A Content Analysis of the ACGME Specialty Milestones to Identify Performance Indicators Pertaining to the Development of Residents as Educators

The More Things Change, the More They Stay the Same: Residents Perspectives on Learning to Teach Over 7 Years

Despite increasing emphasis on the development and implementation of Residents-as-Teachers programs, resident perspectives on their roles as teachers have rarely been explored. This paper explores trends across 7 years of data collected from resident leaders across North American orthopaedic residency programs.

Methods

Data were collected during the American Orthopaedic Association's resident-only engagement activity known as the C. McCollister Evarts Resident Leadership Forum (RLF). A total of 997 of 1,050 RLF participants responded from 2015 to 2021.

Results

Residents perceived themselves as having a strong influence on medical students' education more so than any other teacher. However, less than one third are provided with any formal instruction from their institutions to support their teaching, and nearly 3 quarters of participants felt there was room for improvement in their teaching effectiveness. For the most part, resident perspectives have stayed relatively consistent over time.

Discussion

Residents are keen and willing to invest time into developing their teaching effectiveness. There may be a need for improved advocacy to program directors to increase the presence and availability of formal Residents-as-Teachers programs to support residents in their roles as teachers. We offer suggestions for the composition of such programs for consideration.

Resident-teaching of ethics in undergraduate medical education: a grounded theory analysis

Background

In graduate medical education, teaching is a required subcompetency largely fulfilled via clinical teaching, journal clubs, and grand rounds. Evidence shows that when moving to undergraduate teaching, residents often face a steep learning curve. We aimed to assess residents' perspective of the experience of teaching medical students.

Methods

Psychiatry residents taught small group sections of bioethics to first- and second-year medical students in December 2018. We conducted two 1-hour focus group interviews with four residents on their perspectives on the teaching experience.

Results

Resident-teachers described receiving certain benefits from teaching, such as meeting their altruistic desire to give back to the profession. Nonetheless, some participants felt frustrated by students' varying engagement and respect, while also feeling insecure and intimidated. Resident-teachers experienced some of the medical students as disrespectful and limited in their appreciation for diversity and the profession of medicine and perceived the students' disengagement and lessened professionalism.

Conclusion

As residency programs seek to implement initiatives to improve teaching skills of residents, resident experiences should be considered when implementing these initiatives.

Rheumatology Milestones 2.0: A Roadmap for Competency-Based Medical Training of Rheumatology Fellows in the 21st Century

OBJECTIVE

Since 2014, rheumatology fellows have been assessed not only based on their ability to provide patient care and possession of medical knowledge but also on their skill in serving as patient advocates, navigators of health systems, and members of a health care team. Such assessments have been carried out through the use of competency-based milestones from the Accreditation Council of Graduate Medical Education (ACGME). However, a needs assessment has demonstrated interest in more context validity and subspecialty relevance since the development of the ACGME internal medicine (IM) subspecialty reporting milestones. The ACGME thus created a milestones working group, and the present study was undertaken to develop Rheumatology Milestones 2.0 as well as a supplemental guide to assist with implementation.

METHODS

The working group, consisting of 7 rheumatology program directors, 2 division directors, a community practice rheumatologist, a rheumatology fellow in training, and a public member who is a rheumatology patient, was overseen by the ACGME vice president for milestones development and met through three 12-hour, in-person meetings to compose the rheumatology specialty milestones and supplemental guide within the ACGME Milestones 2.0 project.

RESULTS

Informed by the needs assessment data and stakeholders, the working group revised and adapted the ACGME IM subspecialty reporting milestones to create a rheumatology-specific set of milestones and a supplemental guide for their implementation.

CONCLUSION

The Rheumatology Milestones 2.0 provides a specialty-specific, competency-based evaluation tool that can be used by program directors, clinical competency committees, and others to assess the competencies of rheumatology fellows during training and help measure readiness for independent practice.

