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Jaros BD, Gad I, Bolster MB, Dua AB. Addressing the Rheumatology Workforce Shortage: Clinician Educators. Arthritis Care Res (Hoboken) 2024; 76:585-589. [PMID: 38148587 DOI: 10.1002/acr.25286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Brian D Jaros
- Northwestern University and Northwestern University Hospital, Chicago, Illinois
| | | | - Marcy B Bolster
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anisha B Dua
- Northwestern University and Northwestern University Hospital, Chicago, Illinois
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2
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Inchaustegui CA, Agrawal S, Kulkarni PA. Teaching during Consults: Effects of Multiple Educational Interventions on Satisfaction with Consultant Interactions among Internal Medicine Residents. South Med J 2023; 116:506-510. [PMID: 37263615 DOI: 10.14423/smj.0000000000001562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the effect of an educational intervention on Internal Medicine residents' satisfaction with the inpatient consultation process. METHODS We hosted an optional workshop for Internal Medicine residents on placing and responding to consults using two memory aid tools. We then provided copies of these memory aids to residents on inpatient Medicine and Infectious Diseases teams, and later surveyed all of the residents who were finishing their inpatient Medicine rotation. Surveys assessed residents' participation in the workshop, receipt of the memory-aid tools, and satisfaction with Infectious Diseases consultation using a 5-point Likert scale. Residents were organized into the following groups: group 1 residents were exposed to the workshop and both memory aid tools; group 2 residents were exposed only to the "responding to consults" memory aid tool; group 3 residents were exposed to the workshop and the "placing consults" memory aid tool; and group 4 residents were not exposed to any interventions. We compared the percentage of satisfied residents among groups. RESULTS A total of 36 out of 69 residents answered our survey (response rate of 52%). Among survey respondents, 7 (19.4%) were in group 1, 8 (22.2%) in group 2, 10 (27.8%) in group 3, and 11 (30.6%) in group 4. Group 4 residents had lower satisfaction with the overall consultation process (36.4% residents satisfied vs 90%-100% in the intervention groups, P < 0.001), the consultant's professionalism (54.5% vs 100%, P = 0.002), communication between the primary team and the consultant (54.5% vs 90%-100%, P = 0.01), and teaching received from the consultant (18.2% vs 57.1%-80.0%, P = 0.02). CONCLUSIONS An educational workshop and use of structured memory aids can lead to improved resident satisfaction with the consultation process.
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Affiliation(s)
- Christian A Inchaustegui
- From the Department of Internal Medicine, University of Texas Health Science Center, San Antonio
| | - Suchi Agrawal
- Department of Internal Medicine, Baylor College of Medicine, Houston
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3
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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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Chiel L, Winthrop Z, Huth K, Gross CJ, Gomez A, Marcus CH, Winn AS. Bridge Builders: A Qualitative Study of Fellows' Successful Supervision of Residents. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1195-1202. [PMID: 35385408 DOI: 10.1097/acm.0000000000004687] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Clinical fellows, those training to become subspecialists in a program certified by the Accreditation Council for Graduate Medical Education, supervise residents on inpatient subspecialty rotations. Unlike for supervising residents or for faculty, there is a paucity of literature describing fellows' supervision of residents. The aim of this study was to understand residents' and fellows' perception of successful supervision of residents by fellows on inpatient subspecialty rotations to inform the development of curricula to support fellows as supervisors. METHOD Using grounded theory methodology, the authors held focus groups in May 2020 of pediatric residents and pediatric subspecialty fellows at Boston Children's Hospital, Boston, Massachusetts. Focus groups were conducted until thematic saturation was achieved. Deidentified transcripts were independently coded by 2 authors. The author team consolidated the codes into themes and developed an interpretive model for fellows' successful supervision of residents. Key results were confirmed via member checking. RESULTS The authors conducted 4 resident focus groups, composed of 16 pediatric residents, and 4 fellow focus groups, composed of 13 pediatric subspecialty fellows. Participants perceived that fellows who provided successful resident supervision advanced residents' professional growth and supported residents' development along 5 "bridges": (1) generalist to subspecialist, (2) trainee to autonomous practitioner, (3) individual to member of the interprofessional team, (4) emerging physician to patient-facing care provider, and (5) newcomer to engaged clinical learner. Fellows can further residents' growth in these areas by demonstrating approachability, empathy, appreciation, and kindness. CONCLUSIONS As newcomers on inpatient subspecialty rotations, residents engage in legitimate peripheral participation. Fellows who are successful supervisors move residents toward full participation in their profession via the bridge model. The fellow-resident dynamic carries advantages of near-peer learning. Fellows can harness their role, subspecialty knowledge, and familiarity with the training environment to enhance resident supervision.
