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Soliman SI, McGuire W, Santos T, Goldberg C, Coffey C, Wooten D. Chalk Talks for the Clinical Setting: Evaluation of a Medical Education Workshop for Fellows. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11385. [PMID: 38445069 PMCID: PMC10912192 DOI: 10.15766/mep_2374-8265.11385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/20/2023] [Indexed: 03/07/2024]
Abstract
Introduction Chalk talks are effective teaching tools in the clinical setting. However, data on optimal strategies for teaching medical educators how to develop and deliver them are limited. We designed and implemented two 50-minute workshops to help subspecialty fellows across GME create and deliver a chalk talk. Methods The first workshop comprised a demonstration of an effective chalk talk and a discussion of best practices for creating chalk talks; the second was a practice session where fellows presented their chalk talks and received feedback from faculty and peers. We evaluated pre- and postworkshop confidence in the ability to create and deliver a chalk talk and develop learning objectives. Secondary outcomes were faculty and peer evaluations of the chalk talks. Results Eighteen of 33 participants (54% response rate) completed both pre- and postsession surveys. Fellows reported improved confidence in their ability to create a chalk talk (22% vs. 83%, p < .001), deliver a chalk talk (17% vs. 83%, p < .001), and develop well-written learning objectives (11% vs. 83%, p < .001). After the workshop, participants were more likely to correctly identify a chalk talk that made use of an advanced organizer (67% vs. 89%, p < .05). Thirty-eight faculty and peers completed feedback evaluations of participants' chalk talks; most rated fellows' chalk talks highly in domains of content, delivery, design, learning objectives, and engagement. Discussion The incorporation of these workshop within a course on medical education can effectively develop clinical teaching skills among subspecialty fellows in GME.
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Affiliation(s)
- Shady I. Soliman
- First-Year Resident, Department of Otolaryngology, University of California, Los Angeles, David Geffen School of Medicine
| | - William McGuire
- Assistant Professor of Medicine, Department of Medicine, University of California, San Diego, School of Medicine
| | - Tricia Santos
- Professor of Medicine, Department of Medicine, University of California, San Diego, School of Medicine
| | - Charlie Goldberg
- Professor of Medicine, Department of Medicine, University of California, San Diego, School of Medicine
| | - Charles Coffey
- Professor of Surgery, Department of Otolaryngology, University of California, San Diego, School of Medicine
| | - Darcy Wooten
- Professor of Medicine, Department of Medicine, University of California, San Diego, School of Medicine
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McDaniel LM, Molloy MJ, Blanck J, Beck JB, Shilkofski NA. The Chief Residency in U.S. and Canadian Graduate Medical Education: A Scoping Review. TEACHING AND LEARNING IN MEDICINE 2024:1-10. [PMID: 38247430 DOI: 10.1080/10401334.2023.2298870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
PHENOMENON Despite the nearly universal presence of chief residents within U.S. and Canadian residency programs and their critical importance in graduate medical education, to our knowledge, a comprehensive synthesis of publications about chief residency does not exist. An understanding of the current state of the literature can be helpful to program leadership to make evidence-based improvements to the chief residency and for medical education researchers to recognize and fill gaps in the literature. APPROACH We performed a scoping review of the literature about chief residency. We searched OVID Medline, PsycINFO, ERIC, and Web of Science databases through January 2023 for publications about chief residency. We included publications addressing chief residency in ACGME specialties in the U.S. and Canada and only those using the term "chief resident" to refer to additional responsibilities beyond the typical residency training. We excluded publications using chief residents as a convenience sample. We performed a topic analysis to identify common topics among studies. FINDINGS We identified 2,064 publications. We performed title and abstract screening on 1,306 and full text review on 208, resulting in 146 included studies. Roughly half of the publications represented the specialties of Internal Medicine (n = 37, 25.3%) and Psychiatry (n = 30, 20.5%). Topic analysis revealed six major topics: (1) selection of chief residents (2) qualities of chief residents (3) training of chief residents (4) roles of chief residents (5) benefits/challenges of chief residency (6) outcomes after chief residency. INSIGHTS After reviewing our topic analysis, we identified three key areas warranting increased attention with opportunity for future study: (1) addressing equity and bias in chief resident selection (2) establishment of structured expectations, mentorship, and training of chief residents and (3) increased attention to chief resident experience and career development, including potential downsides of the role.
