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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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Hill E, Rao P, Eidelsafy A, McCaffery H, Waanders K, Cousino M. Improved Patient Outcomes and Pediatric Resident Performance With a Parent and Faculty Communication Coaching Curriculum. Clin Pediatr (Phila) 2024; 63:263-271. [PMID: 37475491 DOI: 10.1177/00099228231183502] [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] [Indexed: 07/22/2023]
Abstract
Communication skills are an important part of patient care, but an often neglected part of residency training. Longitudinal active coaching of communication has the potential to effectively improve communication curricula. A novel communication coach curriculum was implemented with approximately half of a pediatric residency class. Residents were coached by both a parent and faculty coach on multiple occasions throughout their intern year. Effectiveness was evaluated through self-assessment, direct observation, chart review, and follow-up phone calls with families. This longitudinal communication coach curriculum was well-received and resulted in increased self-awareness of communication skills. Coachable behaviors improved in intervention residents, and their patients spoke more positively of their experiences with communication. Additionally, these patients were less likely to be readmitted than patients cared for by control residents. A longitudinal communication coaching model is a feasible and effective curriculum for pediatric residents.
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Affiliation(s)
- Elizabeth Hill
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Priyanka Rao
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amged Eidelsafy
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Chemistry, University of Washington, Seattle, WA, USA
| | - Harlan McCaffery
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Katherine Waanders
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Melissa Cousino
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Taff H, Gilkerson L, Osta A, Seo-Lee A, Schwartz A, Chunara Z, McGinn L, Pillai N, Barnes MM. Strengthening Parent - Physician Communication: A Mixed Methods Study on Attuned Communication Training for Pediatric Residents. TEACHING AND LEARNING IN MEDICINE 2023; 35:577-588. [PMID: 35946430 DOI: 10.1080/10401334.2022.2107528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Problem: High-quality communication improves patient satisfaction and clinical outcomes, yet formal communication training in residency is often minimal. Many studies on empathic communication show mixed results and are often hindered and skewed by brief study lengths, insufficiently and ambiguously defined concepts, and limited methods for objective measurements. Intervention: The FAN Curriculum is a unique communication curriculum, based on the conceptual frameworks of patient-centered communication, reflective practice, mindfulness, and attunement using the Facilitating Attuned Interactions (FAN) model. The first part of the FAN Curriculum was delivered as a 3-hour interactive workshop involving didactics, group discussion, and role play with pediatric residents. Residents then completed weekly self-reflections, a follow-up one-hour training to reinforce concepts, and five monthly mentor sessions, all emphasizing reflective practice. Context: This longitudinal, mixed-methods study examined the effects of the FAN Curriculum on residents' empathy levels and ability to communicate with parents in the clinical setting. The study was conducted at two urban, academic, medium-sized pediatric residency programs in Chicago between October 2016 and November 2017. First- and second-year pediatric residents whose continuity clinic site was located at their home institution participated. Residents received training in the use of the FAN Communication Tool using a delayed-start crossover study design. Impact: At five time points, residents and parents completed instruments validated for measuring physician empathy and mindfulness. Post-study interviews were conducted for one institution's residents and mentors and were evaluated using open and focused coding. Participants (n = 23) demonstrated a high degree of use of the FAN Communication Tool six months post-training and a significant rise in self-reported comfort with four of five FAN core processes. One parent-completed survey (Consultation and Relational Empathy, CARE) showed a statistically significant rise of 3.26% in resident relational empathy and collaboration after training (p = 0.02). In qualitative analysis of interviews, residents and mentors found the FAN Communication Tool beneficial, making clinic visits more efficient and collaborative. Both groups noted improvement in the residents' relationship-building skills; residents were able to use enhanced communication skills to better approach challenging encounters and work through parent concerns. Lessons Learned: Family-centered communication training can improve physician-perceived empathy and mindfulness. Effective communication for pediatric residents incorporates an empathic approach, and introduction to this formal curriculum supported their growth in connecting and engaging with children and parents. The FAN Curriculum may provide a useful method for improving resident communication skills with a positive impact on pediatricians' collaboration with patients and families.
