Teaching systems-based competency in anesthesiology residency: development of an education and assessment tool.
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ABSTRACT:
SUBMITTER: Soto RG
PROVIDER: S-EPMC2930315 | biostudies-other | 2010 Jun
REPOSITORIES: biostudies-other
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Project description:Competency-based medical education (CBME) is being implemented worldwide. In CMBE, residency training is designed around competencies required for unsupervised practice and use entrustable professional activities (EPAs) as workplace "units of assessment". Well-designed workplace-based assessment (WBA) tools are required to document competence of trainees in authentic clinical environments. In this study, we developed a WBA instrument to assess residents' performance of intra-operative pathology consultations and conducted a validity investigation. The entrustment-aligned pathology assessment instrument for intra-operative consultations (EPA-IC) was developed through a national iterative consultation and used clinical supervisors to assess residents' performance at an anatomical pathology program. Psychometric analyses and focus groups were conducted to explore the sources of evidence using modern validity theory: content, response process, internal structure, relations to other variables, and consequences of assessment. The content was considered appropriate, the assessment was feasible and acceptable by residents and supervisors, and it had a positive educational impact by improving performance of intra-operative consultations and feedback to learners. The results had low reliability, which seemed to be related to assessment biases, and supervisors were reluctant to fully entrust trainees due to cultural issues. With CBME implementation, new workplace-based assessment tools are needed in pathology. In this study, we showcased the development of the first instrument for assessing resident's performance of a prototypical entrustable professional activity in pathology using modern education principles and validity theory.
| S-EPMC8516791 | biostudies-literature
Project description:ObjectivesPoint-of-care ultrasound (POCUS) has become an integral diagnostic and interventional tool. Barriers to POCUS training persist, and it continues to remain heterogeneous across training programs. Structured POCUS assessment tools exist, but remain limited in their feasibility, acceptability, reliability, and validity; none of these tools are entrustment-based. The objective of this study was to derive a simple, entrustment-based POCUS competency assessment tool and pilot it in an assessment setting.MethodsThis study was composed of two phases. First, a three-step modified Delphi design surveyed 60 members of the Canadian Association of Emergency Physicians Emergency Ultrasound Committee (EUC) to derive the anchors for the tool. Subsequently, the derived ultrasound competency assessment tool (UCAT) was used to assess trainee (N = 37) performance on a simulated FAST examination. The intraclass correlation (ICC) for inter-rater reliability and Cronbach's alpha for internal consistency were calculated. A statistical analysis was performed to compare the UCAT to other competency surrogates.ResultsThe three-round Delphi had 22, 26, and 26 responses from the EUC members. Consensus was reached, and anchors for the domains of preparation, image acquisition, image optimization, and clinical integration achieved approval rates between 92 and 96%. The UCAT pilot revealed excellent inter-rater reliability (with ICC values of 0.69-0.89; p < 0.01) and high internal consistency (α = 0.91). While UCAT scores were not impacted by level of training, they were significantly impacted by the number of previous POCUS studies completed.ConclusionsWe developed and successfully piloted the UCAT, an entrustment-based bedside POCUS competency assessment tool suitable for rapid deployment. The findings from this study indicate early validity evidence for the use of the UCAT as an assessment of trainee POCUS competence on FAST. The UCAT should be trialed in different populations performing several POCUS study types.
| S-EPMC8138101 | biostudies-literature
Project description:BACKGROUND: Problem solving in a clinical context requires knowledge and experience, and most traditional examinations for learners do not capture skills that are required in some situations where there is uncertainty about the proper course of action. OBJECTIVE: We sought to evaluate anesthesiology residents for deficiencies in cognitive performance within and across 3 clinical domains (operating room, trauma, and cardiac resuscitation) using simulation-based assessment. METHODS: Individual basic knowledge and cognitive performance in each simulation-based scenario were assessed in 47 residents using a 15- to 29-item scenario-specific checklist. For every scenario and item we calculated group error scenario rate (frequency) and individual (resident) item success. For all analyses, alpha was designated as 0.05. RESULTS: Postgraduate year (PGY)-3 and PGY-4 residents' cognitive items error rates were higher and success rates lower compared to basic and technical performance in each domain tested (P < .05). In the trauma and resuscitation scenarios, the cognitive error rate by PGY-4 residents was fairly high (0.29-0.5) and their cognitive success rate was low (0.5-0.68). The most common cognitive errors were anchoring, availability bias, premature closure, and confirmation bias. CONCLUSIONS: Simulation-based assessment can differentiate between higher-order (cognitive) and lower-order (basic and technical) skills expected of relatively experienced (PGY-3 and PGY-4) anesthesiology residents. Simulation-based assessments can also highlight areas of relative strength and weakness in a resident group, and this information can be used to guide curricular modifications to address deficiencies in tasks requiring higher-order processing and cognition.