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Affiliation(s)
- Lauren M McDaniel
- Department of Pediatrics, Division of Hospital Medicine, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Matthew J Molloy
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jaime Blanck
- Informationist Services, Welch Medical Library, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jimmy B Beck
- Department of Pediatrics, Division of Hospital Medicine, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Nicole A Shilkofski
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA
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Kay HG, Mahoney MR, Edwards RA. The Objective Structured Teaching Encounter (OSTE) in health professions education: A systematic review. MEDICAL TEACHER 2023:1-13. [PMID: 36940135 DOI: 10.1080/0142159x.2023.2189539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE New emphasis on the assessment of health professions educators' teaching competence has led to greater use of the Objective Structured Teaching Encounter (OSTE). The purpose of this study is to review and further describe the current uses and learning outcomes of the OSTE in health professions education. MATERIALS AND METHODS PubMed, MEDLINE, and CINAHL (March 2010 to February 2022) were searched for English-language studies describing the use of an OSTE for any educational purpose within health professions education. RESULTS Of the 29 articles that met inclusion criteria, over half of the studies (17 of 29, 58.6%) were published during or after 2017. Seven studies described OSTE use outside of the traditional medical education context. These new contexts included basic sciences, dental, pharmacy, and Health Professions Education program graduates. Eleven articles described novel OSTE content, which included leadership skills, emotional intelligence, medical ethics, inter-professional conduct, and a procedural OSTE. There is increasing evidence supporting the use of OSTEs for the assessment of clinical educators' teaching skills. CONCLUSIONS The OSTE is a valuable tool for the improvement and assessment of teaching within a variety of health professions education contexts. Further study is required to determine the impact of OSTEs on teaching behaviors in real-life contexts.
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Affiliation(s)
- Hannah G Kay
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Roger A Edwards
- Center for Interprofessional Studies and Innovation, MGH Institute of Health Professions, Boston, MA, USA
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Responsibilities of Internal Medicine Chief Residents in the Modern Era: A National Survey. ATS Sch 2023; 4:33-38. [PMID: 37089680 PMCID: PMC10117443 DOI: 10.34197/ats-scholar.2022-0096br] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/03/2022] [Indexed: 01/12/2023] Open
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Caruso C, Arias-Shah A, Rent S, Mukthapuram S, Dadiz R. Fellows as Teachers: Supporting Future Educators. Neoreviews 2022; 23:e438-e447. [PMID: 35773507 DOI: 10.1542/neo.23-7-e438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Teaching is inherent to the practice of medicine, as physicians are relied on to educate those around them, including staff, trainees, colleagues, and the patients and families for whom they provide care. Neonatal-perinatal medicine fellows uniquely serve as both trainee and subspecialty expert and are additionally expected to be strong teachers. In this article, the authors review the benefits of developing fellows as teachers, the challenges and potential mitigating strategies of fulfilling this objective, and the educational foundations and future directions that may inform the development of curricula for training fellows as teachers.
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Affiliation(s)
- Catherine Caruso
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - AnnaMarie Arias-Shah
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Orange County, Orange, CA
| | - Sharla Rent
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Shanmukha Mukthapuram
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rita Dadiz
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
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Serling-Boyd N, Miloslavsky EM. Enhancing the Inpatient Consultation Learning Environment to Optimize Teaching and Learning. Rheum Dis Clin North Am 2021; 46:73-83. [PMID: 31757288 DOI: 10.1016/j.rdc.2019.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Subspecialty consultation is an increasingly used resource in inpatient medicine. Teaching the primary team is an important element of effective consultation and has many potential benefits. However, within academic medical centers many barriers to effective consultation and the consult learning environment exist. High workload, burnout, inexperience, lack of familiarity between teams, quality of the consult requests, and pushback may impede teaching and learning. Herein, the authors review the role of teaching and learning during consultation, challenges to effective consultation facing fellows, and interventions that can enhance primary team-fellow interactions and learning.
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Affiliation(s)
- Naomi Serling-Boyd
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA
| | - Eli M Miloslavsky
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA.