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Affiliation(s)
- Heather Taff
- Department of Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
- VNA Health Care, Aurora, Illinois, USA
| | | | - Amanda Osta
- Department of Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Alisa Seo-Lee
- Department of Pediatrics, Cook County Health, Chicago, Illinois, USA
| | - Alan Schwartz
- Department of Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
- Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Zobia Chunara
- Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Lander McGinn
- Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Nikita Pillai
- Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Michelle M Barnes
- Department of Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
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Murphy JE, Khawaja H, Messina D, Monteiro JFG, Jeremiah J, McGarry K. Implementation, Reach, and Effectiveness of the Direct Observation of Residents in Clinic Program. EDUCATION FOR HEALTH (ABINGDON, ENGLAND) 2023; 36:104-110. [PMID: 38133125 DOI: 10.4103/efh.efh_90_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/19/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Direct observation is important, yet medical residents are rarely observed. We implemented and evaluated a direct observation program in resident clinics to increase the frequency of observation and feedback and improve perceptions about direct observation. METHODS We assigned faculty as observers in our resident clinics between June 2019 and February 2020. We surveyed residents and faculty before and after the program. Faculty completed a form for each observation performed. We analyzed surveys to examine changes in barriers, frequency and type of observations and feedback, and attitudes toward observation. The analytical sample included 38 and 37 pre- and postresident surveys, respectively, and 20 and 25 pre- and postfaculty surveys, respectively. RESULTS Resident survey response rates were 32.3% (40/124) pre- and 30.7% (39/127) postintervention. Most residents (76% [pre], 86% [post], P = 0.258) reported being observed in at least one of the four areas: history, examination, counseling, or wrap-up. We received observation tracking forms on 68% of eligible residents. Observed history taking increased from 30% to 79% after the program (P = 0.0010). Survey response rates for faculty were 64.7% (22/34) pre- and 67.5% (25/37) postintervention. Fewer faculty reported time (80% [pre], 52% [post], P = 0.051) and competing demands (65% [pre], 52% [post], P = 0.380) as barriers postintervention. Fewer faculty postintervention viewed observation as a valuable teaching tool (100% [pre], 79% [post], P = 0.0534). All faculty who did not view observation as valuable were the least experienced. DISCUSSION Assigning faculty as observers can increase observation, especially in history taking, though data suggest an increase in negative perceptions of observation by faculty.
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Affiliation(s)
- Jessica E Murphy
- Department of Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
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Selling SK, Rooholamini SN, Grow HM, McPhillips H, Hoang K, Blankenburg R, Rassbach C. The Effects of Coaching Pediatric Residents on Faculty Coaches' Relationships, Learning, and Professional Identity Formation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:376-383. [PMID: 36205486 DOI: 10.1097/acm.0000000000005011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Coaching programs have been implemented in medical education to improve skill development and feedback for trainees. As more faculty take on coaching roles, it is critical to understand how being a coach affects faculty as well as trainees. This study examined the effects of coaching residents on faculty members' relationships, learning, and professional identity formation (PIF), as they move through intersecting communities across landscapes of practice. METHOD From July 2020 to January 2021, the authors conducted a mixed-methods study of current and former coaches at 2 institutions with longitudinal pediatric resident coaching programs. They used a concurrent triangulation design in which qualitative and quantitative data were collected simultaneously and integrated during data analysis. A survey explored the impact of coaching on faculty members' learning, relationships, and PIF, and semistructured interviews further examined coaches' experiences. The interview transcripts were analyzed inductively guided by the sensitizing principles of PIF and landscapes of practice. RESULTS Of 43 eligible coaches, 32 (74%) completed the survey, and 18 completed interviews. Four themes emerged from the interviews. (1) Coaches' relationships supported belonging in multiple communities. (2) Coaching enabled multidimensional learning. (3) Relationships served as mechanisms of learning for coaches. (4) Coaches' relationships and learning catalyzed PIF. Furthermore, there was a significant difference in the effects of coaching on career growth by faculty rank ( P = .02). Coaches' strengthened PIF increased a sense of purpose, meaning, and professional fulfillment, and inspired new career directions. Survey data further supported these findings. CONCLUSIONS Being a coach deepened faculty members' professional identities through their varied relationships, multidimensional learning, and sense of belonging in intersecting communities. This study introduces a framework to understand the factors mediating coaches' PIF and highlights how investing in coaching leads to important benefits for coaches.
