Trainee Competence Research Articles

A Systematic Review of the Use of Google Glass in Graduate Medical Education.

Graduate medical education (GME) has emphasized the assessment of trainee competencies and milestones; however, sufficient in-person assessment is often constrained. Using mobile hands-free devices, such as Google Glass (GG) for telemedicine, allows for remote supervision, education, and assessment of residents. We reviewed available literature on the use of GG in GME in the clinical learning environment, its use for resident supervision and education, and its clinical utility and technical limitations. We conducted a systematic review in accordance with 2009 PRISMA guidelines. Applicable studies were identified through a review of PubMed, MEDLINE, and Web of Science databases for articles published from January 2013 to August 2018. Two reviewers independently screened titles, abstracts, and full-text articles that reported using GG in GME and assessed the quality of the studies. A systematic review of these studies appraised the literature for descriptions of its utility in GME. Following our search and review process, 37 studies were included. The majority evaluated GG in surgical specialties (n = 23) for the purpose of surgical/procedural skills training or supervision. GG was predominantly used for video teleconferencing, and photo and video capture. Highlighted positive aspects of GG use included point-of-view broadcasting and capacity for 2-way communication. Most studies cited drawbacks that included suboptimal battery life and HIPAA concerns. GG shows some promise as a device capable of enhancing GME. Studies evaluating GG in GME are limited by small sample sizes and few quantitative data. Overall experience with use of GG in GME is generally positive.

Trends in training and trainee competence in personality assessment across health service psychology doctoral students: A pilot study.

Trends in training and trainee competence in personality assessment across health service psychology doctoral students: A pilot study.

Revisiting Miller's pyramid in medical education: the gap between traditional assessment and diagnostic reasoning.

Revisiting Miller's pyramid in medical education: the gap between traditional assessment and diagnostic reasoning.

A Novel Low-Cost Surgical Simulation Tool for Pinning Supracondylar Humerus Fractures.

Simulation-based training is one way to improve basic competence for surgical trainees and thus improve patient safety. Closed reduction and percutaneous pinning of a supracondylar humerus fracture is a common procedure that encompasses many basic orthopaedic skills and has been identified as a residency milestone. Despite this, no quantitative tools exist to help learners attain this basic skill. This study seeks to validate a quantitative, low-cost simulation-based training tool for teaching orthopaedic surgery trainees the fundamentals of fracture stabilization with pins. Two low-cost models were developed with simulated cancellous bone blocks and cortical bone sheets: a pinning agility tool to teach pin placement and redirection, and a low-cost construct stability tool to replicate pinning. A high-cost construct stability tool was cut using a pediatric supracondylar humerus model to simulate pinning a real fracture. Construct stability was assessed by adding weight until ∼1.6 mm of displacement was observed. Participants were tested naively on all 3 models and then completed a training session using only the low-cost models. Performance following training was then assessed and compared with fellowship-trained pediatric orthopaedic surgeons. Participants also rated their preintervention and postintervention confidence, skill, and knowledgeability. A total of 18 novice trainees participated (10 PGY1 and PGY2 orthopaedic surgery residents and 8 medical student members of the orthopaedic surgery interest club), whereas the reference group consisted of 7 orthopaedic surgery attendings. The subjects significantly improved their scores on both the low-cost (P=0.002) and high-cost (P<0.001) construct stability tools after the training with only the low-cost tools. Compared with the attending benchmark, trainee scores improved on the high-fidelity model from 31% preintervention to 86% postintervention and their pinning times decreased by 38%. Trainees reported increased knowledge, skill, and confidence after the intervention (P<0.001). A novel, low-cost simulation model and training session for supracondylar humerus fracture pinning resulted in improved performance in stabilizing a supracondylar humerus model and increased trainee knowledgeability, confidence, and skill. Level II-economic.