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Marshall AL, Thompson CA, Cullen MW, Raffals LE, Oxentenko AS. Medical Education Interest, Exposure, and Career Planning in Subspecialty Trainees. MEDICAL SCIENCE EDUCATOR 2020; 30:1011-1014. [PMID: 34457761 PMCID: PMC8368290 DOI: 10.1007/s40670-020-01007-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We conducted a survey of subspecialty fellows at a three-site academic institution and characterized fellows' perception of, interest, and training in medical education. One hundred sixty-nine of 530 (31.9%) fellows responded. Most (78.2%) planned careers in academic medicine. Fellows' conception of medical education involved supervising trainees clinically (93.5%), classroom teaching (89.3%), and providing mentorship (87.6%). While only 30.2% had received formal training in medical education, 61.5% felt it should be required for careers with strong educational components. This study provides evidence for the creation and promotion of educational training programs for trainees interested in careers involving medical education.
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Affiliation(s)
- Ariela L. Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Mayo Building 10th Floor, 10-90E, 200 First Street SW, Rochester, MN 55905 USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
- Mayo Clinic Alix School of Medicine, Rochester, MN USA
| | - Carrie A. Thompson
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Mayo Building 10th Floor, 10-90E, 200 First Street SW, Rochester, MN 55905 USA
| | - Michael W. Cullen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | - Laura E. Raffals
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Amy S. Oxentenko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
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Timme KH, Hafler JP, Encandela J, Colson ER, Weinzimer SA, Asnes A, Gaither JR, Guest J, Murtha TD, Weiss P. Fellows as Medical Educators: Implementation and Evaluation of a Curriculum to Improve Pediatric Fellow Teaching Skills. Acad Pediatr 2020; 20:140-142. [PMID: 31330315 DOI: 10.1016/j.acap.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Kathleen H Timme
- Department of Pediatrics (KH Timme), University of Utah School of Medicine, Salt Lake City, Utah.
| | - Janet P Hafler
- Teaching and Learning Center (JP Hafler and J Encandela), Yale University School of Medicine, New Haven, Conn
| | - John Encandela
- Teaching and Learning Center (JP Hafler and J Encandela), Yale University School of Medicine, New Haven, Conn
| | - Eve R Colson
- Washington University School of Medicine (ER Colson), St Louis, Mo
| | - Stuart A Weinzimer
- Department of Pediatrics (SA Weinzimer, A Asnes, JR Gaither, J Guest, TD Murtha, and P Weiss), Yale University School of Medicine, New Haven, Conn
| | - Andrea Asnes
- Department of Pediatrics (SA Weinzimer, A Asnes, JR Gaither, J Guest, TD Murtha, and P Weiss), Yale University School of Medicine, New Haven, Conn
| | - Julie R Gaither
- Department of Pediatrics (SA Weinzimer, A Asnes, JR Gaither, J Guest, TD Murtha, and P Weiss), Yale University School of Medicine, New Haven, Conn
| | - Julie Guest
- Department of Pediatrics (SA Weinzimer, A Asnes, JR Gaither, J Guest, TD Murtha, and P Weiss), Yale University School of Medicine, New Haven, Conn
| | - Tanya D Murtha
- Department of Pediatrics (SA Weinzimer, A Asnes, JR Gaither, J Guest, TD Murtha, and P Weiss), Yale University School of Medicine, New Haven, Conn
| | - Pnina Weiss
- Department of Pediatrics (SA Weinzimer, A Asnes, JR Gaither, J Guest, TD Murtha, and P Weiss), Yale University School of Medicine, New Haven, Conn
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Teacher training for rheumatology fellows: a national needs assessment of fellows and program directors. Clin Rheumatol 2019; 39:673-680. [PMID: 31832802 DOI: 10.1007/s10067-019-04829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/07/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Teaching is an integral part of what we do as physicians, and exposure to training on how to effectively teach is not consistently implemented in the curricula within medical training. METHODS We administered anonymous, in-person surveys to fellows and program directors (PDs) at the 2017 American College of Rheumatology national conference to evaluate fellow and PD attitudes regarding development of programs dedicated to teaching fellows on how to teach. RESULTS One hundred seven of 150 fellows returned surveys (response rate 71%). About 60% demonstrated interest in pursuing a teaching-focused career. About 97% felt their