1
|
Schneider AR, Sharma T, Bhattacharya A, Brown A. Exploring the relationship between social accountability and competency-based medical education: A narrative review. MEDICAL TEACHER 2022; 44:1283-1289. [PMID: 35793268 DOI: 10.1080/0142159x.2022.2093702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Social accountability (SA), a quintessential goal of medical education, has been discussed as a precipitant for the transition toward competency-based medical education (CBME). However, the relationship between SA and CBME remains unclear. A narrative review was conducted to systematically explore the relationship between SA and CBME as described in the literature. METHODS Electronic databases, select journals, and medical education organizations were systematically searched. 363 titles and abstracts were screened and 147 full texts were reviewed. The salient text was extracted from 36 records, which were then inductively coded before narrative synthesis and interpretation. RESULTS The relationship between SA and CBME was described in three manners: (1) CBME as a natural driver of SA where CBME was perceived to be inherently socially accountable, (2) CBME as an opportunistic mechanism for actively changing medical training to better meet standards of SA, and (3) CBME as a tool to measure SA relating to measurable outcomes data provided by CBME. CONCLUSION CBME has theoretical potential to assist programs in becoming more socially accountable if the communities they serve are considered key stakeholders in the design, implementation, and evaluation. A paucity of evidence remains which provides empirical evidence of SA within programs that have implemented CBME.
Collapse
Affiliation(s)
| | - Tejeswin Sharma
- Cumming School of Medicine-Undergraduate Medical Education, University of Calgary, Calgary, Canada
| | - Anindita Bhattacharya
- Cumming School of Medicine-Undergraduate Medical Education, University of Calgary, Calgary, Canada
| | - Allison Brown
- Department of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| |
Collapse
|
2
|
Gisondi MA, Branzetti J, Hopson LR, Regan L. Sustainable Engaged Accountable Learners. AEM EDUCATION AND TRAINING 2021; 5:e10470. [PMID: 33842802 PMCID: PMC8019149 DOI: 10.1002/aet2.10470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 06/12/2023]
Abstract
The development of lifelong learners is among the most challenging goals for medical educators. The authors identify two important scholarly works that profoundly altered their understanding and approach to lifelong learning and curriculum design: L. Dee Fink's Taxonomy of Significant Learning and Cutrer et al.'s Master Adaptive Learner model. By applying these guides to their teaching and related research, three important characteristics of lifelong learning became evident: sustainability, engagement, and accountability. These are abbreviated "SEALs," for sustainable engaged accountable learners. This paper defines these qualities as they relate to emergency medicine training, significant learning, and the development of adaptive expertise. Connections to Fink's and Cutrer's works are offered for each learner characteristic. Educational and psychological theories that support the SEALs model are paired with practical suggestions for educators to promote these desired qualities in their trainees. Relevant features of adult learning are highlighted, including self-regulation, motivation, agency, and autonomy.
Collapse
Affiliation(s)
- Michael A. Gisondi
- From theDepartment of Emergency MedicineStanford UniversityStanfordCAUSA
| | - Jeremy Branzetti
- theRonald O. Perelman Department of Emergency MedicineNew York UniversityNew YorkNYUSA
| | - Laura R. Hopson
- theDepartment of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
| | - Linda Regan
- and theDepartment of Emergency MedicineJohns Hopkins Medical InstitutesBaltimoreMDUSA
| |
Collapse
|
3
|
Gupta R, Sehgal N, Arora VM. Aligning Delivery System and Training Missions in Academic Medical Centers to Promote High-Value Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1289-1292. [PMID: 31460917 DOI: 10.1097/acm.0000000000002573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Academic medical centers (AMCs) are transforming to improve their care delivery and learning environments so that they build a culture that fosters high-value care. However, AMCs struggle to create learning environments where trainees are part of the reason for institutional success and their initiatives have high impact and are sustainable. The authors believe that AMCs can reach these goals if they codevelop strategic priorities and provide infrastructure to support alignment between the missions of health delivery systems and graduate medical education (GME).They outline four steps for AMCs and policy makers to create an infrastructure that supports this alignment to deliver value-based care. First, AMCs can align strategic priorities between delivery systems and educators by creating a common understanding of why initiatives require priorities within the health care system. Second, AMCs can support alignment with data from multiple sources that are reliable, valid, and actionable for trainees. Third, resident initiatives can create sustained impact by linking trainees to the institutional staff and infrastructure supporting value improvement efforts. Fourth, incentive payment programs through medical education could augment current system incentives to propel further alignment between education and delivery systems. The authors support their recommendations with concrete examples from emerging models created by GME and health delivery system leaders at AMCs across the country.
Collapse
Affiliation(s)
- Reshma Gupta
- R. Gupta is medical director for quality and value improvement, UCLA Health, assistant professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, California, and director of evaluation and outreach, Teaching Value in Healthcare Learning Network, Costs of Care, Boston, Massachusetts. N. Sehgal is professor, Department of Medicine, University of California, San Francisco, School of Medicine (UCSF), and vice president and chief quality officer, UCSF Health, San Francisco, California. V.M. Arora is professor, Department of Medicine, and director of GME clinical learning environment innovation, University of Chicago Pritzker School of Medicine, Chicago, Illinois, and director of educational initiatives, Costs of Care, Boston, Massachusetts
| | | | | |
Collapse
|
4
|
Schickedanz A, Gupta R, Arora VM, Braddock CH. Measuring Value in Internal Medicine Residency Training Hospitals Using Publicly Reported Measures. Am J Med Qual 2018; 33:604-613. [PMID: 29637791 PMCID: PMC6697657 DOI: 10.1177/1062860618767312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Graduate medical education (GME) lacks measures of resident preparation for high-quality, cost-conscious practice. The authors used publicly reported teaching hospital value measures to compare internal medicine residency programs on high-value care training and to validate these measures against program director perceptions of value. Program-level value training scores were constructed using Centers for Medicare & Medicaid Services Value-Based Purchasing (VBP) Program hospital quality and cost-efficiency data. Correlations with Association of Program Directors in Internal Medicine Annual Survey high-value care training measures were examined using logistic regression. For every point increase in program-level VBP score, residency directors were more likely to agree that GME programs have a responsibility to contain health care costs (adjusted odds ratio [aOR] 1.18, P = .04), their faculty model high-value care (aOR 1.07, P = .03), and residents are prepared to make high-value medical decisions (aOR 1.07, P = .09). Publicly reported clinical data offer valid measures of GME value training.
