Medical Education Core Competencies Research Articles

Comprehensiveness and Instructional Quality of YouTube Videos on Clinical Record-Keeping Training in Medical Education

Objective: Clinical record-keeping is recognized as a core competency in medical education. This study aimed to evaluate comprehensiveness and instructional quality of videos available on the YouTube platform for teaching clinical record-keeping. Methods: YouTube was searched by using relevant keywords. Based on eligibility criteria, 59 videos were included in the study. Videos were assessed for country of origin, video length, number of likes, dislikes, comments , daily views, like ratio, and video power index. Tools to measure the quality of clinical notes, which are QNOTE and RED Checklist, have been used to assess comprehensiveness of the videos. Instructional quality was assessed using the instructional video quality checklist (IVQC). Results: The comprehensiveness score was 60.4±17.89 (out of 100), while instructional quality score was 11.19±3.61 (out of 27). IVQC scores were significantly higher in the university/professional organizations and academics compared to the others (p

Establishment of a Fellowship in Street Medicine.

The American Medical Association recognizes street homelessness as a significant barrier to the provision of high-quality care.1 Traditional medical training provides inadequate preparation for physicians to manage persons experiencing unsheltered homelessness (PEUH). Street medicine is the direct provision of health care and social support to PEUH,2 who experience high barriers to needed care and tend to use acute hospital-based care at high rates.3We established a street medicine fellowship to enable physicians to acquire the requisite clinical and organizational skills to become leaders in improving outcomes in this vulnerable population.The UPMC Mercy Street Medicine Fellowship is the first of its kind. This one-year, one fellow per year program was initiated in 2019 by UPMC Mercy, Pennsylvania. The fellowship accepts applications from physicians who have completed a residency in internal medicine, family medicine, emergency medicine, or psychiatry, and who seek to develop expertise in caring for PEUH while also participating in multidisciplinary care to enable them to serve as future leaders in this field. At the end of the fellowship training a survey is sent to learners.Fellows are instructed in comprehensive management of PEUH. The program uses the “go-to people” approach to health care as promoted by the Street Medicine Institute. Fellows are challenged to set aside the mindset of the “office approach,” which often does not embrace unique social determinants of health, and round 3 to 4 times per week on the streets, on the riverbanks, and in homeless encampments, including general rounds, targeted case management rounds, and specialty rounds (eg, psychiatric, harm reduction, intimate partner violence, etc). They participate in additional outpatient clinics, 3 half days per week, which have been established for PEUH and for those who have transitioned from street homelessness into housing. Fellows maintain this continuity group of patients throughout the fellowship year. Home visits are also conducted for newly placed patients.Fellows apply the concept of “community united” so that changes initiated in one community are spread to others. They utilize multidisciplinary mentors and engage in productive communication with experts in street medicine. They conduct a formal comparative analysis of 2 communities in which street medicine is practiced to further develop insight into improvement opportunities as well as attend the annual International Street Medicine Symposium as a learning activity and for academic presentation as applicable.Fellows are assessed monthly according to the Accreditation Council for Graduate Medical Education's Core Competencies. Fellows also complete a monthly evaluation of their assigned experience. Lastly, fellows are surveyed at the completion of the year (Figure).Our first fellow now carries a university faculty position in another city. She teaches in the outpatient setting and has integrated clinical street work with community initiatives, a street medicine interest group, and a peer outreach group. Our second fellow is practicing emergency medicine in another city and incorporating her skills to improve care in that setting for PEUH.Although our program is young, our graduates have affirmed that formal fellowship training in street medicine is a viable yet heretofore unexplored avenue toward more effectively addressing society's responsibility toward PEUH.

Online medical history taking course: Opportunities and limitations in comparison to traditional bedside teaching.