teaching skills can be improved; 88% felt improved teaching skills will be valuable for their career. With 61% response rate (57/94 PD surveys), most PDs agreed their fellows could use additional instruction in teaching. About 90% noted this would be an asset for fellows' careers. When compared, 56% of fellows reported no structured training in education during fellowship, while 64% of PDs said this type of training was available. All agreed fellow teaching skills can be improved but significantly more fellows than faculty felt confident in the fellows' ability to give feedback (p = 0.03). Both groups identified time constraints and other faculty interest as barriers. CONCLUSION There is significant need to develop effective fellow-as-teacher programs aimed at enhancing fellows' teaching skills, with focus on giving feedback and working within fellow and faculty time constraints. The program can help address a curriculum gap identified by fellows as well as PDs before fellowship-to-faculty transition.Key Points• There is a notable gap between faculty physicians' expectations to teach as clinician-educators and the lack of training dedicated to learning how to teach during medical training. Despite the fact that past clinical educators have identified instructional design and assessment as low-confidence areas, there is a paucity of structured program dedicated to developing these teaching skills during fellowship training.• With 97% fellows and 84% program directors, both groups agreed fellows could use additional instruction in teaching skills, but there was a significant discrepancy between fellow and program director perspectives regarding fellows' ability to give feedback.• Consistent with past needs assessments in other medical specialties, lack of time and potential faculty interest were recognized as potential barriers, calling for a structured training program dedicated to education on didactics that takes into account trainee and faculty time constraints.• Our needs assessment can direct future research on analyzing effectiveness of fellow-as-teacher program implementation by focusing on improvement of fellow teaching and feedback skills.
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Baylis J, Miloslavsky EM, Woods R, Chan TM. Conquering Consultations: A Guide to Advances in the Science of Referral-Consultation Interactions for Residency Education. Ann Emerg Med 2019; 74:119-125. [PMID: 30661857 DOI: 10.1016/j.annemergmed.2018.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Indexed: 11/16/2022]
Abstract
Consultations with specialist services occur with regularity in the emergency department (ED). Emergency physician interactions with consultants in the ED offer an amazing opportunity for collegial patient care but can also present a number of challenges. Navigating the consultation process requires effective communication skills that are considered a core competency within the Accreditation Council for Graduate Medical Education, as well as the CanMEDS frameworks of the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada. Because of time pressure, environmental complexities, patient acuity, and the fast pace of the ED, learning this skill can be challenging for trainees and is something many attending physicians will struggle with at times. It has been established that trustworthiness and familiarity are 2 key components within the referral-consultation process. Both components rely on reputation, which creates a challenge in a training environment in which one's knowledge base and clinical acumen is a constant work in progress. Moreover, poor communication contributes to problematic patient care and decreased patient satisfaction. Knowing this, we believe it is imperative that residents be formally trained in this important skill. In this article, we introduce and highlight the most recent advances in standardized approaches to the referral-consultation process, including the 5C (contact, communicate, core question, collaborate, close the loop), PIQUED (prepare, identify, question, urgency, educational modifications, debrief), and CONSULT (contact courteously, orient, narrow question, story, urgency, later, thank you) models. Common roadblocks and complicating factors involved in resident-consultant interaction are also reviewed, ending with best-practice recommendations for consultants involved in resident education, as well as free open access medical education resources.
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Affiliation(s)
- Jared Baylis
- Department of Emergency Medicine, University of British Columbia, Kelowna, British Columbia, Canada.