Time Given to Trainees to Attempt Cannulation During Endoscopic Retrograde Cholangiopancreatography Varies by Training Program and Is Not Associated With Competence

Advanced endoscopy training programs (AETPs) were developed as a result of the lack of comprehensive endoscopic retrograde cholangiopancreatography (ERCP) training during gastroenterology fellowships. There is no standardized curriculum for AETPs and the influence of program- and trainer-associated factors on trainee competence in ERCP has not been investigated adequately. In prior work, we showed that advanced endoscopy trainees (AETs) achieve ERCP competence at varying rates.1,2 The aims of this study were to measure the variability in time given to AETs to attempt cannulation between AETPs and throughout the 1-year training period, and to determine the association between AET cannulation time and AET competence at the end of training.

Live porcine model for surgical training in tracheostomy and open-airway surgery.

To evaluate the validity of a live porcine model for surgical training in tracheostomy and open-airway surgery. Prospective observational study. Eleven expert otolaryngologists-head and neck surgeons rated a live porcine model's realism/anatomical accuracy (face validity) and perceived effectiveness as a training tool (content validity) for tracheostomy and laryngotracheoplasty using anterior costal cartilage and thyroid ala cartilage grafts using a 53-item post-trial questionnaire with a five-point Likert scale. Experts rated the face validity of the live porcine model a median (interquartile range [IQR]) of 4/5 (4-5) and the content validity a median (IQR) of 5/5 (4-5) for each surgical procedure. Overall, 91% strongly agreed or agreed that the simulator would increase trainee competency for tracheostomy and laryngotracheoplasty using costal cartilage graft, and 82% strongly agreed or agreed that it would increase trainee competency for laryngotracheoplasty using thyroid ala cartilage graft. The live porcine model has high face and content validity as a training tool for tracheostomy and laryngotracheoplasty using costal cartilage and thyroid ala cartilage grafts. This training model can help surgical trainees practice these complex, low-frequency procedures. NA Laryngoscope, 130: 2063-2068, 2020.

Competence in using the arthroscopy stack system: a national survey of orthopaedic trainees in the UK.

Surgeons are required to have a sound knowledge regarding all operating theatre equipment they wish to use. This is important to ensure patient safety and theatre efficiency. Arthroscopy forms a significant part of all orthopaedic subspecialty practice. Proficiency in performing arthroscopic procedures is assessed during registrar training. The aim of this survey was to determine the competence of orthopaedic trainee registrars in setting up the arthroscopy stack system and managing intraoperative problems. Electronic survey forms were sent to all orthopaedic training programme directors in the UK to be forwarded to trainees in their deanery. The electronic survey contained 13 questions aimed at determining trainee experience and competence level with working with the arthroscopy stack system. A total of 138 responses were received from 14 deaneries in the UK. Almost all registrars had experienced intraoperative delays because of equipment malfunction that required addressing by more competent staff. However, 82% of respondents had not received any formal training for operating the arthroscopy stack system. Some 82% of registrars of ST7 grade or above, who had performed over 50 arthroscopic procedures and achieved a level 4 PBA competence, were unable to set up the stack system and successfully address these delays. Inadequate training is delivered to orthopaedic registrars from both the training programme and arthroscopy-themed courses with regards to set-up and operation of the arthroscopy tower system. This training should be part of the curriculum to ensure patient safety and efficient theatre practice.

Content Knowledge Competency of Arabic Language Teacher Trainees during Teaching Practice

This paper investigates the content knowledge competencies of 58 Arabic trainee teachers during their 14-week teaching practice. The competency aspect focused is the level of content knowledge in three areas of Arabic language-specific knowledge including grammatical knowledge/syntax, Arabic morphology, Balaghah and Adab Nusus. This study is a quantitative study which employs the descriptive research approach. Data collection was based on questionnaires which were then analyzed using SPSS statistical analysis. The findings showed that the Arabic language trainee teachers’ competency level in the field of Arabic morphology was good, but the knowledge of grammar and Balaghah/Adab Nusus was only at moderate level.

Evaluation of a novel curriculum on point-of-care ultrasound competency and confidence.