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Affiliation(s)
- Sarah Kate Selling
- S.K. Selling is a medical student, Stanford University School of Medicine, Stanford, California
| | - Sahar N Rooholamini
- S.N. Rooholamini is assistant professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - H Mollie Grow
- H.M. Grow is associate professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Heather McPhillips
- H. McPhillips is professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Kim Hoang
- K. Hoang is clinical assistant professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Rebecca Blankenburg
- R. Blankenburg is clinical professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Caroline Rassbach
- C. Rassbach is clinical professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Burke G, Melvin L, Ginsburg S. "Patients Are the People Who Teach Me the Most": Exploring the Development of Communication Skills During Internal Medicine Residency. J Grad Med Educ 2023; 15:59-66. [PMID: 36817542 PMCID: PMC9934842 DOI: 10.4300/jgme-d-22-00433.1] [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] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Physician-patient communication training is a vital component of medical education, yet physicians do not always achieve the communication expertise expected of them. Despite extensive literature on the efficacy of various training interventions, little is known about how residents believe they learn to communicate. OBJECTIVE To understand residents' perspectives on the development of their communication skills. METHODS Between November 2020 and January 2021 recruitment emails were sent to all 225 internal medicine residents at the University of Toronto; one-on-one interviews were conducted with 15 residents. Participants were asked to reflect on communication skills development. Interviews were conducted and analyzed using constructivist grounded theory. RESULTS Participants credited the majority of their skills development to unsupervised interactions with patients, without explicit guidance from an attending physician. Attendings' contributions were primarily seen through role modeling, with little perceived learning coming from feedback on observed interactions. This was partly explained by residents' proclivity to alter their communication styles when observed, rendering feedback less relevant to their authentic practice, and by receiving generically positive feedback lacking in constructive features. Time constraints led to communication styles that prioritized efficiency at the cost of patient-centeredness. CONCLUSIONS These findings suggest that current models of communication training and assessment may fall short due to overreliance on observation by attendings and examiners, which may fail to unearth the authentic and largely self-taught communication behaviors of residents. Further research is required to ascertain the feasibility and potential value of other forms of communication training and assessment, such as through patient feedback.
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Affiliation(s)
- Gabriel Burke
- All authors are with the University of Toronto, Toronto, Ontario, Canada
- Gabriel Burke, MD, is a PGY-4 Resident in Respirology, Department of Medicine, Temerty Faculty of Medicine
| | - Lindsay Melvin
- All authors are with the University of Toronto, Toronto, Ontario, Canada
- Lindsay Melvin, MD, MHPE, is Assistant Professor and Toronto Western Hospital Site Program Director for Internal Medicine, Department of Medicine, Temerty Faculty of Medicine
| | - Shiphra Ginsburg
- All authors are with the University of Toronto, Toronto, Ontario, Canada
- Shiphra Ginsburg, MD, MEd, PhD, is Professor of Medicine, Department of Medicine, Sinai Health System and Temerty Faculty of Medicine, and Scientist, Wilson Centre for Research in Education, and Canada Research Chair in Health Professions Education
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Logan AA, Rao M, Evans G. Twelve tips for teaching and supervising post-graduate trainees in clinic. MEDICAL TEACHER 2022; 44:720-724. [PMID: 33872095 DOI: 10.1080/0142159x.2021.1912307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
By providing quality teaching and supervision, medical educators can contribute to productive and fulfilling outpatient experiences for postgraduate trainees (sometimes called residents, registrars, or GP trainees). The recent literature addressing practical steps to improve outpatient teaching is limited. Here we present specific trainee-centric behaviors, techniques, and language that educators can employ to enhance their teaching in the outpatient clinic, in the form of twelve tips. The first two tips pertain to navigating the patient-trainee-supervisor dynamic in the exam room, the next four address listening to an oral presentation, and the last six are tips on being an effective teacher and coach.