Efficacy of a resident-as-teacher program (RATP) for general surgery residents: An evaluation of 3 Years of implementation

BACKGROUND

Teaching is a responsibility of general surgery residents and formal teaching instruction is mandated. This study examines the efficacy of a formal RATP incorporated into our general surgery residency curriculum.

METHODS

The RATP was developed locally and delivered longitudinally over the course of the academic year, starting in 2017. Self-assessment surveys were distributed to residents before and after completion of the program each academic year. Medical students were surveyed regarding their impression of teaching on the surgical clerkship.

RESULTS

RATP data was collected annually. All sessions were highly rated. Residents reported improved teaching self-efficacy after participation. Medical student agreement with the statement 'Residents provided effective teaching during the [surgery] clerkship' increased from 68.6% prior to RATP implementation to 79.7% in the following years (p < 0.05).

CONCLUSIONS

Incorporation of a locally developed RATP improved residents' self-perceptions and medical student perception of residents as teachers. RATPs should be adopted widely.

The Distinguished Teaching Society at the Johns Hopkins University School of Medicine: A Student-Led Initiative to Recognize Clinical Educators

PROBLEM

Some focus on recognizing excellence in clinical teaching has been lost with the increasing emphasis placed on clinical efficiency and value. Clinical teaching awards and academies of educators aim to address this problem. In 2015, medical student leaders at the Johns Hopkins University School of Medicine created the Distinguished Teaching Society (DTS), a student-driven program to recognize the best clinical educators.

APPROACH

Medical students designed a comprehensive scoring rubric focusing on 3 domains: feedback and evaluation, role model behavior, and teaching process. A student committee solicits student nominations providing narratives endorsing faculty or house staff for potential inclusion in the DTS. Using the rubric, student judges score each deidentified narrative nomination, as well as an application from finalists and comments about finalists submitted by the student body. Inductees are recognized at an annual ceremony.

OUTCOMES

From academic years 2015-2016 to 2018-2019, students nominated 254 unique candidates, and 82 nominees (32%) were inducted into the DTS. The majority of inductees were faculty and male. In 2017-2018 and 2018-2019, nearly half of inductees were female, and less than 10% of inductees self-reported as underrepresented in medicine and/or LGBTQ+. The Department of Internal Medicine had the greatest departmental representation. There were no statistically significant differences in the proportional representation within the nomination and inductee cohorts by gender, rank, and department. Several process changes were made in response to student feedback and to increase nominee and inductee diversity.

NEXT STEPS

Next steps include adding a diversity and inclusion chair to the student committee and collecting survey data on student and DTS inductee opinions on how to improve learner-teacher engagement and the clinical learning environment. Future activities may include educational workshops, panel discussions, mentorship programs, and networking events. Other medical schools may find value in considering similar structures.

Competency-based medical education for the clinician-educator: the coming of Milestones version 2

Competency-based medical education is emphasized by institutions overseeing medical school and postgraduate training worldwide. The high rate of preventable errors in medicine underscores this need. Expanding physician competency beyond the domains of patient care and medical knowledge towards goals that emphasize a more holistic view of the healthcare system is one aspect of this emphasis. The Accreditation Council on Graduate Medical Education (ACGME), which oversees postgraduate training programs in the USA, has recently expanded to oversee training programs internationally. The original ACGME Milestones effort unveiled in 2013 was met with skepticism. Nevertheless, other outcomes-based education programs worldwide, including the CanMEDS framework (Canada), Tomorrow's Doctor (UK), and Scottish Doctor (Scotland), have suggested that milestones do offer advantages. Missing from the milestone rollout, however, was collaborative buy-in from multiple stakeholders such as from clinician-educators. Consequently, Milestones version 2 is in development. Specifically, these will address the need for specialty-specific milestones, and the usage of harmonized milestones. A concise history of the push towards outcomes-based medical education is presented and contextualized for physicians who must embrace the transition from teacher-based to learner-based outcomes.