Pediatric resident and faculty attitudes toward self-assessment and self-directed learning: a cross-sectional study

Ready, Set, Goal: A Mixed Methods Study of a Goal-Setting Intervention on 2 Competency-Based Geriatric Medicine Rotations

Background More research is required to understand the effects of implementing structured goal-setting on trainee engagement in competency-based clinical learning environments. Objective To explore how residents experienced a rotation-specific goal-setting intervention on geriatric medicine rotations at 2 hospitals. Methods All rotating residents were expected to complete the intervention, consisting of a SMART-based (Specific, Measurable, Achievable, Relevant, and Time-Bound) goal-setting form and feedback sessions with teaching faculty. From November 2019 to June 2021, we recruited a convenience sample of rotating residents. Study participants completed pre- and postrotation 35-item Dutch Residency Educational Climate Test (D-RECT) questionnaires to compare scores from their rotation before the geriatric rotation and a postrotation semistructured interview, which we transcribed and analyzed using principles of constant comparison and reflexive thematic analysis. Results We interviewed 12 of 58 (20.7%) residents participating in the goal-setting intervention, 11 of whom completed both D-RECT questionnaires. Participants' D-RECT scores favored the geriatric medicine rotation versus the immediately preceding clinical rotation (M=4.29±0.37; M=3.84±0.44, P=.002). Analyses of interview transcripts yielded 3 themes on how participants perceived the intervention influenced their learning experience: (1) structured forms and processes mediate, inform, and constrain goal selection; (2) interactions with faculty, patients, and system factors influenced goal enactment; and (3) unstructured assessments led to uncertainty around goal achievement. Challenges included time restrictions and unpredictable clinical opportunities. Conclusions Goal-setting appeared to help many residents direct their learning efforts and engage in collaborative processes with teaching faculty. We identified challenges limiting residents' engagement with the goal-setting intervention, which may inform the practical implementation of goal-setting in other competency-based curricula.

Clinician Educator Milestones: Assessing and Improving Educators' Skills

ABSTRACT

The importance of the clinician educator (CE) role in delivery of competency-based medical education is well recognized. There is, however, no formal mechanism to identify when faculty have the knowledge, skills, and attitudes to be successful CEs. In 2020, the Accreditation Council for Graduate Medical Education, Accreditation Council for Continuing Medical Education, Association of American Medical Colleges, and American Association of Colleges of Osteopathic Medicine convened a workgroup of 18 individuals representing multiple medical specialties and diverse institutions in the United States, including nonphysician educators, a medical student, and a resident, to develop a set of competencies, subcompetencies, and milestones for CEs.A 5-step process was used to create the Clinician Educator Milestones (CEMs). In step 1, the workgroup developed an initial CEM draft. Through brainstorming, 141 potential education-related CE tasks were identified. Descriptive statements for each competency and developmental trajectories for each subcompetency were developed and confirmed by consensus. The workgroup then created a supplemental guide, assessment tools, and additional resources. In step 2, a diverse group of CEs were surveyed in 2021 and provided feedback on the CEMs. In step 3, this feedback was used by the workgroup to refine the CEMs. In step 4, the second draft of the CEMs was submitted for public comment, and the CEMs were finalized. In step 5, final CEMs were released for public use in 2022.The CEMs consist of 1 foundational domain that focuses on commitment to lifelong learning, 4 additional domains of competence for CEs in the learning environment, and 20 subcompetencies. These milestones have many potential uses for CEs, including self-assessment, constructing learning and improvement plans, and designing systematic faculty development efforts. The CEMs will continue to evolve as they are applied in practice and as the role of CEs continues to grow and develop.

Barriers and enablers to achieving clinical procedure competency-based outcomes in a national paediatric training/residency program-a multi-centered qualitative study

BACKGROUND

In 2018, the Royal College of Physicians of Ireland revised its paediatric training program to a competency-based medical education (CBME) training/residency curriculum. This included a requirement to achieve competence in a number of core procedural skills to progress within the program. Internationally, simulation-based medical education (SBME) is gaining interest as an effective teaching pedagogy for training procedural skill competency. The objectives of this study were to (1) identify enablers and barriers for paediatric trainees to achieve their required procedural competencies, (2) gain insight on the feasibility of achieving the required procedural skills, and (3) explore what simulation-based resources are used as well as their role in achieving the required procedural skill competencies.