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Affiliation(s)
- Laura Chiel
- L. Chiel is a fellow, Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Zachary Winthrop
- Z. Winthrop is chief resident, Boston Combined Residency Program, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, and Department of Pediatrics, Boston Medical School and Boston University School of Medicine, Boston, Massachusetts
| | - Kathleen Huth
- K. Huth is assistant professor, Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Caroline J Gross
- C.J. Gross is a fellow, Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amanda Gomez
- A. Gomez is a fellow, Division of Gastroenterology, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carolyn H Marcus
- C.H. Marcus is an instructor, Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ariel S Winn
- A.S. Winn is assistant professor, Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Feijó LP, Pereira GA, Ruffini VMT, Valente FS, dos Santos RA, Fakhouri SA, Nunes MDPT, Augusto KL. Effectiveness of a SNAPPS in psychiatric residents assessed using objective structured teaching encounters: a case-control study. SAO PAULO MED J 2022; 141:e20211028. [PMID: 36197349 PMCID: PMC10065108 DOI: 10.1590/1516-3180.2021.1028.r1.13072022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Residents play the role of teachers in almost one-quarter of their activities in residency programs. OBJECTIVE To evaluate whether a 45-minute class using summarize, narrow, analyze, probe, plan, and select (SNAPPS) could improve psychiatry residents' case discussion skills in diverse practical learning settings. DESIGN AND SETTING This case-control, randomized, blinded study was conducted in a psychiatry hospital at Fortaleza-Ceará. METHODS Using "resident as teacher" (RaT), objective structured teaching encounters (OSTEs), and SNAPPS, we conducted a study with 26 psychiatry residents. We analyzed video footage of psychiatric cases in three settings: outpatient, nursing, and emergency. An intervention was held two months later with the residents, who were then assigned to two groups: group A (lecture on SNAPPS) and group B (lecture on a topics in psychiatry). Shortly after the lectures, they were video recorded while discussing the same cases. Three blinded examiners analyzed the videos using an instrument based on the Stanford Faculty Development Program (SFDP-26). RESULTS We found high internal consistency among external examiners and an interaction effect, group effect, and moment effect (P < 0.05). The residents who received the SNAPPS lecture scored significantly higher than their counterparts who received a traditional case presentation. CONCLUSION This study indicates the efficacy of SNAPPS over traditional case presentation in all three settings as assessed by OSTEs and supports its implementation to improve the teaching of clinical reasoning.
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Affiliation(s)
- Lorena Pinho Feijó
- MSc. Physician and Assistant Professor, Department of Social
Department, Centro Universitário Unichristus, Fortaleza (CE), Brazil
| | - Guilherme Abreu Pereira
- MD. Attending Physician, Department of Internal Medicine,
Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo,
Sao Paulo, SP, BR
| | - Vitor Maia Teles Ruffini
- MD. Physician and Associate Professor, Department of Internal
Medicine, Universidade Santo Amaro (UNISA), São Paulo (SP), Brazil; and Fellow
of Hospital Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo,
Sao Paulo, SP, BR
| | - Fernando Salvetti Valente
- MD. Physician and Assistant Professor, Department of Internal
Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP,
BR
| | - Renato Antunes dos Santos
- PhD. Physician and Assistant Professor, Department of
Psychiatry, University of Toronto, Toronto, Canada. And Adjunct Professor,
Department of Psychiatry, McMaster University, Ontario, Canada
| | - Saadallah Azor Fakhouri
- PhD. Physician and Professor, Department of Internal Medicine,
Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil
| | - Maria do Patrocínio Tenório Nunes
- PhD. Physician and Associate Professor, Department of Internal
Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP,
BR
| | - Kristopherson Lustosa Augusto
- PhD. Physician and Assistant Professor, Department of
Internal Medicine, Faculdade de Medicina, Universidade de Fortaleza (UNIFOR),
Fortaleza (CE), Brazil; Postgraduate Professor at master's level, Centro
Universitário Christus-Unichristus Fortaleza (CE), Brazil; and Assistant
Professor, Department of Internal Medicine, Faculdade de Medicina da
Universidade Federal do Ceará (UFC), Fortaleza (CE), Brazil