| | - Eli M Miloslavsky
- Department of Medicine, Division of Rheumatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Rob Woods
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Teresa M Chan
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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McSparron JI, Huang GC, Miloslavsky EM. Developing internal medicine subspecialty fellows' teaching skills: a needs assessment. BMC MEDICAL EDUCATION 2018; 18:221. [PMID: 30249229 PMCID: PMC6154890 DOI: 10.1186/s12909-018-1283-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 07/19/2018] [Indexed: 05/12/2023]
Abstract
BACKGROUND For academic physicians, teaching represents an essential skill. The proliferation of educator training programs aimed at residents and medical students signals the increasing commitment of training programs to develop teaching skills in their trainees as early as possible. However, clinical fellowships represent an important opportunity to advance training as educators. In addition to enriching the pipeline of future teachers, developing fellows as teachers augments the training experience for more junior trainees and may impact patient care. Fellows' needs for programs to improve teaching skills have been largely unexplored. METHODS We conducted a multi-institutional needs assessment of internal medicine (IM) subspecialty fellows to gauge interest in teaching and improvement of teaching skills. We surveyed IM subspecialty fellows at three academic medical centers about their access to fellow-as-teacher programs and other mechanisms to improve their teaching skills during fellowship. We also elicited their attitudes towards teaching and interest in training related to teaching skills. RESULTS One hundred eighty-three fellows representing 20 programs and nine different subspecialties responded to the survey (48% response rate). The majority of participants (67%) reported having no specific training focused on teaching skills and only 12% reported receiving regular feedback about their teaching during their fellowship. Seventy-nine percent of fellows anticipated teaching to be part of their careers, and 22% planned to participate in medical education scholarship. Fellows reported a strong interest in teaching and programs aimed at improving their teaching skills. CONCLUSIONS The majority of fellows reported a lack of mechanisms to advance their teaching skills as fellows, despite anticipating teaching to be an important aspect of their future careers and having strong interest in such programs. Our findings at three academic medical centers confirm a lost opportunity among subspecialty fellowships to accelerate teaching skills development for future educators.
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Affiliation(s)
- Jakob I. McSparron
- Division of Pulmonary and Critical Care Medicine, University of Michigan, 3916 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
| | - Grace C. Huang
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215 USA
| | - Eli M. Miloslavsky
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Yawkey Center for Outpatient Care, 55 Fruit Street, Suite 2C, Boston, MA 02114 USA
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Chen DC, Miloslavsky EM, Winn AS, McSparron JI. Fellow as Clinical Teacher (FACT) Curriculum: Improving Fellows' Teaching Skills During Inpatient Consultation. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10728. [PMID: 30800928 PMCID: PMC6342376 DOI: 10.15766/mep_2374-8265.10728] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Multiple barriers, including time constraints, a demanding teaching environment, and lack of longitudinal relationships with residents, make it challenging for fellows and learners to engage in effective teaching during consultation. METHODS The Fellow as Clinical Teacher (FACT) curriculum was developed to overcome such barriers and improve fellow teaching in the setting of inpatient consultation. The FACT curriculum consists of two 45- to 60-minute small-group sessions designed for subspecialty fellows. The first session focuses on overcoming barriers to teaching and application of the principles of adult learning theory. The second introduces the PARTNER (partner with resident, assess the learner, reinforce positives, teaching objectives, new knowledge, execute recommendations, review) framework for teaching during consultation and uses video examples to model the application of this framework, allowing fellows to practice its implementation through role-play. RESULTS Previously, the FACT curriculum was shown to improve teaching skills of rheumatology and pulmonary/critical care fellows as evaluated by objective structured teaching exercises. Here, the curriculum has been expanded to 51 internal medicine and pediatrics fellows in 15 different training programs. The curriculum improved fellow teaching skills as assessed by self-assessment surveys. It was highly rated by participants, and fellows reported being more likely to teach during consultation following this educational intervention. DISCUSSION The FACT curriculum can be integrated into subspecialty training programs to improve the teaching skills of internal medicine and pediatrics fellows in the setting of inpatient consultation. Ultimately, improved teaching from fellows may have broad-reaching effects for residents, patients, and the fellows themselves.