METHODS

A multi-centered qualitative study using semi-structured interviews was performed. Twenty-four paediatric consultants and trainees were recruited from two academic tertiary hospitals using purposive and snowball sampling. Interviews were conducted between March and September 2021, audio recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Three main themes regarding enablers for achieving procedural competencies were reported and include having protected training time, routine assessments, and a standardized curriculum. Barriers to achieving procedural competencies focused mainly on limited clinical exposure. The use of SBME was recommended by all participants (n = 24, 100%) to assist in achieving procedural competencies and most (n = 15, 62.5%) reported it is feasible to attain the required procedural skills in the paediatric CBME program.

CONCLUSION

It is feasible to achieve the required procedural competencies for most paediatric trainees, but this can be improved with protected training time, routine assessments, and a standardized curriculum. Barriers to achieving these skills mainly center on limited clinical exposure, which can be remedied by SBME. Further research is warranted to determine the costs and types of SBME tools available as well as teaching pedagogies to support paediatric trainees achieve their required procedural competencies.

Utilizing a Quality Improvement Strategy to Increase Faculty Engagement With Resident Learning Goals

BACKGROUND

Establishing and achieving learning goals (LGs) are important lifelong learning skills for residents. Faculty are critical in facilitation and achievement of residents' LGs, yet many have difficulty with this role in the busy inpatient setting.

OBJECTIVES

Our primary aim was to improve faculty engagement in resident LGs, targeting ≥80% of faculty achieving a mean score ≥goal, over a period of 1 year by setting prerotation expectations and stressing team-based faculty accountability during the rotation in the current inpatient learning environment.

METHODS

We identified key barriers to addressing LGs on an inpatient subspecialty service. Key interventions included 1) introducing LGs to faculty, 2) establishing a communication/handover process among faculty, 3) LGs development, and 4) tracking accountability. Baseline mean faculty milestone scores were determined from the prior year. Over 1 year, we developed and refined a system for residents to create and document LGs with faculty oversight and review. We reviewed faculty evaluations quarterly to measure progress and reviewed rotation evaluations.

RESULTS

Faculty engagement with LGs improved through the course of the academic year. All but one faculty member had improved LGs scores during the intervention year. Most residents were very satisfied with the intervention and gave unprompted favorable feedback on rotation evaluations. The majority of submitted LGs were either partially or completely addressed.

CONCLUSIONS

We demonstrated that a quality improvement approach to a faculty educational skill is feasible and effective. Our intervention related to LGs may be modified for any medical learner in any inpatient or outpatient setting.

Use of Individualized Learning Plans to Facilitate Feedback Among Medical Students

Self-regulated learning theory suggests that individualized learning plans can benefit medical trainees by providing a structured means of goal setting, self-monitoring, and self-evaluation. External feedback also plays an important role in affecting learner motivations, perceptions, and self-evaluations. Accordingly, having learners share individualized learning plans with preceptors might promote self-regulated learning by helping align the feedback they receive with their learning goals. Hypothesis: We hypothesized having medical students share individualized learning plans with attendings and residents would improve the quality of the feedback they received, increase the likelihood that feedback correlated to their learning goals, and improve their perceptions of feedback received. Method: In this multisite study, third-year medical students on their pediatric clerkship created individualized learning plans and shared them with residents and attendings by writing a learning goal on at least one of their required faculty feedback forms. The quality of feedback on forms with versus without a learning goal written on top was scored using a validated scoring tool and compared using a Wilcoxon signed-ranks test, and the frequency with which feedback directly correlated to a student learning goal on forms with versus without a learning goal written on top was compared using a chi-square test. Students completed a post-clerkship survey rating the quality of feedback and teaching they received, perceptions of the individualized learning plans, progress toward achieving learning goals, and whether or not they received teaching and/or feedback related to learning goals. Results: Thirty-six students completed a total of 108 learning goals and 181 feedback forms, of which 42 forms (23.2%) had a learning goal written on top. The mean (SD) feedback score between forms with [3.9 (0.9)] versus without [3.6 (0.6)] a learning goal written on top was not different (p = .113). Feedback on forms with a learning goal written on top was more likely to correlate to a student learning goal than feedback on forms without a learning goal (92.9% vs 23.0% respectively, p < .001). Student perceptions of the usefulness of learning goals did not differ between students who reported receiving teaching or feedback related to a learning goal and those who did not. Conclusions: Sharing individualized learning plans with preceptors helped align feedback with learning goals but did not affect the quality of feedback. Further research should examine the bidirectional relationship between individualized learning plans and feedback in light of other contextual and interpersonal factors.