Point-of-care ultrasound (POCUS) education is a requirement of graduate medical education in EM. Milestones have been established to assess resident US competency. However, the delivery of POCUS education has not been standardized. This study aims to evaluate the impact of implementing a longitudinal, structured POCUS curriculum during EM residency on trainee competency and confidence. A prospective study of PGY-3 trainees before and after implementation of a novel POCUS curriculum was performed over an 18-month period at an EM residency training program. Curriculum design included longitudinal POCUS application-based monthly electronic content, bi-monthly residency conference sessions, and hands-on rotations. PGY-3 resident's POCUS knowledge was assessed with a 38-question multiple-choice and image-based exam. Further, PGY-3 residents were surveyed regarding POCUS confidence. Survey results evaluated provider confidence, satisfaction with the novel curriculum, and overall perception of POCUS utility scored on a 1 (low) to 5 (high) scale. Results were evaluated using an unpaired t test for data analysis. Mean quiz scores of 8 pre-curriculum PGY-3 residents (84%; 95%CI 78.46-89.54) were not significantly different when compared with 13 post-curriculum PGY-3 residents (82%; 95%CI 77.11-86.89) (p = 0.6126). Survey results for pre-curriculum trainees across each section were 4.13 (95%CI 3.91-4.35), 3.68 (95%CI 3.32-4.04), and 4.33 (95%CI 4.06-4.6). Results for post-curriculum trainees trended higher for each section at 4.22 (95%CI 4.04-4.40) (p = 0.4738), 3.84 (95%CI 3.52-4.16) (p = 0.5279), and 4.49 (95%CI 4.21-4.77) (p = 0.4534). Implementation of a structured, longitudinal POCUS curriculum resulted in a trend towards improved trainee confidence, satisfaction, and perception of POCUS. Future studies are needed to identify the optimal structure for POCUS educational content delivery and competency assessment for EM resident providers.

Impact of Critical Care Point-of-Care Ultrasound Short-Courses on Trainee Competence.

Competence in point-of-care ultrasound is recommended/mandated by several critical care specialties. Although doctors commonly attend point-of-care ultrasound short-courses for introductory training, there is little follow-up data on whether they eventually attain competence. This study was done to determine the impact of point-of-care ultrasound short-courses on point-of-care ultrasound competence. Web-based survey. Follow-up after point-of-care ultrasound short-courses in the Asia-Pacific region. Doctors who attended a point-of-care ultrasound short-course between December 2015 and February 2018. Each subject was emailed a questionnaire on or after 6 months following their short-course. They were asked if they had performed at least 30 structured point-of-care ultrasound scans and/or reached point-of-care ultrasound competence and their perceived reasons/challenges/barriers. They were also asked if they used point-of-care ultrasound as a clinical diagnostic aid. The response rate was 74.9% (182/243). Among the 182 respondents, only 12 (6.6%) had attained competence in their chosen point-of-care ultrasound modality, attributing their success to self-motivation and time management. For the remaining doctors who did not attain competence (170/182, 93.4%), the common reasons were lack of time, change of priorities, and less commonly, difficulties in accessing an ultrasound machine/supervisor. Common suggestions to improve short-courses included requests for scanning practice on acutely ill ICU patients and prior information on the challenges regarding point-of-care ultrasound competence. Suggestions to improve competence pathways included regular supervision and protected learning time. All 12 credentialled doctors regularly used point-of-care ultrasound as a clinical diagnostic aid. Of the 170 noncredentialled doctors, 123 (72.4%) reported performing unsupervised point-of-care ultrasound for clinical management, either sporadically (42/170, 24.7%) or regularly (81/170, 47.7%). In this survey of doctors attending point-of-care ultrasound short-courses in Australasia, the majority of doctors did not attain competence. However, the practice of unsupervised point-of-care ultrasound use by noncredentialled doctors was common. Further research into effective strategies to improve point-of-care ultrasound competence is required.

Anesthesia Residency Training in Airway Management: A Competency-Based Model Curriculum.

The Accreditation Council for Graduate Medical Education (ACGME) is moving toward competency-based medical education. This educational framework requires the description of educational outcomes based on the knowledge, skills, and behaviors expected of competent trainees. An assessment program is essential to provide formative feedback to trainees as they progress to competency in each outcome. This article describes the development of 2 model curricula for airway management training (basic and advanced) using a competency-based framework.

Assessing Competence in Central Venous Catheter Placement by Pediatric Critical Care Fellows: A National Survey Study.