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Affiliation(s)
- Debbie C Chen
- Internal Medicine Resident, Massachusetts General Hospital
| | - Eli M Miloslavsky
- Assistant Professor of Medicine, Harvard Medical School
- Member, Division of Rheumatology, Massachusetts General Hospital
| | - Ariel S Winn
- Instructor in Pediatrics, Harvard Medical School
- Member, Division of General Pediatrics, Boston Children's Hospital
| | - Jakob I McSparron
- Assistant Professor, Division of Pulmonary and Critical Care Medicine, University of Michigan
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Rope R, Merrell SB, Stedman M, Young B. Education in consultation: A comparative survey-based assessment of perceived educational effectiveness within a university and community-based internal medicine residency. MEDEDPUBLISH 2017; 6:153. [PMID: 38406436 PMCID: PMC10885288 DOI: 10.15694/mep.2017.000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Background: Education in consultation is a potentially valuable, but understudied, element of medical education. Inpatient consultation is an opportunity for significant subspecialist contact for resident trainees and an avenue for improving their knowledge and patient care across content areas. We evaluated the perceived educational effectiveness of education in consultation among internal medicine residents, within a university and a community-based program, as well as the role of barriers in medical training that may limit education. Methods: We used a web-based survey expanded from a previously published survey consisting of 12 questions, including one free-response, on education in consultation. Data were analyzed descriptively and qualitatively. We surveyed residents from two internal medicine programs in 2016. One within a large university-based hospital and the second within a smaller community-based safety-net hospital. Results: 91/198 (46%) of residents responded. Overall results from both programs were similar despite their structural differences. Residents viewed education in consultation as a priority and the majority felt it was at least moderately effective but underutilized. Importantly, educational interactions are largely dependent on outreach from residents. While in-person teaching interactions were the most effective, key barriers to these interactions include a lack of time, difficulty locating residents, and the perception of residents as being too busy. Conclusions: Inpatient consultation offers a unique opportunity for specialist-led education for internal medicine residents. It is potentially effective but constrained extensively in modern training environments. Interventions aimed at emphasizing education in consultation within fellowships and residencies, increasing in-person resident-specialist interactions, and addressing structural barriers, may improve resident knowledge across specialties and strengthen patient care.
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Affiliation(s)
- Robert Rope
- Oregon Health and Science University Division of Nephrology and Hypertension
| | | | | | - Brian Young
- University of California at Davis School of Medicine Division of Nephrology
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Miloslavsky EM, Criscione-Schreiber LG, Jonas BL, O'rourke KS, McSparron JI, Bolster MB. Fellow As Teacher Curriculum: Improving Rheumatology Fellows' Teaching Skills During Inpatient Consultation. Arthritis Care Res (Hoboken) 2017; 68:877-81. [PMID: 26414763 DOI: 10.1002/acr.22733] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/01/2015] [Accepted: 09/15/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Enhancing rheumatology fellows' teaching skills in the setting of inpatient consultation may have a broad positive impact. Such efforts may improve fellows' clinical skills and overall patient care. Most importantly, effective resident-fellow teaching interactions may not only increase residents' knowledge of rheumatology but may influence their career choice. However, a number of barriers to the resident-fellow teaching interaction have been identified, including fellows' teaching skills. We developed the Fellow As Clinical Teacher (FACT) curriculum in order to enhance fellows' teaching skills during inpatient consultation. METHODS The FACT curriculum was delivered in two 45-minute workshops during the 3-day Winter Symposium of the Carolinas Fellows Collaborative. We evaluated its effect with self-assessment surveys and fellow performance on the objective structured teaching exercise (OSTE) before and after participation in the curriculum. RESULTS Nineteen fellows from 4 rheumatology training programs participated in the pre- and post-curriculum OSTEs and 18 fellows completed pre- and post-curriculum surveys. OSTE scores improved on 5 of the 8 items assessed, and the total OSTE score improved as well (34.7 versus 29.5; P < 0.01) after the FACT curriculum. Fellows' self-assessment of their teaching skills and intent to teach during consultation also increased after participation in the curriculum. CONCLUSION The FACT curriculum, focused on teaching during consultation, improved fellows' teaching skills and attitudes toward teaching. Improving and increasing fellow teaching, particularly in the consultation setting, may impact patient care, resident and fellow learning, and teaching skills of future faculty, and could potentially influence residents' career choice.