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Affiliation(s)
- Alexander A Logan
- Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Mayuree Rao
- Department of Medicine, VA Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - Ginger Evans
- Department of Medicine, VA Puget Sound Health Care System, University of Washington, Seattle, WA, USA
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Zale AD, Song CI, Zhou A, Lai J, Jang M, Lipsett PA, Desai SV, Hanyok LA, Bienstock JL. A Qualitative Study of the Barriers and Benefits to Resident Education in Ambulatory Surgical Centers. JOURNAL OF SURGICAL EDUCATION 2021; 78:1825-1837. [PMID: 34092534 DOI: 10.1016/j.jsurg.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/03/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE As Ambulatory Surgical Centers (ASCs) become more common in academic medical centers, large hospital systems must determine how to shift resident education from inpatient to outpatient surgical centers. This study aims to define stakeholders' views regarding the integration of surgical residents into ASCs. DESIGN Long-form interviews lasting 30 to 60 minutes were conducted. Interviews were hand-transcribed and analyzed by qualitative analysis to determine benefits of learning in ASCs for residents, challenges that arise from integrating residents, and recommendations to improve resident incorporation. SETTING Interviews were conducted using a video conferencing platform. PARTICIPANTS Residency program directors, attending surgeons, graduate medical learners, and a nursing manager were interviewed. Twenty-one total interviews were conducted, representing ten different departments. RESULTS Stakeholders agreed that residents benefit from being placed in ASCs because the fast, surgical pace allows the residents to engage in more cases. However, different stakeholders highlighted different challenges, all centered around the notion of inter-stakeholder conflict due to conflicting priorities among residents, attending physicians, and administration. Likewise, recommendations differed by stakeholder group-faculty members sought more defined learning objectives and enhanced communication, whereas residents desired that ambulatory surgical time be more structured. CONCLUSIONS Despite the pressures of rapid case turnover, stakeholders agreed that there are many benefits to resident education in ASCs. Findings related to challenges and recommendations support the need to strengthen communication between stakeholder groups and better plan for resident integration into ASCs.
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Affiliation(s)
- Andrew D Zale
- Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | | | - Ashley Zhou
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan Lai
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Minyoung Jang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela A Lipsett
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sanjay V Desai
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura A Hanyok
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Brand PLP, Jaarsma ADC, van der Vleuten CPM. Driving lesson or driving test? : A metaphor to help faculty separate feedback from assessment. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:50-56. [PMID: 32902828 PMCID: PMC7809072 DOI: 10.1007/s40037-020-00617-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Although there is consensus in the medical education world that feedback is an important and effective tool to support experiential workplace-based learning, learners tend to avoid the feedback associated with direct observation because they perceive it as a high-stakes evaluation with significant consequences for their future. The perceived dominance of the summative assessment paradigm throughout medical education reduces learners' willingness to seek feedback, and encourages supervisors to mix up feedback with provision of 'objective' grades or pass/fail marks. This eye-opener article argues that the provision and reception of effective feedback by clinical supervisors and their learners is dependent on both parties' awareness of the important distinction between feedback used in coaching towards growth and development (assessment for learning) and reaching a high-stakes judgement on the learner's competence and fitness for practice (assessment of learning). Using driving lessons and the driving test as a metaphor for feedback and assessment helps supervisors and learners to understand this crucial difference and to act upon it. It is the supervisor's responsibility to ensure that supervisor and learner achieve a clear mutual understanding of the purpose of each interaction (i.e. feedback or assessment). To allow supervisors to use the driving lesson-driving test metaphor for this purpose in their interactions with learners, it should be included in faculty development initiatives, along with a discussion of the key importance of separating feedback from assessment, to promote a feedback culture of growth and support programmatic assessment of competence.