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Savaria MC, Min S, Aghagoli G, Tunkel AR, Hirsh DA, Michelow IC. Enhancing the one-minute preceptor method for clinical teaching with a DEFT approach. Int J Infect Dis 2021; 115:149-153. [PMID: 34883233 PMCID: PMC8805221 DOI: 10.1016/j.ijid.2021.12.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/04/2022] Open
Abstract
Few validated methods that are grounded in educational theory exist to effectively teach medical knowledge, clinical skills, and diagnostic reasoning to learners at different stages of medical training. The goal of this Perspective was to address potential gaps in clinical education pedagogy by modeling new concepts for teaching in the field of infectious diseases. Our approach involved synthesizing the relevant literature, identifying proven approaches, and enhancing an existing educational microskills model — the one-minute preceptor. Our strategy was to emphasize the essential core elements of the one-minute preceptor using a descriptive acronym — DEFT (Diagnosis, Evidence, Feedback, Teaching), meaning skillful — as a potentially helpful reminder to improve the quality of interactions between learners and preceptors. The need for learners to discuss risk factors, mechanisms of disease, and potential complications, and for preceptors to model analytical and diagnostic skills, was further illustrated using a practical example of a teacher-learner interaction about a child with a respiratory infection. The one-minute preceptor/DEFT approach is experiential, adaptable, case-driven, and skills-focused, and also applicable to clinical training in other specialties.
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Affiliation(s)
- Michael C Savaria
- Office of Medical Education, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sugi Min
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ghazal Aghagoli
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Allan R Tunkel
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - David A Hirsh
- Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Ian C Michelow
- Department of Pediatrics, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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7
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Brondfield S, Blum AM, Lee K, Linn MC, O'Sullivan PS. The Cognitive Load of Inpatient Consults: Development of the Consult Cognitive Load Instrument and Initial Validity Evidence. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1732-1741. [PMID: 34039851 DOI: 10.1097/acm.0000000000004178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Fellows and residents provide inpatient consultations. Though consults vary considerably, measuring the associated cognitive load (CL) is key to guiding faculty on how to optimize learning during consults. However, existing CL instruments, such as the unidimensional Paas scale, cannot separate the 3 components of CL and may miss the nuances of consult CL. Therefore, the authors developed the Consult Cognitive Load (CCL) instrument to measure the 3 CL components during consults. METHOD In 2018-2019, the authors developed the CCL at the University of California, San Francisco, using Wilson's constructive approach to measurement. To generate content and response process validity evidence, the authors consulted the literature and experts to generate construct maps, items, and a scoring rubric and conducted cognitive interviews. They administered the CCL to internal medicine and psychiatry trainees across 5 University of California campuses and used Rasch family and linear regression models to assess internal structure validity and relationships to key predictor variables. They compared the CCL with the Paas scale using Wright maps and used latent correlations to support separating CL into 3 components. RESULTS Analysis revealed appropriate fit statistics, appropriate mean respondent location increases across all levels, threshold banding, and expected relationships with key predictor variables. The CCL provided more coverage of the 3 CL components compared with the Paas scale. Correlations among the 3 CL components were not strong, suggesting that the CCL offers more nuance than a unidimensional measure of CL in the context of consults. CONCLUSIONS This study generated initial validity evidence to support the CCL's use as a measure of consult CL and supports measuring the 3 CL components separately rather than as a single construct in the context of consults. Learners and faculty could compare learner CCL scores with reference scores to promote reflection, metacognition, and coaching.