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Affiliation(s)
| | | | - Beth L Jonas
- University of North Carolina and Thurston Arthritis Research Center, Chapel Hill, North Carolina
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Miloslavsky EM. Use of Fellow as Clinical Teacher (FACT) Curriculum for Teaching During Consultation: Effect on Subspecialty Fellow Teaching Skills. J Grad Med Educ 2017; 9. [PMID: 28638515 PMCID: PMC5476386 DOI: 10.4300/jgme-d-16-00464.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Subspecialty consultation in inpatient care is increasing. Teaching by subspecialty fellows in a consultation setting may be an important source of work-based learning for students and residents. However, teaching and evaluation of learners in this context may be challenging due to personal and systems-based barriers. OBJECTIVE We developed and evaluated a framework designed to overcome barriers to teaching and to improve fellow teaching skills during inpatient consultation. METHODS The PARTNER (Partner with resident, Assess the learner, Reinforce positives, Teaching objectives, New knowledge, Execute recommendations, Review) framework was delivered to rheumatology and pulmonary and critical care medicine fellows at 3 academic medical centers as part of a 2-session Fellow as Clinical Teacher (FACT) curriculum. Fellows' teaching skills were evaluated using an objective structured teaching exercise (OSTE) pre- and postcurriculum, and at the end of the academic year. Self-assessment surveys were used to evaluate fellows' self-perception of teaching skills. RESULTS Twelve of 16 eligible fellows (75%) participated in the program and completed 73 OSTE cases. Teaching skills measured by OSTEs and self-assessment surveys improved after administration of the FACT curriculum. There was no significant skill decay at the end-of-year evaluation. The curriculum was rated highly, and 73% (8 of 11) of fellows stated they would teach more frequently as a result of the intervention. CONCLUSIONS The FACT curriculum was practical and feasible, and significantly improved fellows' teaching skills teaching during inpatient consultation.
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Daouk-Öyry L, Zaatari G, Sahakian T, Rahal Alameh B, Mansour N. Developing a competency framework for academic physicians. MEDICAL TEACHER 2017; 39:269-277. [PMID: 28019135 DOI: 10.1080/0142159x.2017.1270429] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND There is a mismatch between the requirements of the multifaceted role of academic physicians and their education. Medical institutions use faculty development initiatives to support their junior academic physicians, however, these rarely revolve around academic physician competencies. The aim of this study was to identify these academic physician competencies and develop a competency framework customized to an organizational context. METHODS The authors conducted semi-structured interviews and Critical Incident Technique with 25 academic physicians at a teaching medical center in the Middle East region inquiring about the behaviors of academic physicians in teaching, clinical, research, and administrative roles. RESULTS Using content analysis, the authors identified 16 competencies: five "Supporting Competencies", common to all four roles of academic physicians, and 11 "Function-Specific Competencies", specific to the role being fulfilled. The developed framework shared similarities with frameworks reported in the literature but also had some distinctions. CONCLUSIONS The framework developed represents a step towards closing the gap between the skills medical students are taught and the skills required of academic physicians. The model was customized to the context of the current organization and included a future orientation and addressed the literature calling for increasing focus on the administrative skills of academic physicians.
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Affiliation(s)
- Lina Daouk-Öyry
- a Suliman S. Olayan School of Business , American University of Beirut , Beirut , Lebanon
- b Evidence-based Healthcare Management Unit, Faculty of Medicine , American University of Beirut , Beirut , Lebanon
| | - Ghazi Zaatari
- c Department of Pathology and Laboratory Medicine, Faculty of Medicine , American University of Beirut , Beirut , Lebanon
| | - Tina Sahakian
- b Evidence-based Healthcare Management Unit, Faculty of Medicine , American University of Beirut , Beirut , Lebanon
| | - Boushra Rahal Alameh
- d Department of Post Graduate Medicine, Faculty of Medicine , American University of Beirut , Beirut , Lebanon
| | - Nabil Mansour
- d Department of Post Graduate Medicine, Faculty of Medicine , American University of Beirut , Beirut , Lebanon
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Abstract
Fellows are expected to educate trainees, peers, and patients, during and long after fellowship. However, there has been relatively little emphasis on the acquisition of teaching skills in fellowship programs. Challenges to teaching by fellows during subspecialty training include demanding clinical duties, their limited knowledge base in the field, brief contact time with learners during consultative roles, and, for new fellows, personal unfamiliarity with the learners and hospital culture. Fellows' teaching skills can be improved by formal curricula addressing teaching, and by direct observation and feedback of teaching akin to what is provided for learning clinical care. Further expansion of fellow-as-teacher programs will allow in-depth training for fellows seeking careers as medical educators. Even without such dedicated programs, emphasis on honing teaching skills during fellowship will telegraph the importance of teaching and help evolve divisional culture. Such efforts can have a positive impact on patients and learners, and enhance the teaching skills of future faculty.