To describe the current approach to initial training, ongoing skill maintenance, and assessment of competence in central venous catheter placement by pediatric critical care medicine fellows, a subset of trainees in whom this skill is required. Cross-sectional internet-based survey with deliberate sampling. United States pediatric critical care medicine fellowship programs. Pediatric critical care medicine program directors of Accreditation Council for Graduate Medical Education-accredited fellowship programs. None. A working group of the Education in Pediatric Intensive Care Investigators research collaborative conducted a national study to assess the degree of standardization of training and competence assessment of central venous catheter placement across pediatric critical care medicine fellowship programs. After piloting, the survey was sent to all program directors (n = 67) of Accreditation Council for Graduate Medical Education-accredited pediatric critical care medicine programs between July 2017 and September 2017. The response rate was 85% (57/67). Although 98% of programs provide formalized central venous catheter placement training for first-year fellows, only 42% of programs provide ongoing maintenance training as part of fellowship. Over half (55%) of programs use a global assessment tool and 33% use a checklist-based tool when evaluating fellow central venous catheter placement competence under direct supervision. Only two programs (4%) currently use an assessment tool previously published and validated by the Education in Pediatric Intensive Care group. A majority (82%) of responding program directors believe that a standardized approach to assessment of central venous catheter competency across programs is important. Despite national mandates for skill competence by many accrediting bodies, no standardized system currently exists across programs for assessing central venous catheter placement. Most pediatric critical care medicine programs use a global assessment and decisions around the ability of a fellow to place a central venous catheter under indirect supervision are largely based upon subjective assessment of performance. Further investigation is needed to determine if this finding is consistent in other specialties/subspecialties, if utilization of standardized assessment methods can improve program directors' abilities to ensure trainee competence in central venous catheter insertion in the setting of variable training approaches, and if these findings are consistent with other procedures across critical care medicine training programs, adult and pediatric.

68. EVALUATING THE PERCEIVED EFFECTIVENESS OF PEDIATRIC INTERN ORIENTATION

Background Effective means of preparing interns for transition to residency remains elusive. Recent studies indicate program directors perceive new interns to be underprepared for residency. While intern orientation is ubiquitous, content can vary greatly and often does not assess trainee competence. Objective To determine the content of intern orientation across several pediatric residency programs and evaluate intern perceptions of the effectiveness of orientation. Methods This cross-sectional study included pediatric residency programs in the Mid-America region. A survey with questions regarding orientation activities including content, allotted time, format, and assessment was sent to 24 program directors. Current interns at these programs were surveyed regarding their perceptions of the effectiveness of activities completed during orientation. Descriptive statistics were used to analyze survey responses. Results Fifty-eight percent of program directors responded to the initial survey. Median time in orientation was 65.5 hours (range 30-120). Variation was noted across programs in content and format. Only 9 activities were represented among all survey participants. Additionally, 93 interns from 15 programs completed the intern survey. Approximately 80% of interns perceived the overall time spent in orientation was “just right”; however, 37% felt too little time was spent on orientation to intern roles, and 38% perceived that too little time was spent on review of clinical skills. Fifty-four percent of respondents felt electronic health record training was slightly or not at all effective. Conclusions Pediatric intern orientation varied across the institutions surveyed and intern responses indicate that time on clinical skills and intern roles should be increased. This study is the first to characterize the activities included in pediatric orientation and their perceived value to interns. Next steps include expanding the study to additional pediatric programs and utilizing findings to help inform best practices for orientation and onboarding of pediatric residents.

It’s the destination: diagnostic accuracy and reasoning

While multiple theories exist to explain the diagnostic process, there are few available assessments that reliably determine diagnostic competence in trainees. Most methods focus on aspects of the process of diagnostic reasoning, such as the relation between case features and diagnostic hypotheses. Inevitably, detailed elucidation of aspects of the process requires substantial time per case and limits the number of cases that can be examined given a limited testing time. Shifting assessment to the outcome of diagnostic reasoning, accuracy of the diagnosis, may serve as a reliable measure of diagnostic competence and would allow increased sampling across cases. The present study is a retrospective analysis of 7 large studies, conducted by 3 research teams, that all used a series of brief written cases to examine the outcome of diagnostic reasoning-the diagnosis. The studies involved over 600 clinicians ranging from final year medical students to practicing emergency physicians. For 4 studies with usable reliability data, reliability for a 2h test ranged from .63 to .94. On average speeded tests were more reliable (.85 vs. .73).To achieve a reliability of .75 required an average test time of 1.11h for speeded tests and 1.99 for unspeeded tests. The measure was shown to be positively correlated with both written knowledge tests and measures of problem solving derived from OSCE performance tests. This retrospective analysis provides evidence to support the implementation of outcome-based assessments of clinical reasoning.