| S-EPMC3963801 | biostudies-other
Project description:IntroductionIn a competency-based approach to resident education, a component of training should focus on skills needed for the transition from residency to independent practice. The ability to run an outpatient clinic represents one such skill. Resident-run clinics (RRC) have been implemented in family medicine programs to allow residents to practice this skill, and have enhanced learning while providing excellent patient satisfaction. To date, there has been little experience with RRCs in surgical residency programs. We describe a urology RRC and report assessments of both resident performance and patient satisfaction.MethodsThe RRC was run independently by a senior urology resident. All cases were reviewed with faculty at the end of the day, and an evaluation form assessing resident performance was completed. Residents also completed a brief self-assessment. All patients completed an anonymous survey to assess aspects of patient satisfaction.ResultsOverall, resident performance was excellent, with changes to the management plan in 6% (3/47) of cases after faculty review. All clinics finished within 30 minutes of planned end time. Residents reported confidence in their ability to manage the clinic (8.25/10). Forty-three patient surveys were completed. On a five-point scale, patient ratings of wait time, clinic environment, and appointment duration were 3.91, 4.23, and 4.12, respectively. Patient ratings of resident skills (communication, sensitivity, treatment options, and answering questions) were 4.30, 4.35, 4.40, and 4.42, respectively. Overall, confidence in residents was 9.07/10 and 100% of patients would recommend the RRC.ConclusionsBased on our ongoing experience, RRCs provide well-received, safe patient care and serve as a learning tool for residents as they prepare for independent practice. Given these results, residency programs could consider inclusion of a RRC as a component of the transition- to-practice training within a competency-based curriculum.
| S-EPMC6754258 | biostudies-literature
Project description:BackgroundA suitably prepared and qualified nutrition and dietetics workforce is part of the solution to combating the burden of disease. Competency-based assessment is a key part of the education of future workforces. Although there has been recent attention on competency-based assessment in dietetics, there is little exploration of competency-based education for the preparation of nutritionists. The present study aimed to understand how competency-based assessment is implemented and evaluated in nutrition education.MethodsA systematic literature review was carried out according to PRISMA guidelines. Four databases were initially searched in February 2020 using key words related to competenc* in combination with nutrition or dietetic and their synonyms. An updated search was completed again in March 2021. Studies that met eligibility criteria where the focus was on nutrition and involved a method of competency-based assessment were synthesised narratively.ResultsFrom a total of 6262 titles and abstracts, six studies on competency assessment in nutrition education were identified. The assessments focused on the development of key skills, including motivational interviewing and nutrition assessment, changes to knowledge and attitudes on food and culture, and self-perceived development of communication, collaboration, management, advocacy, scholarship and professional capabilities. No studies were found that assessed promotion of health and wellbeing or the food chain competencies.ConclusionsThe lack of research in competency-based assessment must be addressed to ensure we are effectively preparing future nutritionists for work such that they can impact health outcomes.
| S-EPMC9290644 | biostudies-literature
Project description:BackgroundCompetency-based medical education (CBME) has revolutionized approaches to training by making expectations more concrete, visible, and relevant for trainees. Designing, applying, and updating CBME requirements challenges residency programs, which must address many aspects of training simultaneously. This challenge also exists for educational regulatory bodies in creating and adjusting national competencies to standardize training expectations. We propose that an international approach for mapping residency training requirements may provide a baseline for assessing commonalities and differences. This approach allows us to take our first steps towards creating international competency goals to enhance sharing of best practices in education and clinical work.MethodsWe chose anesthesiology residency training as our example discipline. Using two rounds of content analysis, we qualitatively compared published anesthesiology residency competencies for the European Union (The European Training Requirement), United States (ACGME Milestones), and Canada (CanMEDS Competence By Design), focusing on similarities and differences in representation (round one) and emphasis (round two) to generate hypotheses on practical solutions regarding international educational standards.ResultsWe mapped the similarities and discrepancies between the three repositories. Round one revealed that 93% of competencies were common between the three repositories. Major differences between European Training Requirement, US Milestones, and Competence by Design competencies involved critical emergency medicine. Round two showed that over 30% of competencies were emphasized equally, with notable exceptions that European Training Requirement emphasized Anaesthesia Non-Technical Skills, Competence by Design highlighted more granular competencies within specific anesthesiology situations, and US Milestones emphasized professionalism and behavioral practices.ConclusionsThis qualitative comparison has identified commonalities and differences in anesthesiology training which may facilitate sharing broader perspectives on diverse high-quality educational, clinical, and research practices to enhance innovative approaches. Determining these overlaps in residency training can prompt international educational societies responsible for creating competencies to collaborate to design future training programs. This approach may be considered as a feasible method to build an international core of residency competency requirements for other disciplines.
