Professionalism Milestones Assessments Used by Emergency Medicine Residency Programs: A Cross-sectional Survey

Exploring the Critical Driving Forces and Strategy Adoption Paths of Professional Competency Development for Various Emergency Physicians Based on the Hybrid MCDM Approach

The implementation of competency-based medical education (CBME) focuses on learners' competency outcomes and performance during their training. Competencies should meet the local demands of the healthcare system and achieve the desired patient-centered outcomes. Continuous professional education for all physicians also emphasizes competency-based training to provide high-quality patient care. In the CBME assessment, trainees are evaluated on applying their knowledge and skills to unpredictable clinical situations. A priority of the training program is essential in building competency development. However, no research has focused on exploring strategies for physician competency development. In this study, we investigate the professional competency state, determine the driving force, and provide emergency physicians' competency development strategies. We use the Decision Making Trial and Evaluation Laboratory (DEMATEL) method to identify the professional competency state and investigate the relationship among the aspects and criteria. Furthermore, the study uses the PCA (principal component analysis) method to reduce the number of components and then identify the weights of the aspects and components using the ANP (analytic network process) approach. Therefore, we can establish the prioritization of competency development of emergency physicians (EPs) with the VIKOR (Vlse kriterijumska Optimizacija I Kompromisno Resenje) approach. Our research demonstrates the priority of competency development of EPs is PL (professional literacy), CS (care services), PK (personal knowledge), and PS (professional skills). The dominant aspect is PL, and the aspect being dominated is PS. The PL affects CS, PK, and PS. Then, the CS affects PK and PS. Ultimately, the PK affects the PS. In conclusion, the strategies to improve the professional competency development of EPs should begin with the improvement from the aspect of PL. After PL, the following aspects that should be improved are CS, PK, and PS. Therefore, this study can help establish competency development strategies for different stakeholders and redefine emergency physicians' competency to reach the desired CBME outcomes by improving advantages and disadvantages.

Evaluation Evolution: Designing Optimal Evaluations to Enhance Learning in Nephrology Fellowship

Evaluations serve as the backbone of any educational program and can be broadly divided into formative and summative evaluations. Formative evaluations are "just in time" evaluations focused on informing the learning process, whereas summative evaluations compare fellows to a preset standard to determine their readiness for unsupervised practice. In the nephrology fellowship programs, evaluations assess competence in the framework of ACGME Milestones 2.0. A variety of learning venues, evaluators, and tools should be incorporated into the measurement process. It is important to determine which milestones can be best assessed in each education venue to decrease the burden of assessment fatigue. Additionally, programs can diversify the evaluators to include nurses, medical students, peers, and program coordinators in addition to faculty to provide a well-rounded assessment of the fellows and share the assessment burden. Lastly, the evaluation data should be presented to fellows in a format where it can inform goal setting. The evaluation system needs to evolve along with the changes being made in curriculum design. This will help to make fellowship learning effective and efficient.

Accreditation Council for Graduate Medical Education Milestones for Emergency Medicine Residency Training Incorporated into First- and Second-Year Medical Student Elective

INTRODUCTION

As part of its Next Accreditation System, the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine describe 6 competencies containing 23 sub-competencies graded by milestones ranging from level 1 (expected of an incoming intern) to level 5 (demonstrates abilities of an attending) that are used to track resident training progression. To the best of our knowledge, there have been no studies introducing a milestones-based curriculum to medical students prior to their introduction to the wards, so we sought to determine the effects that a pre-clinical Emergency Medicine Interest Group (EMIG) Milestones Elective would have on preparing the students interested in Emergency Medicine (EM) as a specialty to meet the level 1 milestones prior to their intern year.

METHODS

The elective hosted 15 events throughout the academic year, and pre- and post-curriculum surveys were administered. Thirteen first- and second-year medical students at our institution who completed the elective self-reported their perception of preparedness for each level 1 milestone in the 19 sub-competencies. A repeated measures design was used through identical pre- and post-curriculum surveys to determine any changes in self-reported preparedness for meeting level 1 milestones after completing the elective using Wilcoxon Signed Ranks Test.

RESULTS

There was a significant increase in the median scoring from 1 to 2 (p=0.027) in overall self-reported preparedness for meeting the level 1 milestones included in the elective, as well as significant increases in subcategories across competencies 1-4 outlined by the ACGME. There was no significant increase in preparedness for professionalism or interpersonal communication competencies. There was no significant increase in interest in EM as a result of the elective.

CONCLUSION

Implementing a milestones-based curriculum during the pre-clinical years shows improved self-reported preparedness of students interested in pursuing EM for meeting level 1 milestones prior to residency. Additionally, a specialty-based elective such as this one offered through EMIG may further increase interest in the field during pre-clinical years.

A Critical Disconnect: Residency Selection Factors Lack Correlation With Intern Performance

BACKGROUND

Emergency medicine (EM) residency programs want to employ a selection process that will rank best possible applicants for admission into the specialty.

OBJECTIVE

We tested if application data are associated with resident performance using EM milestone assessments. We hypothesized that a weak correlation would exist between some selection factors and milestone outcomes.

METHODS

Utilizing data from 5 collaborating residency programs, a secondary analysis was performed on residents trained from 2013 to 2018. Factors in the model were gender, underrepresented in medicine status, United States Medical Licensing Examination Step 1 and 2 Clinical Knowledge (CK), Alpha Omega Alpha (AOA), grades (EM, medicine, surgery, pediatrics), advanced degree, Standardized Letter of Evaluation global assessment, rank list position, and controls for year assessed and program. The primary outcomes were milestone level achieved in the core competencies. Multivariate linear regression models were fitted for each of the 23 competencies with comparisons made between each model's results.

RESULTS

For the most part, academic performance in medical school (Step 1, 2 CK, grades, AOA) was not associated with residency clinical performance on milestones. Isolated correlations were found between specific milestones (eg, higher surgical grade increased wound care score), but most had no correlation with residency performance.

CONCLUSIONS

Our study did not find consistent, meaningful correlations between the most common selection factors and milestones at any point in training. This may indicate our current selection process cannot consistently identify the medical students who are most likely to be high performers as residents.