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Affiliation(s)
- Paul L P Brand
- Department of Medical Education and Faculty Development, Isala Hospital, Isala Academy, Zwolle, The Netherlands.
- Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, The Netherlands.
| | - A Debbie C Jaarsma
- Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, The Netherlands
- Centre for Educational Development and Research (CEDAR), University Medical Centre Groningen, Groningen, The Netherlands
| | - Cees P M van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Greenberg L. Can the Recruitment of Senior Transitioning Clinician Educators Enhance the Number and Quality of Resident Observations? Thinking Outside the Box. TEACHING AND LEARNING IN MEDICINE 2020; 32:569-574. [PMID: 32841577 DOI: 10.1080/10401334.2020.1801442] [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: 06/11/2023]
Abstract
Issue: The Accreditation Council for Graduate Medical Education's Next Accreditation System has forever changed the way faculty evaluate residents, fellows, and medical students, mandating direct observation by faculty of trainee performance. Evidence: The literature suggests that institutional culture does not support trainee observation, and faculty perceive that they have limited time to observe trainees in an efficient and effective manner. These factors contribute to an inadequate number of trainee observations, limiting faculty ability to assess trainees' achievement of competency. Hiring more faculty to increase observations has not been feasible or a priority, nor have faculty development programs been universally effective in recruiting faculty to enhance observations. Implications: To alleviate this important problem, the author proposes recruiting senior clinician educators transitioning to retirement. These are faculty who in their full-time careers have established themselves as playing a major role in teaching and might be interested in continuing their relationship with the academic health center. The number of these physicians is increasing and therefore there will be a larger pool seeking an opportunity to continue their commitment to education. Recruitment of senior clinician educators transitioning to retirement could significantly increase the number and quality of resident observations, addressing a previously insoluble problem with a relatively significant return on investment to the academic health center.
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Affiliation(s)
- Larrie Greenberg
- Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Potomac, Maryland, USA
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Graddy R, Reynolds SS, Wright SM. Longitudinal resident coaching in the outpatient setting: A novel intervention to improve ambulatory consultation skills. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:186-190. [PMID: 32232781 PMCID: PMC7283426 DOI: 10.1007/s40037-020-00573-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Direct observation with feedback to learners should be a mainstay in resident education, yet it is infrequently done and its impact on consultation skills has rarely been assessed. APPROACH This project presents the framework and implementation of a longitudinal low-frequency, high-intensity direct observation and coaching intervention, and elaborates on insights learned. Internal medicine interns at one residency training program were randomized to an ambulatory coaching intervention or usual precepting. Over one year, coached interns had three complete primary care visits directly observed by a faculty clinician-coach who provided feedback informed by a behavior checklist. Immediately after each of the coached patient encounters, interns completed a structured self-assessment and coaches led a 30-minute feedback session informed by intern self-reflection and checklist items. Interns with usual precepting had two mini-CEX observations over the course of the year without other formal direct observation in the ambulatory setting. EVALUATION As part of the post-intervention assessment, senior faculty members blinded to intervention and control group assignments evaluated videotaped encounters. Coached interns completed an average of 21/23 behaviors from the checklist, while interns from the control group completed 18 (p < 0.05). The median overall grade for coached interns was B+, compared to B-/C+ for controls (p < 0.05). REFLECTION Coaching interns longitudinally using a behavior checklist is feasible and associated with improved consultation performance. Direct observation of complete clinical encounters followed by systematic coaching is educationally valuable, but time and resource intensive.
