Ten ways to get a grip on resident co-production within medical education change.
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ABSTRACT:
SUBMITTER: Buttemer S
PROVIDER: S-EPMC7082475 | biostudies-literature | 2020 Mar
REPOSITORIES: biostudies-literature
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Ten ways to get a grip on resident co-production within medical education change.
Buttemer Samantha S Hall Jena J Berger Liora L Weersink Kristen K Dagnone J Damon JD
Canadian medical education journal 20200316 1
The Royal College of Physicians and Surgeons of Canada (RCPSC) is transforming its national approach to postgraduate medical education by transitioning all specialty programs to competency based medical education (CBME) curriculums over a seven-year period. Queen's University, with special permission from the RCPSC, launched CBME curricula for all incoming residents across its 29 specialty programs in July 2017. Resident engagement, empowerment, and co-production through this transition has been ...[more]
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Project description:Competency-based medical education (CBME) curricula are becoming increasingly common in graduate medical education. Put simply, CBME is focused on educational outcomes, is independent of methods and time, and is composed of achievable competencies.1 In spite of widespread uptake, there remains much to learn about implementing CBME at the program level. Leveraging the collective experience of program leaders at Queen's University, where CBME simultaneously launched across 29 specialty programs in 2017, this paper leverages change management theory to provide a short summary of how program leaders can navigate the successful preparation, launch, and initial implementation of CBME within their residency programs.
| S-EPMC7522884 | biostudies-literature
Project description:Background:Residency training programs in Canada are undergoing a mandated transition to competency-based medical education (CBME). There is limited literature regarding resident perspectives on CBME. As upper year residents act as mentors and assessors for incoming cohorts, and are themselves key stakeholders in this educational transition, it is important to understand how they view CBME. We examined how residents who are not currently enrolled in a competency-based program view that method of training, and what they perceive as potential advantages, disadvantages, and considerations regarding its implementation. Methods:Sixteen residents volunteered to participate in individual semi-structured interviews, with questions focussing on participants' knowledge of CBME and its implementation. We used a grounded theory approach to develop explanations of how residents perceive CBME. Results:Residents anticipated improved assessment and feedback, earlier identification of residents experiencing difficulties in training, and greater flexibility to pursue self-identified educational needs. Disadvantages included logistical issues surrounding CBME implementation, ability of attending physicians to deliver CBME-appropriate feedback, and the possibility of assessment fatigue. Clear, detailed communication and channels for resident feedback were key considerations regarding implementation. Conclusions:Resident views align with educational experts regarding the practical challenges of implementation. Expectations of improved assessment and feedback highlight the need for both residents and attending physicians to be equipped in these domains. Consequently, faculty development and clear communication will be crucial aspects of successful transitioning to CBME.
| S-EPMC7522862 | biostudies-literature
Project description:Introduction. The big data present in the medical curriculum that informs undergraduate medical education is beyond human abilities to perceive and analyze. The medical curriculum is the main tool used by teachers and directors to plan, design, and deliver teaching and assessment activities and student evaluations in medical education in a continuous effort to improve it. Big data remains largely unexploited for medical education improvement purposes. The emerging research field of visual analytics has the advantage of combining data analysis and manipulation techniques, information and knowledge representation, and human cognitive strength to perceive and recognize visual patterns. Nevertheless, there is a lack of research on the use and benefits of visual analytics in medical education. Methods. The present study is based on analyzing the data in the medical curriculum of an undergraduate medical program as it concerns teaching activities, assessment methods and learning outcomes in order to explore visual analytics as a tool for finding ways of representing big data from undergraduate medical education for improvement purposes. Cytoscape software was employed to build networks of the identified aspects and visualize them. Results. After the analysis of the curriculum data, eleven aspects were identified. Further analysis and visualization of the identified aspects with Cytoscape resulted in building an abstract model of the examined data that presented three different approaches; (i) learning outcomes and teaching methods, (ii) examination and learning outcomes, and (iii) teaching methods, learning outcomes, examination results, and gap analysis. Discussion. This study identified aspects of medical curriculum that play an important role in how medical education is conducted. The implementation of visual analytics revealed three novel ways of representing big data in the undergraduate medical education context. It appears to be a useful tool to explore such data with possible future implications on healthcare education. It also opens a new direction in medical education informatics research.
| S-EPMC4250066 | biostudies-literature
Project description:Currently, accreditation in medical education is a priority for many countries worldwide. The World Federation for Medical Education’s (WFME) launch of its 1st trilogy of standards in 2003 was a seminal event promoting accreditation in basic medical education (BME) globally. In parallel, the WFME also actively spearheaded a project to recognize accrediting agencies within individual countries. The introduction of competency-based medical education (CBME), with the 2 key concepts of entrusted professional activity and milestones, has enabled researchers to identify the relationships between patient outcomes and medical education. The recent data-driven approach to CBME has been used for ongoing quality improvement of trainees and training programs. The accreditation goal has shifted from the single purpose of quality assurance to balancing quality assurance and quality improvement. Although there are many types of postgraduate medical education (PGME), it may be possible to accredit resident programs on a global scale by adopting the concept of CBME. It will also be possible to achieve accreditation alignment for BME and PGME, which center on competency. This approach may also make it possible to measure accreditation outcomes against patient outcomes. Therefore, evidence of the advantages of costly and labor-consuming accreditation processes will be available soon, and quality improvement will be the driving force of the accreditation process.