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Gupta S, Alladina J, Heaton K, Miloslavsky E. A randomized trial of an intervention to improve resident-fellow teaching interactions on the wards. BMC MEDICAL EDUCATION 2016; 16:276. [PMID: 27765029 PMCID: PMC5072305 DOI: 10.1186/s12909-016-0796-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/08/2016] [Indexed: 06/03/2023]
Abstract
BACKGROUND Subspecialty fellows can serve as a tremendous educational resource to residents; however, there are multiple barriers to an effective resident-fellow teaching interaction in the setting of inpatient consultation. We designed and evaluated a resident-directed intervention to enhance communication and teaching during consultation on the general medicine wards. METHODS Five medical teams were randomized to receive the intervention over a 3 month period (3 control, 2 intervention teams). The intervention was evaluated with pre and post-intervention surveys. RESULTS Fifty-nine of 112 interns completed the pre-intervention survey, and 58 completed the post-intervention survey (53 % response rate). At baseline, 83 % of the interns noted that they had in-person interactions with fellows less than 50 % of the time. 81 % responded that they received teaching from fellows in less than 50 % of consultations. Following the intervention, the percentage of interns who had an in-person interaction with fellows greater than 50 % of the time increased in the intervention group (9 % control versus 30 % intervention, p = 0.05). Additionally, interns in the intervention group reported receiving teaching in more than 50 % of their interactions more frequently (19 % control versus 42 % intervention, p = 0.05). There were no differences in other measures of teaching and communication. CONCLUSIONS We demonstrate that a time-efficient intervention increased perceptions of in-person communication and the number of teaching interactions between interns and fellows. Further studies are warranted to determine whether such an approach can impact resident learning and improve patient care.
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Affiliation(s)
- Shruti Gupta
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Jehan Alladina
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - Kevin Heaton
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Eli Miloslavsky
- Division of Rheumatology, Department of Medicine, Massachusetts General Hospital, Yawkey Center for Outpatient Care, Harvard Medical School, 55 Fruit Street, Suite 2C, Boston, MA 02114 USA
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Miloslavsky EM, McSparron JI, Richards JB, Puig A, Sullivan AM. Teaching during consultation: factors affecting the resident-fellow teaching interaction. MEDICAL EDUCATION 2015; 49:717-30. [PMID: 26077219 DOI: 10.1111/medu.12760] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/23/2015] [Accepted: 03/30/2015] [Indexed: 05/26/2023]
Abstract
OBJECTIVES The subspecialty consultation represents a potentially powerful opportunity for resident learning, but barriers may limit the educational exchanges between fellows (subspecialty registrars) and residents (house officers). We conducted a focus group study of internal medicine (IM) residents and subspecialty fellows to determine barriers against and factors facilitating resident-fellow teaching interactions on the wards, and to identify opportunities for maximising teaching and learning. METHODS We conducted four focus groups of IM residents (n = 18) and IM subspecialty fellows (n = 16) at two academic medical centres in the USA during February and March 2013. Participants represented trainees in all 3 years of residency training and seven IM subspecialties. Four investigators analysed the transcripts using a structured qualitative framework approach, which was informed by literature on consultation and the theoretical framework of activity theory. RESULTS We identified two domains of barriers and facilitating factors: personal and systems-based. Sub-themes in the personal domain included fellows' perceived resistance to consultations, residents' willingness to engage in teaching interactions, and perceptions and expectations. Sub-themes in the systems-based domain included the process of requesting the consult, the quality of the consult request, primary team structure, familiarity between residents and fellows, workload, work experience, culture of subspecialty divisions, and fellows' teaching skills. These barriers differentially affected the two stages of the consult identified in the focus groups (initial interaction and follow-up interaction). CONCLUSIONS Residents and fellows want to engage in positive teaching interactions in the context of the clinical consult; however, multiple barriers influence both parties in the hospital environment. Many of these barriers are amenable to change. Interventions aimed at reducing barriers to teaching in the setting of consultation hold promise for improving teaching and learning on the wards.
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Affiliation(s)
- Eli M Miloslavsky
- Division of Rheumatology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jakob I McSparron
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeremy B Richards
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alberto Puig
- Clinician Educator Service, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Amy M Sullivan
- Shapiro Institute for Education and Research, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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