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Affiliation(s)
- Sam Brondfield
- S. Brondfield is assistant professor, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Alexander Mario Blum
- A.M. Blum is lecturer, Department of Special Education, San Francisco State University, San Francisco, California
| | - Kewchang Lee
- K. Lee is professor, Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Marcia C Linn
- M.C. Linn is professor, Graduate School of Education, University of California, Berkeley, Berkeley, California
| | - Patricia S O'Sullivan
- P.S. O'Sullivan is professor, Departments of Medicine and Surgery, University of California, San Francisco, San Francisco, California
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Matsuo T, Hayashi K, Uehara Y, Mori N. Essential consultants' skills and attitudes (Willing CONSULT): a cross-sectional survey. BMC MEDICAL EDUCATION 2021; 21:366. [PMID: 34217282 PMCID: PMC8254944 DOI: 10.1186/s12909-021-02810-9] [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: 02/02/2021] [Accepted: 06/04/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Despite multi-professional collaboration via consultation being increasingly important given the variety of disease diagnoses and treatment, the key elements as consultants remain unclear. The study aimed to identify the skills and attitudes that are important for consultants from the residents' perspective so that they can be targeted as priority goals in subsequent educational interventions. METHODS We conducted our research in two phases: a preliminary survey (May 1 to 14, 2020) and a main survey (June 1 to 14, 2020). As a preliminary survey, first-year postgraduate residents at St. Luke's International Hospital in Tokyo, Japan, were first asked an open-ended question about the types of skills and attitudes that are important for consultants. After eliminating duplicate answers, there were 19 skills and attitudes in total. In the main survey with residents who completed their residency training at our institute, from 2014 to 2018 and current residents (2019-2020), we first asked them about their demographic characteristics (gender, years of postgraduate education, and type of specialty). Then, they answered how important each skill and attitude are for consultants. All 19 items were scored on a seven-point Likert scale that ranged from 0 (completely disagree) to 6 (totally agree). Cronbach's alpha confirmed the internal consistency of the questionnaire items. Principal component analysis and exploratory factor analysis were performed. RESULTS The survey included 107 individuals (61.1 %, 175 potential participants). The median postgraduate years of education was four (interquartile range: 2-5), and 64.5 % were men (n = 69). Seven key elements for consultants were identified and termed Willing CONSULT. These included (1) willingness (willingness to accept consultation requests), (2) contact (easy access to consultants), (3) needs (consideration of consulters' needs), (4) suggestions and support (providing clear recommendations and suggestions, following up on the patients, and supporting the consulters continuously), (5) urgency (considering the situation's urgency and responding appropriately), (6) learning opportunities (providing teaching points), and (7) text (writing medical records). CONCLUSIONS We propose Willing CONSULT, which are important skills and attitudes for consultants.
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Affiliation(s)
- Takahiro Matsuo
- Department of Infectious Diseases, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, Japan.
| | - Kuniyoshi Hayashi
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Yuki Uehara
- Department of Infectious Diseases, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, Japan
- Department of Clinical Laboratory, St. Luke's International Hospital, Tokyo, Japan
- Department of Microbiology, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Nobuyoshi Mori
- Department of Infectious Diseases, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, Japan
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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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Impact of Fellows-as-Teachers Workshops on Teaching Rounds: An Observational Study in an ICU. Crit Care Explor 2020; 2:e0235. [PMID: 33134936 PMCID: PMC7581023 DOI: 10.1097/cce.0000000000000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. During training, fellows serve as teachers and role models for junior colleagues. Fellows-as-teachers curricula may support these roles, but little is known about their effectiveness and durability. We sought to measure the long-term effects on ICU rounds after administering fellows-as-teachers workshops.
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11
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Miloslavsky EM, Bolster MB. Addressing the rheumatology workforce shortage: A multifaceted approach. Semin Arthritis Rheum 2020; 50:791-796. [PMID: 32540672 PMCID: PMC7255118 DOI: 10.1016/j.semarthrit.2020.05.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 10/28/2022]
Abstract
A significant challenge facing the field of rheumatology is the projected gap between the growing demand for rheumatologists and the available workforce. In order to improve access to care, augmenting the rheumatology workforce is required. Herein we discuss potential solutions to the anticipated workforce shortage, including 1) expanding the training of rheumatology physicians; 2) increasing nurse practitioner, physician assistant and pharmacist utilization in rheumatology practice; 3) growing the use of telemedicine; and 4) reducing burnout in order to retain practicing rheumatologists. Building on the existing literature in these areas, we propose a multifaceted approach to addressing the rheumatology workforce shortage.