The Impact of E-Training Model on the Improvement of Professional Competence of PAUD-DIKMAS Educators

Theface-to-facetrainingthathasbeencarriedoutallthistimeisconsideredincapable to fully improve the professional competence of trainees. So, it is needed an E-training model which is based on the needs of the trainees. The purpose of this study were: (a) to find out and analyze the E-Training model implemented in the training of PAUDDikmas Educators and, (b) to analyze the impact of the implementation of E-Training models on the improvement of professional competence of PAUD-Dikmas Educators. The subjects of this research were the management and trainers, 8 people in total, to reveal data related to model design and 120 trainees (PAUD-Dikmas Educators) to reveal data about the impact of E-Training model implementation. The data collection methodsusedwereinterviewandquestionnaire.Thetechniquesusedtoanalyzewere descriptive-quantitative statistical analysis. The results of the study showed: (a) the implementation of E-Training model follows the flow of activities: training problems and needs analysis, training socialization and trainees recruitment, training planning, training learning process including independent learning, assignment, unit evaluation, and mentoring, comprehensive evaluation through independent assignments, they are given a certificate if they passed, and follow-up in the form of competency tests, and advanced training; and (b) the implementation of the E-Training model had animpactontheimprovementofprofessionalcompetenceofPAUD-Dikmaseducators.

Development and outcomes of an immersive obesity summit workshop for medical resident and fellow education.

SummaryPhysicians need better training to manage patients with obesity. Our study capitalized on the intimate nature of an extracurricular obesity workshop, creating an interactive educational programme. We assessed the short‐ and long‐term impact of the workshop on trainees' knowledge, competence and confidence in caring for patients with obesity in an outpatient setting. This is a cross‐sectional study, involving regionally diverse mix of resident and fellow physicians. A live 2.5‐day continuing medical education summit was held 11 to 13 March 2016. Obesity‐related topics were reviewed using state‐of‐the art pedagogical techniques. Pre‐/post‐levels of knowledge, competence and clinical practice strategies were analysed. Sixty‐three candidates interested in additional obesity medicine training were nominated by US residency and fellowship programme directors and selected to attend the summit. On average, learners experienced a 110% relative increase in knowledge and competence. The overall effect size was 0.95, with participants being ~54% more knowledgeable about the management of patients with obesity. All participants self‐reported that this activity increased their knowledge about the subject matter, improving their performance in caring for patients when asked about their practice in a follow‐up survey 6 months following the workshop. This immersive summit promoted robust gains in knowledge and confidence, ultimately translating to reported practice improvements at the individual and health system levels. Future research is warranted on the sustainability of gained skills.

How consultants determine diagnostic competence in histopathology trainees

AimsThis is a qualitative study exploring how consultant histopathologists determine diagnostic competence in their trainees.MethodsSemi-structured interviews were conducted with consultants and trainees and analysed using the Framework Method.ResultsFive major themes...

Embracing Multiple Stakeholder Perspectives in Defining Trainee Competence.

To explore how multiple stakeholder groups contribute to the understanding of trainee competence. The authors conducted a constructivist qualitative study in 2015 using focus group discussions to explore the perceptions of different stakeholder groups (patients, nurses/nurse practitioners, supervisors/senior physicians, leaders/administrators, trainees) regarding trainee competence in the emergency department. The authors used a conventional content analysis, a comparative analysis of supervisors'/senior physicians' versus other stakeholders' perspectives, and a directed analysis informed by stakeholder theory to analyze the focus group transcripts. Forty-six individuals participated in nine focus groups. Four categories of competence were identified: Core Clinical Activities, Patient Centeredness, Aligning Resources, and Code of Conduct. Stakeholders generally agreed in their overall expectations regarding trainee competence. Within individual categories, each stakeholder group identified new considerations, details, and conflicts, which were a replication, elaboration, or complication of a previously identified theme. All stakeholders stressed those aspects of trainee competence that were relevant to their work or values. Trainees were less aware of the patient perspective than that of the other stakeholder groups. Considering multiple stakeholder perspectives enriched the description and conceptualization of trainee competence. It also can inform the development of curricula and assessment tools and guide learning about inter- and intradisciplinary conflicts. Further research should explore how trainees' perceptions of value are influenced by their organizational context and, in particular, how trainees adapt their learning goals in response to the divergent demands of key stakeholders.