The Role of Gender in the Experience and Impact of Recertification Exam Preparation: A Qualitative Study of Primary Care Physicians

Background: Little is known about how physicians experience preparing for board recertification examinations. As women make up a growing proportion of the primary care physician workforce, we aimed to explore how primary care physicians experience the personal and professional impacts of recertification examination preparation activities, and whether these impacts differ by gender. Materials and Methods: We conducted exploratory qualitative semistructured interviews with 80 primary care physicians, who had recently taken either the American Board of Family Medicine or American Board of Internal Medicine recertification examination and who practice outpatient care. We used an iterative recruitment approach to obtain a representative sample. We applied a team-based constant comparative analytic approach to identify and categorize themes related to how preparing for the recertification examination impacted their personal or professional lives, and then compared these themes by physician gender. Results: We interviewed 41 male and 39 female participants. Physicians most frequently described taking time from personal rather than professional activities to study, but often said this was "no big deal." Physicians described impacts on personal life such as missing out on family or leisure time, conflicts with parenting responsibilities, and an increased reliance on their spouse for domestic and childcare duties. Female physicians more frequently described parenting and leisure time impacts than males did. Conclusions: Recertification examination preparation impacts physicians' personal lives in a variety of ways and are sometimes experienced differently along gendered lines. These findings suggest opportunities for employers, payers, and specialty boards to help physicians ease potential burdens related to maintaining board certification.

Self-regulated learning in the clinical context: a systematic review

OBJECTIVES

Research has suggested beneficial effects of self-regulated learning (SRL) for medical students' and residents' workplace-based learning. Ideally, learners go through a cyclic process of setting learning goals, choosing learning strategies and assessing progress towards goals. A clear overview of medical students' and residents' successful key strategies, influential factors and effective interventions to stimulate SRL in the workplace is missing. This systematic review aims to provide an overview of and a theoretical base for effective SRL strategies of medical students and residents for their learning in the clinical context.

METHODS

This systematic review was conducted according to the guidelines of the Association for Medical Education in Europe. We systematically searched PubMed, EMBASE, Web of Science, PsycINFO, ERIC and the Cochrane Library from January 1992 to July 2016. Qualitative and quantitative studies were included. Two reviewers independently performed the review process and assessed the methodological quality of included studies. A total of 3341 publications were initially identified and 18 were included in the review.

RESULTS

We found diversity in the use of SRL strategies by medical students and residents, which is linked to individual (goal setting), contextual (time pressure, patient care and supervision) and social (supervisors and peers) factors. Three types of intervention were identified (coaching, learning plans and supportive tools). However, all interventions focused on goal setting and monitoring and none on supporting self-evaluation.

CONCLUSIONS

Self-regulated learning in the clinical environment is a complex process that results from an interaction between person and context. Future research should focus on unravelling the process of SRL in the clinical context and specifically on how medical students and residents assess their progress towards goals.

Coaching Residents in the Ambulatory Setting: Faculty Direct Observation and Resident Reflection

BACKGROUND

Direct observation can be valuable for learners' skill development in graduate medical education, but it is done infrequently. Information on how to optimize trainee learning from, and best practices of, direct observation interventions in the ambulatory setting is limited.

OBJECTIVE

We explored the impact of a focused outpatient direct observation and coaching intervention on internal medicine residents.

METHODS

Using a behavior checklist based on tenets of clinical excellence, 2 faculty preceptors observed outpatient primary care visits with 96% (46 of 48) of the internal medicine residents in 2017. Residents self-assessed their performance after the visit using the same checklist. Next, a focused coaching feedback session, emphasizing reflection, was structured to highlight areas of discrepancy between resident self-assessment and coach observation (blind spots), and residents were asked to identify goals for practice improvement.