Objective: Obtaining a systematic medical history (MH) from a patient is a core competency in medical education and plays a vital role in the diagnosis of diseases. At the Faculty of Medicine at LMU Munich, students have their first course in MH taking during their second year. Due to the COVID-19 pandemic, the traditional bedside MH taking course had to be transformed into an online course (OC). Our objectives were to implement an online MH taking course, to evaluate its feasibility and to compare the evaluation results to a historic cohort that had undertaken the traditional bedside teaching course (BTC).Methods: 874 second-year students participated in the OC (BTC=827). After teaching the theoretical background via asynchronous online lectures, students participated in a practical exercise with fellow students using the video communication platform Zoom where they were able to practice taking a MH on the basis of fictitious, text-based patient cases. Students were then asked to evaluate the course through a standardized online survey with 31 questions on teaching quality and self-perceived learning success, which had also been used in previous years. The survey results were compared to the results of the historic cohort using the Mann-Whitney U test.Results: A total of n=162 students (18.5%) evaluated the OC. In the historic cohort, n=252 (30.5%) completed the survey. 85.3% of the OC respondents thought that the atmosphere during the practical exercise was productive and 83.0% greatly appreciated the flexibility in terms of time management. Moreover, they appreciated the online resources as well as having the opportunity to undertake a MH taking course during the COVID-19 pandemic. 27.7% of the respondents thought that traditional BTCs should be supplemented through more online activities in the future. With respect to the ability of independently taking a MH upon completion of the course, the OC was rated significantly lower relative to the BTC (mean OC=2.4, SD=±1.1 vs. mean BTC=1.9, SD=±1.1 (1=strongly agree; 5=strongly disagree); p<0.0001).Conclusion: OCs are a feasible format and seem to convey the theory and practical implementation in a peer-exercise format of MH taking to medical students. The theoretical background can be acquired with great flexibility. Nevertheless, the students’ self-appraisal suggested that the traditional teaching format was more effective at teaching MH taking skills. Thus, we propose a blended learning concept, combining elements of both formats. In this context, we suggest prospective, randomized trials to evaluate blended learning approaches.

AN ASSESSMENT OF MEDICAL STUDENTS’ PERCEPTIONS TOWARDS PROFESSIONALISM IN HEALTH CARE AT HUE UNIVERSITY OF MEDICINE AND PHARMACY, HUE UNIVERSITY

Professionalism has become one of the core competencies in medical education which will shape physicians’s behavior in the future to provide high-quality and patient-centered care services. Objectives: To assess the perceptions and attitudes of medical students regarding professionalism in health care. Methods: A cross-sectional descriptive study was carried out with 717 second-year and fifth-year medical students of Hue University of Medicine and Pharmacy, Hue University. Results: Students’ perception on professionalism was not high, at 3.85 out of 5 points. In which, “respect” was the domain having highest score and “communication skills” was the lowest recognition domain (4.15 and 3.54 out of 5, respectively). Preclinical students had higher perception than students having clinical experiences in all aspects of professionalism (p&lt;0.05). Conclusion: Priority should be given to train professionalism and communication skills through the early clinical exposure program and hidden curriculum across all years of medical education program. Furthermore, the core aspects of professionalism are needed to be consistently identified and evaluated in the training program among medical universities in Vietnam

Comparison of self and simulated patient assessments of first-year medical students\u2019 Interpersonal and Communication Skills (ICS) during Objective Structured Clinical Examinations (OSCE)