| S-EPMC8582177 | biostudies-literature
Project description:The Integrative Medicine in Residency (IMR) program, a 200-hour Internet-based, collaborative educational initiative was implemented in 8 family medicine residency programs and has shown a potential to serve as a national model for incorporating training in integrative/complementary/alternative medicine in graduate medical education.The curriculum content was designed based on a needs assessment and a set of competencies for graduate medical education developed following the Accreditation Council for Graduate Medical Education outcome project guidelines. The content was delivered through distributed online learning and included onsite activities. A modular format allowed for a flexible implementation in different residency settings.TO ASSESS THE FEASIBILITY OF IMPLEMENTING THE CURRICULUM, A MULTIMODAL EVALUATION WAS UTILIZED, INCLUDING: (1) residents' evaluation of the curriculum; (2) residents' competencies evaluation through medical knowledge testing, self-assessment, direct observations, and reflections; and (3) residents' wellness and well-being through behavioral assessments.The class of 2011 (n = 61) had a high rate of curriculum completion in the first and second year (98.7% and 84.2%) and course evaluations on meeting objectives, clinical utility, and functioning of the technology were highly rated. There was a statistically significant improvement in medical knowledge test scores for questions aligned with content for both the PGY-1 and PGY-2 courses.The IMR program is an advance in the national effort to make training in integrative medicine available to physicians on a broad scale and is a success in terms of online education. Evaluation suggests that this program is feasible for implementation and acceptable to residents despite the many pressures of residency.
| S-EPMC3312539 | biostudies-other
Project description:The transition from internship to residency training may be a stressful time for interns, particularly if it involves a change among programs or institutions after completing a preliminary year.We explored whether an e-learning curriculum would increase interns' preparedness for the transition to the first year of clinical anesthesiology training and reduce stress by improving confidence and perceived competence in performing professional responsibilities.We tested a 10-month e-learning program, Successful Transition to Anesthesia Residency Training (START), as a longitudinal intervention to increase interns' self-perceived preparedness to begin anesthesiology residency training in a prospective, observational study and assessed acceptance and sustainability. After a needs assessment, we administered the START modules to 22 interns, once a month, using an integrated learning management and lecture-capture system. We surveyed interns' self-assessed preparedness to begin anesthesiology residency before and after completing the START modules. Interns from the prior year's class, who did not participate in the online curriculum, served as controls.After participation in the START intervention, self-assessed preparedness to begin residency improved by 72% (P = .02). Interns also felt more connected to, and had improved positive feelings toward, their new residency program and institution.Participation in our novel 10-month e-learning curriculum and virtual mentorship program improved interns' impression of their residency program and significantly increased interns' subjective assessment of their preparedness to begin anesthesiology residency. This e-learning concept could be more broadly applied and useful to other residency programs.
| S-EPMC3613296 | biostudies-other
Project description:IntroductionThe coronavirus pandemic forced universities to transfer academic curricula into the digital realm and calls for the introduction of new teaching methods to adequately compensate for the limited in-patient training. Especially in the field of dermatology, the use of 3D models presents an interesting opportunity to maintain the teaching of diagnostically essential sensory and haptic characteristics of primary lesions.ObjectivesWe developed a prototype silicone model and presented it to the medical service of the Department of Dermatology of the Ludwig-Maximilians University for evaluation.MethodsSilicone models demonstrating primary skin lesions were produced by using negative 3D-printed molds and different types of silicone. An online survey obtained evaluations from a group of dermatologists regarding the quality of previously supplied silicone 3D models and their potential use in medical education. Data from 58 dermatologists were collected and analyzed.ResultsThe majority of the participants rated the models overall as positive and innovative, providing constructive feedback for additional modifications, and recommended further implementation into the regular curriculum as an additional tool after the end of the pandemic.ConclusionsOur study underlined the possible advantages of using 3D models as a supplement in educational training even after the end of the SARS-CoV-2 pandemic.
| S-EPMC9946078 | biostudies-literature
Project description:BACKGROUND: Germany, like many other countries, will soon have a shortage of qualified doctors. One reason for the dissatisfaction amongst medical residents are the relatively unstructured residency training programs despite increasing importance of outcome-based education. The aim of our study was to identify characteristics and requirements for good teaching during anesthesiology residency training from the resident's point of view. METHODS: A consensus workshop with residents from all medical universities in Germany was held. Participants were allocated to one of the three topics, chosen based on a 2009 nationwide evaluation of residency. The three topics were (A) characteristics of helpful/good teachers, (B) characteristics of helpful/good conditions and (C) characteristics of helpful/good curricular structure. Each group followed a nominal group technique consensus process to define and rank characteristics for a good residency. RESULTS: 31 (79.5%) resident representatives were present. The consented results put emphasis on the importance of structured curricula including transparent goals and objectives, in training formative assessments and quality assurance measures for the program. Residents further long for trained trainers with formal teaching qualifications and protected teaching time. CONCLUSIONS: Good residency training requires careful consideration of all stakeholders' needs. Results reflect and extend previous findings and are at least to some degree easily implemented. These findings are an important step to establish a broader consensus within the discipline.
| S-EPMC3935158 | biostudies-other