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Affiliation(s)
- Ryan Graddy
- Division of Addiction Medicine, Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Stasia S Reynolds
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott M Wright
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Rea J, Stephenson C, Leasure E, Vaa B, Halvorsen A, Huber J, Bonnes S, Hafdahl L, Post J, Wingo M. Perceptions of scheduled vs. unscheduled directly observed visits in an internal medicine residency outpatient clinic. BMC MEDICAL EDUCATION 2020; 20:64. [PMID: 32131806 PMCID: PMC7057513 DOI: 10.1186/s12909-020-1968-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/17/2020] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Learners may subconsciously change their behavior once they know they are being observed, and this Hawthorne effect should be considered when designing assessments of learner behavior. While there is a growing body of literature to suggest direct observation is the ideal standard for formative assessment, the best method to directly observe learners is unknown. We explored scheduled and unscheduled methods of direct observation among internal medicine residents in the outpatient continuity clinic to advance the understanding of both observation methods. METHODS We conducted a thematic analysis of faculty and internal medicine residents in an outpatient clinic setting. A semi-structured interview guide for focus group sessions was created. Focus groups were used to explore the internal medicine resident and core teaching faculty perceptions of the scheduled and unscheduled direct observation methods in the outpatient clinc. An experienced qualitative research interviewer external to the internal medicine residency was moderating the sessions. Eight peer focus groups were held. Abstraction of themes from focus group transcripts identified resident and faculty perceptions of the different observation methods. RESULTS Focus groups had 14 resident participants and 14 faculty participants. Unscheduled observations were felt to be more authentic than scheduled observations since residents perceived their behavior to be unmodified. Unscheduled observations allowed for increased numbers of observations per resident, which permitted more frequent formative assessments. Residents and faculty preferred remote video observation compared to in-room observation. Participants found direct observation a useful learning tool for high-yield, specific feedback. CONCLUSIONS Unscheduled remote direct observation captures authentic clinical encounters while minimizing learner behavior modification. An unscheduled observation approach results in more frequent formative assessment and therefore in more instances of valuable feedback compared to scheduled observations. These findings can help guide the best practice approaches to direct clinical observation in order to enhance residents learning and experience.
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Affiliation(s)
- Joanna Rea
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55902 USA
| | | | - Emily Leasure
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55902 USA
| | - Brianna Vaa
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55902 USA
| | | | - Jill Huber
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55902 USA
| | - Sara Bonnes
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55902 USA
| | - Luke Hafdahl
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55902 USA
| | - Jason Post
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55902 USA
| | - Majken Wingo
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55902 USA
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Lockyer J. In-the-Moment Feedback and Coaching: Improving R2C2 for a New Context. J Grad Med Educ 2020; 12:27-35. [PMID: 32089791 PMCID: PMC7012514 DOI: 10.4300/jgme-d-19-00508.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The R2C2, a 4-phase feedback and coaching model, builds relationships, explores reactions, determines content and coaches for change, and facilitates formal feedback conversations between clinical supervisors/preceptors and residents. Formal discussions about performance are typically based on collated information from daily encounter sheets, objective structured clinical examinations, multisource feedback, and other data. This model has not been studied in settings where brief feedback and coaching conversations occur immediately after a specific clinical experience. OBJECTIVE We explored how supervisors adapt the R2C2 model for in-the-moment feedback and coaching and developed a guide for its use in this context. METHODS Eleven purposefully selected supervisors were interviewed in 2018 to explore where they used the R2C2 model, how they adapted it for in-the-moment conversations, and phrases used corresponding to each phase that could guide design of a new R2C2 in-the-moment model. RESULTS Participants readily adapted the model to varied feedback situations; each of the 4 phases were relevant for conversations. Phase-specific phrases that could enable effective coaching conversations in a limited amount of time were identified. Data facilitated a revision of the original R2C2 model for in-the-moment feedback and coaching conversations and design of an accompanying trifold brochure to enable its effective use. CONCLUSIONS The R2C2 in-the-moment model offers a systematic approach to feedback and coaching that builds on the original model, yet addresses time constraints and the need for an iterative conversation between the reaction and content phases. The model enables supervisors to coach and co-create an action plan with residents to improve performance.
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