BackgroundInterpersonal and communication skills (ICS) are important core competencies in medical education and certification. In this study, we identified self- and simulated patient (SP)-reported ratings of US first-year medical students’ ICS and the influence of age and gender on performance appraisal during the Objective-Structured Clinical Examination (OSCE).MethodsOSCE participants, including 172 first-year medical students and 15 SPs were asked to evaluate the students’ ICS using the American Board of Internal Medicine–Patient-Satisfaction Questionnaire (ABIM–PSQ), electronically and via paper, respectively. Self- and SP-reported ratings of students’ ICS were presented as the median on a 5-point Likert-scale and as three categories defined as “good,” “very good,” and “inadequate.”ResultsSPs assessed all 172 students in the OSCE, while 43.6% of students assessed their own performance. The majority of students and SPs evaluated the students’ ICS as very good. 23.3% of SPs and 5.3% of students rated the medical students’ ability to encourage patient question-asking and answer questions as inadequate (P < 0.002). Neither age nor gender influenced the medical students’ self-assessment of ICS. Female SPs assigned lower scores to students in regard to respecting patients and encouraging patient question-asking and answering. Older SPs was more likely to assign lower scores on all survey questions.ConclusionsIn the present study, self- and SP-reported ratings of first-year medical students’ ICS were mainly “very good” with no influence of students’ age or gender. Older age and female gender among the SPs were associated with a reduction in SP-reported ratings of students’ ICS.

Utilizing Psychodynamic Principles to Teach Professionalism to Medical Students Through an Innovative Curriculum.

Professionalism is a fundamental expectation of practicing medicine and a core competency in medical education, yet the methods of how to teach and evaluate it are still experimental. Professionalism involves self-reflection, a psychodynamic understanding of the patient's and the doctor's predicament, and conflict resolution, so psychiatrists are uniquely qualified to teach it. This article describes an innovative course that utilizes psychodynamic principles to teach professionalism to medical students. The authors present a novel 2-year curriculum for teaching professionalism to first- and second-year medical students utilizing psychodynamic principles to help develop awareness of others' feelings and motivations, self-reflection, compassion, empathy, and skills in ethical conflict resolution by means of written and oral narrative exercises. Outcomes are evaluated by the student ratings about the course and the faculty, and by using the test for emotional intelligence (EI), administered as a baseline and then at the end of each year. Each subsequent year the students demonstrated a statistically significant increase in EI scores, student evaluations of the course ranked among the highest in the medical school, clerkship supervisors and residency training directors noted the high degree of professionalism of the students, and the number of student applicants to psychiatry residency were consistently higher than the national average. In addition, this course was awarded the 2018 Alpha Omega Alpha Honor Medical Society's Edward B. Harris Medical Professionalism Award for the best professionalism course of U.S. medical schools. Psychodynamic principles are fundamental for teaching medical professionalism at a medical-student level. Professionalism also serves as a way to introduce students to psychiatry early in the curriculum, and psychiatrists and other mental health professionals are uniquely qualified to teach medical professionalism.

32.H. Round table: Emergency preparedness: Core competencies for medical students as part of public health workforce

The duties encompassed within public health, according to Acheson's definition, are to be undertaken by society as a whole. This is further emphasised within 'ASPHER's European List of Core Competencies for the Public Health Professional' which mentions that public health responsibilities fall upon the 'public health workforce'. If even those outside the medical profession are considered part of the public health workforce, why are medical students being overlooked as a group who can contribute? As representatives of the future generation of medical professionals, shouldn't they be an obvious starting point for practising public health advocacy? Medical students have the potential to act and, with better integration into the public health workforce, could become an asset. Despite them having a legal obligation to contribute in emergency situations, there are insufficiencies or a lack of clarity within the guidelines to highlight and elaborate on what students are specifically expected to be able to carry out in various situations. This is in stark contrast to the predefined lists of competencies against which medical professionals are assessed.This workshop will focus on identifying the core competencies regarding medical students in their contribution to emergency preparedness and how these could be integrated into the existing framework for effecting a structured and organised response. The primary outcome is to achieve better advocacy for public health in future medical professionals with a focus on preparedness for emergency situations.To begin with, research carried out to elucidate whether different countries have set guidelines or competencies that are expected of medical students by the conclusion of their medical studies will be presented. Such guidelines both on national and regional levels were identified and then compared following analysis.This will be followed by more personal accounts from medical students and a discussion of the potential steps that could be introduced to improve emergency preparedness.Shortcomings of such guidelines concerning medical student competencies are further highlighted in times of crisis such as the ongoing COVID-19 pandemic. It is during this time when healthcare systems are stretched and their contribution may be most valuable. The nature of this contribution within the context of international pandemic plans will be explored and debated.Finally this workshop will conclude by opening up the floor for discussion between the panellists and the audience regarding the topics and issues raised.This workshop aims to highlight the need for core competencies in medical education and bring this topic to the forefront for further discussion and analysis amongst professionals, with the eventual international unification, simplification and clarification of these being the ultimate goal. This could be pivotal for the future of public health and in the advancement and evolution of education.Key messages Armed with suitable competencies, medical students can be an asset to the public health workforce if utilised effectively and in doing so can enhance preparedness response.This project’s outcomes are in alignment with ASPHER’s European Public Health Core Competencies Programme (EPHCCP) and the WHO Coalition of Partners (CoP).