RESULTS

Common blind spots in resident self-assessment related to collaborating with patients while using the electronic health record (48%, 21 of 44), hand washing (43%, 20 of 46), and asking thoughtful questions (40%, 18 of 45). At 1-month follow-up, 93% (43 of 46) of responding residents reported change in practice toward goals often or sometimes. All residents reported that the intervention felt comfortable, and 98% (45 of 46) noted that it helped them identify new behaviors to incorporate into clinical practice.

CONCLUSIONS

Structured episodes of direct observation and coaching in the outpatient setting, with a behavior checklist, appear acceptable and useful for internal medicine residents' learning and development.

Evaluation of a National Pediatric Subinternship Curriculum Implemented Through Individual Learning Plans

OBJECTIVE

The Council on Medical Student Education in Pediatrics and Association of Pediatric Program Directors developed a Pediatric Subinternship (CAPS) curriculum for use with an individualized learning plan (ILP). The authors determined which learning objectives (LOs) pediatric subinterns selected when provided the CAPS curriculum, summarized students' self-reported progress, and determined feasibility of ILPs in subinternship.

METHODS

Students from 10 medical schools completed a standardized ILP during pediatric subinternship. Students listed ≥3 LOs using CAPS curriculum as a guide and self-assessed their progress. Students reviewed ILPs with faculty preceptors; preceptors completed questionnaires on time and effort spent. Authors mapped student LOs to CAPS curriculum objectives and grouped in Accreditation Council for Graduate Medical Education competency domains.

RESULTS

Two hundred four students documented 850 LOs. Authors mapped student LOs to 61 of the 69 CAPS objectives (88%). Students most commonly chose Patient Care LOs, with the top 3 related to oral presentations, time management, and management plans. Student LOs not in CAPS addressed nutrition, child development, test interpretation, and cost. No students chose LOs related to health disparities, shared decision making, informed consent, or patient safety. Students self-reported significant progress on most LOs (73%). Faculty met with students ≥1 time and 93% met for a total of ≤1 hour. According to faculty, students required little or no help completing ILPs.

CONCLUSIONS

Students chose a wide range of LOs when provided the CAPS curriculum. Revision to include additional student-identified LOs would enhance CAPS curriculum's comprehensiveness. Using this curriculum with an ILP during subinternship is feasible, but gaps between educator-identified and student-identified objectives require further exploration.

A model of self-directed learning in internal medicine residency: a qualitative study using grounded theory

BACKGROUND

Existing theories of self-directed learning (SDL) have emphasized the importance of process, personal, and contextual factors. Previous medical education research has largely focused on the process of SDL. We explored the experience with and perception of SDL among internal medicine residents to gain understanding of the personal and contextual factors of SDL in graduate medical education.

METHODS

Using a constructivist grounded theory approach, we conducted 7 focus group interviews with 46 internal medicine residents at an academic medical center. We processed the data by using open coding and writing analytic memos. Team members organized open codes to create axial codes, which were applied to all transcripts. Guided by a previous model of SDL, we developed a theoretical model that was revised through constant comparison with new data as they were collected, and we refined the theory until it had adequate explanatory power and was appropriately grounded in the experiences of residents.

RESULTS

We developed a theoretical model of SDL to explain the process, personal, and contextual factors affecting SDL during residency training. The process of SDL began with a trigger that uncovered a knowledge gap. Residents progressed to formulating learning objectives, using resources, applying knowledge, and evaluating learning. Personal factors included motivations, individual characteristics, and the change in approach to SDL over time. Contextual factors included the need for external guidance, the influence of residency program structure and culture, and the presence of contextual barriers.

CONCLUSIONS

We developed a theoretical model of SDL in medical education that can be used to promote and assess resident SDL through understanding the process, person, and context of SDL.

In Pursuit of Meaningful Use of Learning Goals in Residency: A Qualitative Study of Pediatric Residents

PURPOSE

Medical education aims to equip physicians for lifelong learning, an objective supported by the conceptual framework of self-regulated learning (SRL). Learning goals have been used to develop SRL skills in learners across the medical education continuum. This study's purpose was to elicit residents' perspectives on learning goal use and to develop explanations suggesting how aspects of the learning environment may facilitate or hinder the meaningful use of learning goals in residency.