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Affiliation(s)
- Eli M Miloslavsky
- Massachusetts General Hospital, Department of Medicine, Division of Rheumatology, Yawkey Center for Outpatient Care, Suite 2C, Boston MA 02114, United States.
| | - Marcy B Bolster
- Massachusetts General Hospital, Department of Medicine, Division of Rheumatology, Yawkey Center for Outpatient Care, Suite 2C, Boston MA 02114, United States
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12
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Gross CJ, Chiel LE, Gomez AR, Marcus CH, Michelson CD, Winn AS. Defining the Essential Components of a Teaching Service. Pediatrics 2020; 146:peds.2020-0651. [PMID: 32487591 DOI: 10.1542/peds.2020-0651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES A large portion of residency education occurs in inpatient teaching services without widely accepted consensus regarding the essential components that constitute a teaching service. We sought to generate consensus around this topic, with the goal of developing criteria programs that can be used when creating, redesigning, or evaluating teaching services. METHODS A list of potential components of teaching services was developed from a literature search, interviews, and focus groups. Eighteen pediatric medical education experts participated in a modified Delphi method, responding to a series of surveys rating the importance of the proposed components. Each iterative survey was amended on the basis of the results of the previous survey. A final survey evaluating the (1) effort and (2) impact of implementing components that had reached consensus as recommended was distributed. RESULTS Each survey had 100% panelist response. Five survey rounds were conducted. Fourteen attending physician characteristics and 7 system characteristics reached consensus as essential components of a teaching service. An additional 25 items reached consensus as recommended. When evaluating the effort and impact of these items, the implementation of attending characteristics was perceived as requiring less effort than system characteristics but as having similar impact. CONCLUSIONS Consensus on the essential and recommended components of a resident teaching service was achieved by using the modified Delphi method. Although the items that reached consensus as essential are similar to those proposed by the Accreditation Council for Graduate Medical Education, those that reached consensus as recommended are less commonly discussed and should be strongly considered by institutions.
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Affiliation(s)
- Caroline J Gross
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and .,Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Laura E Chiel
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and
| | - Amanda R Gomez
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and
| | - Carolyn H Marcus
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and
| | - Catherine D Michelson
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Ariel S Winn
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and
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13
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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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Ashton RW, Burkart KM, Lenz PH, Kumar S, McCallister JW. Response. Chest 2019; 153:1082-1083. [PMID: 29626963 DOI: 10.1016/j.chest.2018.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Kristin M Burkart
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY
| | - Peter H Lenz
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Cincinnati, Cincinnati, OH
| | - Sunita Kumar
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Loyola University Medical Center and Stritch School of Medicine, Maywood, IL
| | - Jennifer W McCallister
- Division of Pulmonary, Critical Care and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, OH
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Making the Consult Interaction More Than a Transaction: Helping Fellows Be Better Teachers and Residents Be Better Learners. J Pediatr 2019; 209:3-4.e2. [PMID: 31128730 DOI: 10.1016/j.jpeds.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 11/22/2022]
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Hale AJ, Freed JA, Alston WK, Ricotta DN. What Are We Really Talking About? An Organizing Framework for Types of Consultation and Their Implications for Physician Communication. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:809-812. [PMID: 30768469 DOI: 10.1097/acm.0000000000002659] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Consultation amongst providers is a foundation of modern health care and one of the most frequent means of interdisciplinary communication. Accordingly, clear and efficient communication between providers and across medical specialties during consultation is essential to patient care and a collegial work environment. Traditionally, consultation requests are felt to require a clear question that falls within the purview of the consultant's expertise. However, this narrow constraint is often lacking in the real-world clinical environment and may in fact be detrimental to physician communication and patient care. In this Perspective, the authors propose an organizing framework of seven specific consultation types, which apply broadly across disciplines: ideal, obligatory, procedural, S.O.S., confirmatory, inappropriate, and curbside. The authors describe what factors define each type and the benefits and pitfalls of each. The proposed framework may help providers have more productive, efficient, and collegial conversations about patient care, which may facilitate improved work satisfaction and an enhanced learning environment.