| S-EPMC7605903 | biostudies-literature
Project description:The University of California, Los Angeles (UCLA)/Charles R. Drew University Medical Education Program was developed to train physicians for practice in underserved areas. The UCLA/Drew Medical Education Program students receive basic science instruction at UCLA and complete their required clinical rotations in South Los Angeles, an impoverished urban community. We have previously shown that, in comparison to their UCLA counterparts, students in the Drew program had greater odds of maintaining their commitment to medically disadvantaged populations over the course of medical education.To examine the independent association of graduation from the UCLA/Drew program with subsequent choice of physician practice location. We hypothesized that participation in the UCLA/Drew program predicts future practice in medically disadvantaged areas, controlling for student demographics such as race/ethnicity and gender, indicators of socioeconomic status, and specialty choice.Retrospective cohort study.Graduates (1,071) of the UCLA School of Medicine and the UCLA/Drew Medical Education Program from 1985-1995, practicing in California in 2003 based on the address listed in the American Medical Association (AMA) Physician Masterfile.Physician address was geocoded to a California Medical Service Study Area (MSSA). A medically disadvantaged community was defined as meeting any one of the following criteria: (a) federally designated HPSA or MUA; (b) rural area; (c) high minority area; or (d) high poverty area.Fifty-three percent of UCLA/Drew graduates are located in medically disadvantaged areas, in contrast to 26.1% of UCLA graduates. In multivariate analyses, underrepresented minority race/ethnicity (OR: 1.57; 95% CI: 1.10-2.25) and participation in the Drew program (OR: 2.47; 95% CI: 1.59-3.83) were independent predictors of future practice in disadvantaged areas.Physicians who graduated from the UCLA/Drew Medical Education Program have higher odds of practicing in underserved areas than those who completed the traditional UCLA curriculum, even after controlling for other factors such as race/ethnicity. The association between participation in the UCLA/Drew Medical Education Program and physician practice location suggests that medical education programs may reinforce student goals to practice in disadvantaged communities.
| S-EPMC1852922 | biostudies-other
Project description:BackgroundPrevious studies have assessed note quality and the use of electronic medical record (EMR) as a part of medical training. However, a generalized and user-friendly note quality assessment tool is required for quick clinical assessment. We held a medical record writing competition and developed a checklist for assessing the note quality of participants' medical records. Using the checklist, this study aims to explore note quality between residents of different specialties and offer pedagogical implications.MethodsThe authors created an inpatient checklist that examined fundamental EMR requirements through six note types and twenty items. A total of 149 records created by residents from 32 departments/stations were randomly selected. Seven senior physicians rated the EMRs using a checklist. Medical records were grouped as general medicine, surgery, paediatric, obstetrics and gynaecology, and other departments. The overall and group performances were analysed using analysis of variance (ANOVA).ResultsOverall performance was rated as fair to good. Regarding the six note types, discharge notes (0.81) gained the highest scores, followed by admission notes (0.79), problem list (0.73), overall performance (0.73), progress notes (0.71), and weekly summaries (0.66). Among the five groups, other departments (80.20) had the highest total score, followed by obstetrics and gynaecology (78.02), paediatrics (77.47), general medicine (75.58), and surgery (73.92).ConclusionsThis study suggested that duplication in medical notes and the documentation abilities of residents affect the quality of medical records in different departments. Further research is required to apply the insights obtained in this study to improve the quality of notes and, thereby, the effectiveness of resident training.
| S-EPMC8590775 | biostudies-literature
Project description:BACKGROUND: Little is known about the factors that influence applicants' decisions to select a graduate medical education training program. Programs may improve their recruitment by better understanding that process. METHODS: Following the Match for the years 2008 though 2010, an electronic survey was sent to 664 applicants to 15 Duke University graduate medical education programs. Those individuals were ranked high enough to match to Duke University but chose to match at another institution. We used quantitative and qualitative analyses to explore factors influencing candidates' decisions and to identify program and institutional improvements to better attract top candidates. RESULTS: Response rate was 63% (417/664). The quantitative analysis identified factors that were "very important" to applicants (current resident satisfaction, relationship between faculty and residents, collegiality of current residents, quantity and quality of faculty content/mentoring, faculty teaching expertise, diversity of patients and types of procedures, and location), and those that were "not important" to applicants (child care or education opportunities for children, salary, United States Medical Licensing Examination requirements, part-time training options, favorable environment for minorities or women). There were statistically significant differences among specialties. Qualitative analysis identified 3 themes as most influential in their choice: location, program relationships, and the interview experience. CONCLUSION: The collection of 3 years of data across specialties identified factors that are important to applicants' choice of a training program. Some factors can be addressed quickly and with little effort, such as the format of the interview day. Others require programs and institutions to revisit their mission, priorities, and training culture to improve relationships between residents and faculty. Programs may wish to be more tactical in selecting the residents and faculty who meet with applicants and be more focused in planning how the interview time is used.