METHOD

Resident focus groups and program director interviews were conducted in 2012-2013, audio-recorded, and transcribed. Programs were selected to maximize diversity of size, geographic location, type of program, and current use of learning goals. Data were analyzed using the constant comparative method associated with grounded theory. Further analysis compared themes frequently occurring together to strengthen the understanding of relationships between the themes. Through iterative discussions, investigators built a grounded theory.

RESULTS

Ninety-five third-year residents and 12 program directors at 12 pediatric residency programs participated. The analysis identified 21 subthemes grouped into 5 themes: program support, faculty roles, goal characteristics and purposes, resident attributes, and accountability and goal follow-through. Review of relationships between the themes revealed a pyramid of support with program support as the foundation that facilitates the layers above it, leading to goal follow-through.

CONCLUSIONS

Program support facilitates each step of the SRL process that leads to meaningful use of learning goals in residency. A strong foundation of program support should include attention to aspects of the implicit curriculum as well as the explicit curriculum.

Resident Self-Assessment and Learning Goal Development: Evaluation of Resident-Reported Competence and Future Goals

OBJECTIVE

To determine incidence of learning goals by competency area and to assess which goals fall into competency areas with lower self-assessment scores.

METHODS

Cross-sectional analysis of existing deidentified American Academy of Pediatrics' PediaLink individualized learning plan data for the academic year 2009-2010. Residents self-assessed competencies in the 6 Accreditation Council for Graduate Medical Education (ACGME) competency areas and wrote learning goals. Textual responses for goals were mapped to 6 ACGME competency areas, future practice, or personal attributes. Adjusted mean differences and associations were estimated using multiple linear and logistic regression.

RESULTS

A total of 2254 residents reported 6078 goals. Residents self-assessed their systems-based practice (51.8) and medical knowledge (53.0) competencies lowest and professionalism (68.9) and interpersonal and communication skills (62.2) highest. Residents were most likely to identify goals involving medical knowledge (70.5%) and patient care (50.5%) and least likely to write goals on systems-based practice (11.0%) and professionalism (6.9%). In logistic regression analysis adjusting for postgraduate year (PGY), gender, and degree type (MD/DO), resident-reported goal area showed no association with the learner's relative self-assessment score for that competency area. In the conditional logistic regression analysis, with each learner serving as his or her own control, senior residents (PGY2/3+s) who rated themselves relatively lower in a competency area were more likely to write a learning goal in that area than were PGY1s.

CONCLUSIONS

Senior residents appear to develop better skills and/or motivation to explicitly turn self-assessed learning gaps into learning goals, suggesting that individualized learning plans may help improve self-regulated learning during residency.

Information-seeking behavior during residency is associated with quality of theoretical learning, academic career achievements, and evidence-based medical practice: a strobe-compliant article

Data regarding knowledge acquisition during residency training are sparse. Predictors of theoretical learning quality, academic career achievements and evidence-based medical practice during residency are unknown. We performed a cross-sectional study on residents and attending physicians across several residency programs in 2 French faculties of medicine. We comprehensively evaluated the information-seeking behavior (I-SB) during residency using a standardized questionnaire and looked for independent predictors of theoretical learning quality, academic career achievements, and evidence-based medical practice among I-SB components using multivariate logistic regression analysis. Between February 2013 and May 2013, 338 fellows and attending physicians were included in the study. Textbooks and international medical journals were reported to be used on a regular basis by 24% and 57% of the respondents, respectively. Among the respondents, 47% refer systematically (4.4%) or frequently (42.6%) to published guidelines from scientific societies upon their publication. The median self-reported theoretical learning quality score was 5/10 (interquartile range, 3-6; range, 1-10). A high theoretical learning quality score (upper quartile) was independently and strongly associated with the following I-SB components: systematic reading of clinical guidelines upon their publication (odds ratio [OR], 5.55; 95% confidence interval [CI], 1.77-17.44); having access to a library that offers the leading textbooks of the specialty in the medical department (OR, 2.45, 95% CI, 1.33-4.52); knowledge of the specialty leading textbooks (OR, 2.12; 95% CI, 1.09-4.10); and PubMed search skill score ≥5/10 (OR, 1.94; 95% CI, 1.01-3.73). Research Master (M2) and/or PhD thesis enrolment were independently and strongly associated with the following predictors: PubMed search skill score ≥5/10 (OR, 4.10; 95% CI, 1.46-11.53); knowledge of the leading medical journals of the specialty (OR, 3.33; 95% CI, 1.32-8.38); attending national and international academic conferences and meetings (OR, 2.43; 95% CI, 1.09-5.43); and using academic theoretical learning supports several times a week (OR, 2.23; 95% CI, 1.11- 4.49). This study showed weaknesses in the theoretical learning framework during residency. I-SB was independently associated with quality of academic theoretical learning, academic career achievements, and the use of evidence-based medicine in everyday clinical practice.