Sustained effects of faculty leadership development modules for clinical instructors of core competences education in Taiwan: a four-year explanatory case study

BackgroundThe Accreditation Council for Graduate Medical Education (ACGME) core competencies (CC) in general medicine-based primary care are essential for junior medical trainees. In this country, a regular faculty development (FD) program aimed at training faculty in instructing (teaching and assessing) these CC had operated. However, leadership was not emphasized. In a new intervention module, the roles and associated responsibilities of clinical instructors to conduct, design, and lead CC-based education were emphasis.AimsThis follow-up explanatory case study compares the effectiveness of intervention module with that of the previous regular module.MethodsThe regular group (n = 28) comprised clinical instructors who participated in the FD module during the 2013–2014 year while the intervention group (n = 28) was composed of 2015–2016 participants. Prior to the formal (hands-on) training, participants in the intervention group were asked to study the online materials of the regular module. These participants then received a 30-h hands-on training in conducting, designing, and leading skills. Finally, they prepared a 10-h reflective end-of-module presentation of their real-world practices.ResultsFollowing the training, a higher degree improvement in participants self-reported familiarity with CC education, self-confidence in their ability to deliver CC education and sustained involve CC education were noted among the intervention FD group, compared with the regular FD group. In the intervention group, senior academicians (associate and full professor) are more substantially involved in designing and leading CC-based courses than junior academicians (lecturers and assistant professors). Among non-teaching award winners of in the intervention FD group, the follow-up degree of sustained involvement in delivering, designing and leading CC-based courses was significantly higher than that of the regular group.ConclusionsOur study demonstrated that leadership training in the intervention FD modules substantially motivated clinical instructors to become leaders in CC education.

The Vital Role of Professionalism in Physical Medicine and Rehabilitation.

Professionalism in medicine is universally embraced, and it is the foundation for core competencies in medical education, clinical practice, and research. Physical medicine and rehabilitation physicians must master a complex body of knowledge and use this to responsibly care for patients. Rehabilitation professionals work in various settings; however, each one must establish and maintain ethical standards consistent with the specialty and national standards. For example, the Accreditation Council for Graduate Medical Education lists professionalism as one of its six core competencies, which trainees must master. There is a growing interest in professionalism and some of the ethical issues that it encompasses. This report provides a general overview of professionalism. Future reports are needed, and there is an opportunity to consider many facets of professionalism in greater detail.

Powerful Lessons from Cuban Medical Education Programs: Fostering the Social Contract in Athletic Training Programs

