations that could be perceived as negative, and clerkship directors report that some students pass who should have failed. Student perception of faculty may be considered in faculty promotion, teaching awards, and leadership positions. Therefore, faculty of lower academic rank may perceive themselves to be more vulnerable and, therefore, be less likely to document poor student performance. This study investigated faculty characteristics associated with low performance evaluations (LPEs). METHOD The authors analysed individual faculty evaluations of medical students who completed the third-year clerkships over 15 years using a generalised mixed regression model to assess the association of evaluator academic rank with likelihood of an LPE. Other available factors related to experience or academic vulnerability were incorporated including faculty age, race, ethnicity, and gender. RESULTS The authors identified 50 120 evaluations by 585 faculty on 3447 students between January 2007 and April 2021. Faculty were more likely to give LPEs at the midpoint (4.9%), compared with the final (1.6%), evaluation (odds ratio [OR] = 4.004, 95% confidence interval [CI] [3.59, 4.53]; p < 0.001). The likelihood of LPE decreased significantly during the 15-year study period (OR = 0.94 [0.90, 0.97]; p < 0.01). Full professors were significantly more likely to give an LPE than assistant professors (OR = 1.62 [1.08, 2.43]; p = 0.02). Women were more likely to give LPEs than men (OR = 1.88 [1.37, 2.58]; p 0.01). Other faculty characteristics including race and experience were not associated with LPE. CONCLUSIONS The number of LPEs decreased over time, and senior faculty were more likely to document poor medical student performance compared with assistant professors.
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Affiliation(s)
- Jennifer L Swails
- Department of Internal Medicine, Mc Govern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Meghana A Gadgil
- Division of Hospital Medicine, San Francisco General Hospital, San Francisco, California, USA
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Heath Goodrum
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Resmi Gupta
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, Houston, Texas, USA
| | - Mohammad H Rahbar
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, Houston, Texas, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elmer V Bernstam
- Department of Internal Medicine, Mc Govern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
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