STUDY REGISTRATION

CNIL No.1797639.

Scaffolding reflective learning in clinical practice: a comparison of two types of reflective activities

BACKGROUND

The development of reflective learning skills is a continuous process that needs scaffolding. It can be described as a continuum, with the focus of reflection differing in granularity from recent, concrete activities to global competency development.

AIM

To explore learners' perceptions regarding the effects of two reflective writing activities designed to stimulate reflection at different degrees of granularity during clinical training.

METHODS

Totally 142 respondents (students and recent graduates) completed a questionnaire. Quantitative and qualitative data were triangulated.

RESULTS

Immediate reflection-on-action was perceived to be more valuable than delayed reflection-on-competency-development because it facilitated day-to-day improvement. Delayed reflection was perceived to facilitate overall self-assessment, self-confidence and continuous improvement, but this perception was mainly found among graduates. Detailed reflection immediately after a challenging learning experience and broad reflection on progress appeared to serve different learning goals and consequently require different arrangements regarding feedback and timing.

CONCLUSIONS

Granularity of focus has consequences for scaffolding reflective learning, with immediate reflection on concrete events and reflection on long-term progress requiring different approaches. Learners appeared to prefer immediate reflection-on-action.

Assessing residents' written learning goals and goal writing skill: validity evidence for the learning goal scoring rubric

PURPOSE

To provide validity evidence for use of the Learning Goal Scoring Rubric to assess the quality of written learning goals and residents' goal writing skills.

METHOD

This two-part study used the rubric to assess University of Colorado third-year pediatric residents' written learning goals to obtain validity evidence. In study 1, five raters independently scored 48 goals written in 2010-2011 and 2011-2012 by 48 residents, who also responded to the Jefferson Scale of Physician Lifelong Learning (JeffSPLL). In study 2, two raters independently scored 48 goals written in 2011-2012 by 12 residents. Intraclass correlation coefficients (ICCs) assessed rater agreement to provide evidence for response process. Generalizability theory assessed internal structure. Independent-samples Mann-Whitney U tests and correlations assessed relationship to other variables. Content was matched to published literature and instructional methods.

RESULTS

The ICC was 0.71 for the overall rubric. In study 1, where the generalizability study's (G study's) object of measurement was learning goals, the phi coefficient was 0.867. In study 2, where the G study's object of measurement was the resident (goal writing skill), the phi coefficient was 0.751. The total mean score of residents with goal writing training was significantly higher than that of those without (7.54 versus 4.98, P < .001). Correlation between goal quality and JeffSPLL score was not significant. Investigators agreed that the content matched the published literature and instructional methods.

CONCLUSIONS

Preliminary validity evidence indicates that this scoring rubric can assess learning goal quality and goal writing skill.

How does the medical graduates' self-assessment of their clinical competency differ from experts' assessment?

BACKGROUND

The assessment of the performance of medical school graduates during their first postgraduate years provides an early indicator of the quality of the undergraduate curriculum and educational process. The objective of this study was to assess the clinical competency of medical graduates, as perceived by the graduates themselves and by the experts.

METHODS

This is a hospital based cross-sectional study. It covered 105 medical graduates and 63 experts selected by convenient sampling method. A self-administered questionnaire covering the different areas of clinical competency constructed on a five-point Likert scale was used for data collection. Data processing and analysis were performed using the Statistical Package for Social Science (SPSS) 16.0. The mean, frequency distribution, and percentage of the variables were calculated. A non-parametric Kruskal Wallis test was applied to verify whether the graduates' and experts' assessments were influenced by the graduates' variables such as age, gender, experience, type of hospital, specialty and location of work at a (p ≤ 0.05) level of significance.