ContextThe Cuban medical education and health care systems provide powerful lessons to athletic training educators, clinicians, and researchers to guide educational reform initiatives and professional growth.ObjectiveThe purpose of this paper is to provide a brief overview of the Cuban medical education system to create parallels for comparison and growth strategies to implement within athletic training in the United States.BackgroundCubans have experienced tremendous limitations in resources for decades yet have substantive success in medical education and health care programs. As a guiding practice, Cubans focus on whole-patient care and have established far-reaching research networks to help substantiate their work.SynthesisCuban medical education programs emphasize prevention, whole-patient care, and public health in a unique approach that reflects disablement models recently promoted in athletic training in the United States. Comprehensive access and data collection provide meaningful information for quality improvement of education and health care processes. Active community engagement, education, and interventions are tailored to meet the biopsychosocial needs of individuals and communities.ResultsCuban medical education and health care systems provide valuable lessons for athletic training programs to consider in light of current educational reform initiatives. Strong collaborations and rich integration of disablement models in educational programs and clinical practice may provide meaningful outcomes for athletic training programs. Educational reform should be considered an opportunity to expand the athletic training profession by embracing the evolving role of the athletic trainer in the competitive health care arena.Recommendation(s)Through careful consideration of Cuban medical education and health care initiatives, athletic training programs can better meet the contract with society as health care professionals by integrating the Accreditation Council for Graduate Medical Education's core competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice now promoted in the Commission on Accreditation of Athletic Training Education's 2020 Standards for Accreditation of Professional Athletic Training Programs.Conclusion(s)Educational and health care outcomes drive change. Quality improvement efforts transcend both education and health care. Athletic training can learn valuable lessons from the Cubans about innovation, preventative medicine, patient-centered community outreach, underserved populations, research initiatives, and globalization. Not unlike Cuba, athletic training has a unique opportunity to embrace the challenges associated with change to create a better future for athletic training students and professionals.

To What Degree Are the 13 Entrustable Professional Activities Already Incorporated Into Physicians’ Performance Schemas for Medical Students?

Phenomenon: There is an abundance of literature on Entrustable Professional Activities (EPAs) in theory, but there are few studies on the EPAs in practice for undergraduate clinical education. In addition, little is known about the degree to which the EPAs are or are not aligned with physician assessors’ performance schemas of the clerkship student. Investigating the degree to which physician assessors’ performance schemas are already aligned with the activities described by the EPAs is critical for effective workplace assessment design. Approach: We sampled 1,032 areas of strength (strength) and areas for improvement (improvement) written evaluation comments by 423 physician assessors for clerkship students’ performance in academic years 2014–15 and 2015–16 at the University of Utah School of Medicine. Two researchers independently categorized each comment by EPA and/or coded by non-EPA topic. The proportion of comment types was compared between strength comments and improvement comments with the Wilcoxon Signed-Rank Test. Findings: The most frequently mentioned EPAs in comments were about history gathering/physical exam, differential diagnosis, documentation, presentation, and interprofessional collaboration; few mentioned diagnostic tests, patient handovers, recognition of urgent patient care, and patient safety, and none mentioned orders/prescriptions and informed consent. The most frequent non-EPA topics were about medical knowledge, need to read more, learning attitude, work ethic, professionalism/maturity, and receptiveness to feedback. The proportion of comments aligned with an EPA only, a non-EPA topic only, or both an EPA and non-EPA topic was significantly different for clerkship students’ strength compared to improvement. Insights: Physician assessors’ performance schemas for clerkship students were aligned with EPAs to varying degrees depending on the specific EPA and whether describing strength or improvement. Of interest, the frequently mentioned non-EPA comments represented some of the competencies that contribute to effectively performing particular EPAs and are Accreditation Council for Graduate Medical Education (ACGME) core competencies (e.g., medical knowledge, professionalism), used in residency programs. Because physician assessors for undergraduate medical education often also participate in graduate medical education, the frequency of non-EPA topics aligned to ACGME competencies may suggest influence of graduate medical education evaluative frameworks on performance schemas for clerkship students; this could be important when considering implementation of EPAs in undergraduate medical education.