Defining Trainee Competence: Value Is in the Eye of the Stakeholder.

In this issue of Academic Medicine, Lundsgaard and colleagues present "Embracing Multiple Stakeholder Perspectives in Defining Trainee Competence," a qualitative exploration of how various stakeholders contribute to the understanding of trainee competence. Drawing on stakeholder theory from business management, the authors of that report explore how the perceptions of key stakeholders (leaders/administrators, nurses/nurse practitioners, trainees, and patients) either confirm, enhance, or complicate the picture of competence that emerges from the perspectives of senior physician supervisors.In this Invited Commentary, the author considers the potential effects of applying stakeholder theory to educational assessment and elaborates on Lundsgaard and colleagues' findings that additional stakeholder perceptions may be redundant in some instances and present conflicting understandings of competence in others. She also emphasizes the importance of a process of defining competence, and ultimately developing assessment programs, that includes measuring and illuminating conflicting perceptions of what constitutes competence. Finally, the author considers potential applications of Lundsgaard and colleagues' results for educators and assessors with comprehensive assessment programs already in place.There are limitations and risks to applying a conceptual framework that aims to increase value for a company to the training of physicians. However, with thoughtful application, incorporating multiple stakeholders into instrument development and workplace-based assessment may provide educators with a more nuanced picture of competence that incorporates the values of those ultimately impacted by trainee performance.

Pediatric Gastroenterology Fellows' Self-Assessment of Endoscopy Skills

Background: Endoscopy is a fundamental skill learned during a pediatric gastroenterology fellowship. The aim of this study was to determine the number of procedures performed during fellowship and to evaluate a trainee's self-perceived competency of their endoscopic skills. Methods: A survey link was emailed to the NASPGHAN PEDI GI Fellows listserv composed of 372 fellows. Procedural count of eight routine procedures and a visual analogue scale measuring fellow's self-perceived competency for each procedure were evaluated. The data was collected and stored using REDCap. Findings: One hundred sixty-seven fellows (45%) completed the survey: 28% first year, 41% second year, and 31% third year. 50% or fewer of third-year fellows felt competent and met the complete procedural number thresholds recommended by the 2013 NASPGHAN training guidelines for routine procedures except for diagnostic esophagogastroduodenoscopy (EGD). Subjects felt competent regarding colonoscopy but only 24% reached the threshold. There was no difference in EGD counts between small vs large training programs (p=0·51). Therapeutic endoscopy scored the lowest on self-reported competency scale. Interpretation: study showed that a majority of third-year trainees feel competent regarding EGD and colonoscopy skills, but only reached threshold counts in EGD. Although pediatric gastroenterologists and trainees are thought to perform safe and effective gastrointestinal endoscopy, this data suggests that time could be changed to emphasize other procedural training. Additional research should be completed in this area to evaluate the value of self-reported competency and to consider revision of the 2013 NASPGHAN training guidelines to reflect current practice. Funding Statement: The authors declare: sources of funding exist for either author. Declaration of Interests: No conflicts of interest exist for Heidi E. Hagerott. Joel Friedlander is president, chief medical officer, and co-founder of Triple Endoscopy, Inc. He is also inventor on patent pending US 62/184,077, PCT/US2016/039352, AU201683112, CA 2,990,182, EU 16815420.1, JP 2017-566710, US 15/850,939, US 15/853,521, US15/887,438, US 62/680,798 related to endoscopic methods and technologies. Ethics Approval Statement: The authors state: This study met criteria for IRB exemption.