Collapse
Affiliation(s)
- Adam Schickedanz
- Primary Care & Health Services Research Fellow, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA
| | - Reshma Gupta
- Medical Director for Quality Improvement & Value at UCLA Health, Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | | | | |
Collapse
|
5
|
Conrad SS, Addams AN, Young GH. Holistic Review in Medical School Admissions and Selection: A Strategic, Mission-Driven Response to Shifting Societal Needs. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1472-1474. [PMID: 27627631 DOI: 10.1097/acm.0000000000001403] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Medical schools and residency programs have always sought excellence in the areas of education, research, and clinical care. However, these pursuits are not accomplished within a vacuum-rather, they are continually and necessarily influenced by social, cultural, political, legal, and economic forces. Persistent demographic inequalities coupled with rapidly evolving biomedical research and a complex legal landscape heighten our collective awareness and emphasize the continued need to consider medicine's social contract when selecting, educating, and developing physicians and physician-scientists.Selection-who gains access to a medical education and to a career as a physician, researcher, and/or faculty member-is as much art as science. Quantitative assessments of applicants yield valuable information but fail to convey the full story of an applicant and the paths they have taken. Human judgment and evidence-based practice remain critical parts of implementing selection processes that yield the desired outcomes. Holistic review, in promoting the use of strategically designed, evidence-driven, mission-based, diversity-aware processes, provides a conceptual and practical framework for marrying the art with the science without sacrificing the unique value that each brings.In this Commentary, the authors situate medical student selection as both responsive to and informed by broader social context, health and health care needs, educational research and evidence, and state and federal law and policy. They propose that holistic review is a strategic, mission-driven, evidence-based process that recognizes diversity as critical to excellence, offers a flexible framework for selecting future physicians, and facilitates achieving institutional mission and addressing societal needs.
Collapse
Affiliation(s)
- Sarah S Conrad
- S.S. Conrad is director, Advancing Holistic Review Initiative, Association of American Medical Colleges, Washington, DC. A.N. Addams is director, Student Affairs, Strategy & Alignment, Association of American Medical Colleges, Washington, DC. G.H. Young is senior director, Student Affairs and Programs, Association of American Medical Colleges, Washington, DC
| | | | | |
Collapse
|
6
|
Joshi N, Haber J. Let Me Heal: The Opportunity to Preserve Excellence in American Medicine. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
7
|
Innes SI, Leboeuf-Yde C, Walker BF. Similarities and differences of graduate entry-level competencies of chiropractic councils on education: a systematic review. Chiropr Man Therap 2016; 24:1. [PMID: 26798453 PMCID: PMC4721112 DOI: 10.1186/s12998-016-0084-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/06/2016] [Indexed: 11/13/2022] Open
Abstract
Background Councils of Chiropractic Education (CCE) indirectly influence patient care and safety through their role of ensuring the standards of training delivered by chiropractic educational institutions. This is achieved by CCEs defining competence and creating lists of descriptive statements to establish the necessary standards for students to attain before graduating. A preliminary review suggested that these definitions and descriptive lists lacked consensus. This creates the potential for variations in standards between the CCE jurisdictions and may compromise patient care and safety and also inter-jurisdictional mutual recognition. The purposes of this study were 1) to investigate similarities and differences between the CCEs in their definitions of competence, domains of educational competencies, components of the domains of competencies, as represented by assessment and diagnosis, ethics, intellectual development, and 2) to make recommendations, if significant deficiencies were found. Method We undertook a systematic review of the similarities and differences between various CCEs definitions of competence and the descriptive lists of educational competencies they have adopted. CCEs were selected on the basis of WHO recommendations. Blinded investigators selected the data from CCE websites and direct contact with CCEs. This information was tabulated for a comparative analysis. Results All CCEs’ definitions of competence included the elements of “knowledge”, “skills” and “attitudes” whereas only one CCE included the expected “abilities” element. The educational application of the definition of competency among CCEs varied. A high level of similarity when comparing the domains of competence adopted by CCEs was found despite variations in the structure. Differences between CCEs became increasingly apparent when the three selected representative domains were compared. CCEs were found to stipulate varying levels of prescriptiveness for graduate entry level standards. Conclusions A series of recommendations are proposed to create uniform and high quality international standards of care. Future research should compare the levels of CCEs enforcement of standards to see if similarities and differences exist.
Collapse
Affiliation(s)
- Stanley I Innes
- School of Health Professions, Murdoch University, Murdoch, Australia
| | - Charlotte Leboeuf-Yde
- School of Health Professions, Murdoch University, Murdoch, Australia ; Institut Franco-Européen de Chiropraxie, Ivry sur Seine, France ; Complexité, Innovation et Activités Motrices et Sportives, UFR STAPS, Université Paris Sud-11, Orsay Cedex, France
| | - Bruce F Walker
- School of Health Professions, Murdoch University, Murdoch, Australia
| |
Collapse
|