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Affiliation(s)
- Andrew J Hale
- A.J. Hale is an infectious diseases specialist, University of Vermont Medical Center, and assistant professor of medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont. J.A. Freed is a hematologist, Beth Israel Deaconess Medical Center, and instructor of medicine, Harvard Medical School, Boston, Massachusetts. W.K. Alston is director of infectious diseases, University of Vermont Medical Center, and professor of medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont. D.N. Ricotta is a hospitalist, Beth Israel Deaconess Medical Center, and instructor of medicine, Harvard Medical School, Boston, Massachusetts
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Sidhu NS, Edwards M. Deliberate teaching tools for clinical teaching encounters: A critical scoping review and thematic analysis to establish definitional clarity. MEDICAL TEACHER 2019; 41:282-296. [PMID: 29703088 DOI: 10.1080/0142159x.2018.1463087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE AND METHOD We conducted a scoping review of tools designed to add structure to clinical teaching, with a thematic analysis to establish definitional clarity. RESULTS Six thousand and forty nine citations were screened, 434 reviewed for eligibility, and 230 identified as meeting study inclusion criteria. Eighty-nine names and 51 definitions were identified. Based on a post facto thematic analysis, we propose that these tools be named "deliberate teaching tools" (DTTs) and defined as "frameworks that enable clinicians to have a purposeful and considered approach to teaching encounters by incorporating elements identified with good teaching practice." We identified 46 DTTs in the literature, with 38 (82.6%) originally described for the medical setting. Forty justification articles consisted of 16 feedback surveys, 13 controlled trials, seven pre-post intervention studies with no control group, and four observation studies. Current evidence of efficacy is not entirely conclusive, and many studies contain methodology flaws. Forty-nine clarification articles comprised 12 systematic reviews and 37 narrative reviews. The most number of DTTs described by any review was four. A common design theme was identified in approximately three-quarters of DTTs. CONCLUSIONS Applicability of DTTs to specific alternate settings should be considered in context, and appropriately designed justification studies are warranted to demonstrate efficacy.
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Affiliation(s)
- Navdeep S Sidhu
- a Department of Anaesthesia and Perioperative Medicine , North Shore Hospital , Auckland , New Zealand
- b Department of Anaesthesiology , University of Auckland , Auckland , New Zealand
| | - Morgan Edwards
- a Department of Anaesthesia and Perioperative Medicine , North Shore Hospital , Auckland , New Zealand
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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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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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Bernson-Leung ME, Urion DK. The Child Neurology Trainee-as-Teacher: A Clinical Teaching Curriculum Tailored to Learners' Needs and Developmental Roles. Pediatr Neurol 2018; 78:41-45. [PMID: 29174856 DOI: 10.1016/j.pediatrneurol.2017.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clinical teaching skills programs for resident physicians are increasingly offered. Less attention has been devoted to the unique educational roles of specialty residents and subspecialty fellows, many of whom will become academic faculty physicians. These teaching roles, and therefore a trainee's learning needs and motivation, also change over the course of training. METHODS We designed and implemented a two-year longitudinal teaching curriculum for child neurology and neurodevelopmental disabilities residents using adult learning theory principles: experiential learning and immediate applicability to specific roles. Core modules included teaching in clinical settings, adult learning, and giving feedback. Training-year-specific modules for second-year residents (n = 11) and final-year residents (n = 10) included teaching through consultation and promoting clinical reasoning in supervisory roles. Learners completed an 11-item self-assessment before and after intervention. RESULTS The overall program significantly increased residents' self-assessed knowledge of how to assess the level of a learner (P = 0.02, Cohen d = 0.84) and comfort and skill in giving feedback (P = 0.04, d = 0.64; P = 0.04, d = 0.71). The final-year-specific curriculum additionally increased self-assessed skill in teaching same-specialty residents (P = 0.05, d = 1.07) and in promoting clinical reasoning (P = 0.03, d = 1.14). The program was rated highly by trainees and faculty, and has been adopted as an ongoing part of our training program. CONCLUSIONS Our experience offers a reproducible model and theoretical framework for child neurology, neurodevelopmental disabilities, and other specialty programs to develop customized trainee-as-teacher curricula with specialty- and training-year-specific content.
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Affiliation(s)
- Miya E Bernson-Leung
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - David K Urion
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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