RESULTS

The overall mean scores for experts' and graduates' assessments were 3.40 and 3.63, respectively (p= 0.035). Almost 87% of the graduates perceived their competency as good and very good in comparison with only 67.7% by experts. Female and male graduates who rated themselves as very good were 33.8% and 25% respectively. More than 19% of the graduates in the age group > 30 years perceived their clinical competency as inadequate in contrast with only 6.2% of the graduates in the youngest age group. Experts rated 40% of the female graduates as inadequate versus 20% of males, (p= 0.04). More than 40% of the graduates in younger age group were rated by experts as inadequate, versus 9.7% of the higher age group >30 years (p = 0.03).

CONCLUSION

There was a wide discrepancy between the graduates' self-assessment and experts' assessment, particularly in the level of inadequate performance. Graduates in general, and those of younger age groups in particular, tend to overestimate their clinical skills and competency.

Self-assessment on the competencies and reported improvement priorities for pediatrics residents

BACKGROUND

Self-assessment and self-directed learning are essential to becoming an effective physician.

OBJECTIVE

To identify factors associated with resident self-assessment on the competencies, and to determine whether residents chose areas of self-assessed relative weakness as areas for improvement in their Individualized Learning Plan (ILP).

METHODS

We performed a cross-sectional analysis of the American Academy of Pediatrics' PediaLink ILP database. Pediatrics residents self-assessed their competency in the 6 Accreditation Council for Graduate Medical Education competencies using a color-coded slider scale with end anchors "novice" and "proficient" (0-100), and then chose at least 1 competency to improve. Multivariate regression explored the relationship between overall confidence in core competencies, sex, level of training, and degree (MD or DO) status. Correlation examined whether residents chose to improve competencies in which they rated themselves as lower.

RESULTS

A total of 4167 residents completed an ILP in academic year 2009-2010, with residents' ratings improving from advanced beginner (48 on a 0-100 scale) in postgraduate year-1 residents (PGY-1s) to competent (75) in PGY-3s. Residents rated themselves as most competent in professionalism (mean, 75.3) and least competent in medical knowledge (mean, 55.8) and systems-based practice (mean, 55.2). In the adjusted regression model, residents' competency ratings increased by level of training and whether they were men. In PGY-3s, there was no difference between men and women. Residents selected areas for improvement that correlated to competencies where they had rated themselves lower (P < .01).

CONCLUSION

Residents' self-assessment of their competencies increased by level of training, although residents rated themselves as least competent in medical knowledge and systems-based practice, even as PGY-3s. Residents tended to choose subcompetencies, which they rated as lower to focus on improving.

Use of individualized learning plans among fourth-year sub-interns in pediatrics and internal medicine

BACKGROUND

Individualized Learning Plans (ILPs) are an effective tool for promoting self-directed learning among residents. However, no literature details ILP use among medical students.

METHODS

Fifty fourth-year sub-interns in pediatrics and internal medicine created ILPs, including a self-assessment of strengths and weaknesses based on ACGME core competencies and the setting of learning objectives. During weekly follow-up meetings with faculty mentors and peers, students discussed challenges and revised goals. Upon completion of the rotation, students completed a survey of Likert-scale questions addressing satisfaction with and perceived utility of ILP components.

RESULTS

Students most often self-identified strengths in the areas of Professionalism and Interpersonal and Communication Skills and weaknesses in Patient Care and Systems-Based Practice. Eighty-two percent set at least one learning objective in an identified area of weakness. Students expressed high confidence in their abilities to create achievable learning objectives and to generate strategies to meet those objectives. Students agreed that discussions during group meetings were meaningful, and they identified the setting learning objectives and weekly meetings as the most important elements of the exercise.

CONCLUSIONS

Fourth-year sub-interns reported that ILPs helped them to accomplish rotation goals, with the setting of learning objectives and weekly discussions being the most useful elements.

Is residents' progress on individualized learning plans related to the type of learning goal set?

PURPOSE

To determine the types of learning goals residents select for their individualized learning plans (ILPs) and the relationship between goal type and progress toward achieving that goal.