| S-EPMC3399606 | biostudies-other
Project description:IntroductionA common career aspiration among residents is to become a clinician-educator, though standard postgraduate training may not prepare trainees for the academic and scholarly requirements of this career. To address this need, we designed and implemented an asynchronous, interactive webinar series detailing a systematic approach to medical education research and scholarship. The series was piloted as part of a new track at the University of Chicago for residents interested in additional training and completing an educational learning project in medical education.MethodsWe aimed to use this series to introduce relevant frameworks in curriculum development, program evaluation, and learning theory. Materials associated with this publication include six webinars and corresponding summary reference handouts, discussion assignments, and answer keys. Additional materials include a faculty course director packet and sample feedback for discussion assignments. Each webinar is an 8- to 20-minute narrated presentation with goals and objectives, an overview of each session's content, and example vignettes. Residents viewed presentations and completed a two-part discussion assignment for each webinar, which included reflection on the educational material and vignettes, faculty feedback on this reflection, and application of webinar material and faculty feedback to their own experiences in medical education.ResultsAll residents in the pilot completed the webinars and assignments. Residents' reactions to the webinar series have been positive, and residents have commented that self-paced learning with directed faculty feedback is a desirable instructional method for this material.DiscussionThis series is well suited to introduce fundamental concepts in medical education scholarship and inspire self-directed study for motivated learners.
| S-EPMC6464455 | biostudies-literature
Project description:IntroductionClinical rotations in emergency medicine (EM) can be challenging for medical students because of the lack of continuity with attending physicians. To overcome this challenge, institutions have started to match a student's schedule with that of a resident, referred to as "paired shifts." We sought to pilot and compare two schedule formats for fourth-year medical students (MS4) - a resident-paired shifts (RPS) and a traditional resident-unpaired shifts (RUS) schedule.MethodsThis prospective, crossover trial included MS4s rotating in the emergency department over four consecutive four-week blocks. Each MS4 was assigned two weeks using the RUS schedule and two weeks with the RPS schedule, alternating the format order each month. At the end of the rotation students were anonymously surveyed regarding the differences in learning experience, their ability to showcase their knowledge and clinical skills, and familiarity with the residency program with the two formats.ResultsThe response rate was 47 of 58 students (84%). Respondents indicated that RPS resulted in more teaching time (64.6% RPS vs 8.3% RUS), a better overall educational experience (68.8% RPS vs 8.3% RUS), and a greater ability to showcase their medical knowledge (52.1% RPS vs 6.3% RUS). Additionally, students felt that the program was better able to evaluate them (66.7% RPS vs 10.4% RUS) and they were better able to better evaluate the program (66.7% RPS vs 6.3% RUS) in the RPS format.ConclusionsWhen compared to traditional RUS during an MS4 rotation, a RPS format provided students with the perception of an improved learning experience, ability to showcase knowledge, and familiarity with the residency program without sacrificing teaching from attending physicians.
| S-EPMC7806323 | biostudies-literature
Project description:BackgroundPatient care order sets are increasingly being used to optimize care. While studies have evaluated the impact of order sets on provider performance and patient outcomes, their impact on postgraduate medical trainee knowledge remains unknown. We sought to evaluate the impact of order sets on respirology knowledge, order-writing skills, and self-reported learning.MethodsWe conducted a prospective before-after study. Postgraduate trainees completing a Respirology rotation at a quaternary-care hospital 6 months before (no order set period) and 12 months after (order set period) order set introduction. Guideline-based admission order sets with educational prompts detailing recommended management of cystic fibrosis and chronic obstructive pulmonary disease were implemented on the respirology ward. Each resident completed a test before and after the rotation assessing knowledge and order-writing. Residents in the order set period additionally completed a questionnaire regarding the impact of order set use on their learning.AnalysisThe primary outcome, the difference between pre and post rotation scores was compared between residents in the no order set period and residents in the order set period, using univariate linear regression. Test validity was assessed with a 2-sample t-test, analysis of variance and Pearson's correlation coefficient. Self-reported impact of order set use were descriptively analyzed, and written responses were collated and coded.ResultsInvestigators consecutively recruited 11 subjects before and 28 subjects after order set implementation. Residents in the order set period had a greater improvement in post-rotation test scores than residents in the no order set period (p = 0.04); after adjustment for baseline scores, this was not significant (p = 0.3). The questionnaire demonstrated excellent convergent, discriminant and construct validity. Residents reported that order sets improved their knowledge and skills and provided a systematic approach to care.ConclusionsOrder sets do not appear to impair resident education, and may impart a benefit. This will require validation in larger studies and across diseases.
| S-EPMC3829666 | biostudies-literature