METHOD

Pediatric and combined pediatric residents at 46 U.S. training programs completed a Web-based survey on ILPs in 2008-2009, describing their most important learning goal and the goals on which they made the most and least progress. Using iterative inductive review, responses were categorized into seven types (six corresponding with the Accreditation Council for Graduate Medical Education general competencies). Descriptive statistics and regression models were used to assess the relationship between goal type and progress made.

RESULTS

Of 1,739 eligible residents, 992 (57%) completed the survey; 668 (38%) had previously completed an ILP and described their learning goals. Residents were more likely to report medical knowledge (MK) (53.7%) and patient care (PC) (25.9%) goals as most important and less likely to report professionalism (1.5%) and systems-based practice (SBP) (1.0%) goals as most important. Compared with progress on MK goals, residents reported significantly greater progress on PC (odds ratio [OR]: 2.20; 95% confidence interval [CI]: 1.57-3.09) and practice-based learning and improvement teaching (OR: 2.99; 95% CI: 1.59-5.63) goals and less progress on SBP goals (OR: 0.16; 95% CI: 0.05-0.56).

CONCLUSIONS

Residents most commonly identified MK and PC learning goals as the most important. Residents made more progress on goals related to everyday tasks, such as PC and teaching, compared with goals less integrated in everyday training, such as SBP.

Internal medicine residents' acceptance of self-directed learning plans at the point of care

OBJECTIVES

We implemented a curriculum using self-directed learning plans (SDLPs) based on clinical questions arising from the residents' practice, and we report on perceptions and attitudes from residents in internal medicine regarding the use of SDLPs conceived at point of care.

METHODS

Internal medicine residents at a single community hospital in the Midwest were surveyed in 2006 regarding SDLPs. We report their perceived effectiveness in identifying knowledge gaps, the processes used to fill those gaps, and the resident outcomes using descriptive statistics.

RESULTS

A total of 26 out of 37 residents (70%) responded. Most (24 of 26; 92%) perceived SDLPs helped them to identify and fill knowledge gaps and that their skills in framing questions (23 of 26; 88%), identifying resources (21 of 26; 81%), and critically appraising the evidence (20 of 26; 77%) improved through regular use. They also felt these plans led to a meaningful change in their practice or provided further direction for learning (17 of 26; 65%). Most (21 of 26; 81%) reported their intent to include point-of-care learning in their continuing education after residency. We found no significant differences in the responses of first-year compared with second- or third-year residents.

CONCLUSIONS

Questions arising during patient care are strong motivators for physician self-directed learning. The residents' responses indicated that they accepted the SDLPs and intend to use them in practice. Embedding the discussion of the SDLPs in preclinic conferences has ensured sustainability during the past 5 years and has enabled us to demonstrate teaching of practice-based learning and improvement.

Factors associated with successful self-directed learning using individualized learning plans during pediatric residency

OBJECTIVE

The aim of this study was to determine whether resident or program characteristics are associated with effective self-directed learning of residents.

METHODS

A cross-sectional survey of pediatric and medicine/pediatric residents and program directors from a nationally representative sample of residency programs was conducted. Self-directed learning efficacy was measured by resident-reported progress on learning goals from their most recent individualized learning plan (ILP). Multilevel linear regression models were used to analyze the relationship between learner and program characteristics and self-directed learning efficacy of residents.

RESULTS

All program directors of participating programs (N = 46) completed the survey; the response rate from residents was 57% (992/1739). At the time of the survey, 78% of residents had previously written an ILP. Most residents achieved moderate self-directed learning efficacy. The most important factors associated with greater self-directed learning efficacy included using a system to track one's own progress in achieving learning goals, higher score on a propensity toward lifelong learning scale, and reporting greater confidence in self-directed learning abilities. Program characteristics, including program-level support for ILPs, had little or mixed association with resident self-directed learning efficacy.

CONCLUSIONS

The most important factors associated with effective self-directed learning were resident characteristics. Our findings imply that residency programs should invest their limited resources in curricula that help residents develop measurable goals and systems for tracking progress toward goal attainment. Since propensity toward lifelong learning was an important factor, medical schools and residency training programs should enhance their efforts to develop this characteristic in learners.