A workshop to train medicine faculty to teach clinical reasoning

Background Clinical reasoning (CR) is a core competency in medical education. Few studies have examined efforts to train faculty to teach CR and lead CR curricula in medical schools and residencies. In this report, we describe the development and preliminary evaluation of a faculty development workshop to teach CR grounded in CR theory. Methods Twenty-six medicine faculty (nine hospitalists and 17 subspecialists) participated in a workshop that introduced a framework to teach CR using an interactive, case-based didactic followed by role-play exercises. Faculty participated in pre- and post-Group Observed Structured Teaching Exercises (GOSTE), completed retrospective pre-post assessments (RPPs), and made commitment to change statements (CTCs). Results In the post-GOSTE, participants significantly improved in their use of problem representation and illness scripts to teach CR. RPPs revealed that faculty were more confident in their ability and more likely to teach CR using educational strategies grounded in CR educational theory. At 2-month follow-up, 81% of participants reported partially implementing these teaching techniques. Conclusions After participating in this 3-h workshop, faculty demonstrated increased ability to use these teaching techniques and expressed greater confidence and an increased likelihood to teach CR. The majority of faculty reported implementing these newly learned educational strategies into practice.

Plain language communication as a priority competency for medical professionals in a globalized world

This brief report aims to highlight the impact of globalization - the international movement of goods, people, and ideas - on patient-provider communication in medical training and practice, and how the implementation of plain language communication training as a core competency for care providers can mitigate this impact. Globalization influences both patient and provider population diversity, which presents challenges with regard to patient-provider communication, particularly in cases of limited health literacy. Plain language communication - the delivery of information in a simple, succinct, and accurate manner - can help address these challenges. Training in plain language communication, however, is not a part of standard education for health care providers. Based on a synthesis of relevant literature pertaining to globalization, plain language communication, and medical education curricula, it is hoped that the information presented establishes the need for plain language communication as a core competency in medical education to enable providers to better meet the needs of an increasingly globalized health system.

Coding Discrepancies Between Medical Student and Physician Documentation

Accurate medical documentation is a core competency in medical education and is critical to successful surgical practice. The following study aims to assess the coding accuracy of medical student documentation. Retrospective chart review identified patient encounters in a surgery clinic that contained documentation by both a faculty member and a third-year medical student. Records were de-identified and assigned a level of service (LOS) and diagnostic code by trained, expert coders. Differences in LOS and diagnostic code were then compared between medical student and faculty documentation. A single academic health system. Third-year medical students. 80 full patient evaluations and 20 postoperative visits were analyzed. Median faculty and student LOS was 4 (range 3-4) and 3 (range 0-4) respectively (p < 0.001). Students failed to document a sufficient number of elements in the evaluation, failed to specify studies ordered, and documented low medical decision making. Diagnostic code was concordant between students and faculty for only 31% of documentation. Student documentation of clinical encounters is coded at a lower LOS than faculty documentation. These results likely reflect the lack of education regarding E/M coding in medical school, which is integral to real world practice. Accurate medical documentation is critical to the correct diagnostic coding and billing of a medical encounter. We found that compared to faculty documentation of the same patient evaluations, student documentation was typically coded at a lower level of service and assigned a different diagnostic code by professional medical coders. Addressing these topics in medical school may better prepare students for real-world practice.

Data and Lifelong Learning Protocol: Understanding Cultural Barriers and Facilitators to Using Clinical Performance Data to Support Continuing Professional Development.

Continuing professional development (CPD) can support delivery of high-quality care, but may not be optimized until we can understand cultural barriers and facilitators, especially as innovations emerge. Lifelong learning (LLL), linked with quality improvement, competence, and professionalism, is a core competency in medical education. The purpose of this study is to examine cultural factors (individual, organizational, and systemic) that influence CPD and specifically the use of clinical data to inform LLL and CPD activities. This mixed-method study will examine the perceptions of two learner groups (psychiatrists and general surgeons) in three phases: (1) a survey to understand the relationship between data-informed learning and orientation to LLL; (2) semistructured interviews using purposive and maximum variation sampling techniques to identify individual-, organizational-, and system-level barriers and facilitators to engaging in data-informed LLL to support practice change; and (3) a document analysis of legislation, policies, and procedures related to the access and the use of clinical data for performance improvement in CPD. We obtained research ethics approval from the University Health Network in Toronto, Ontario, Canada. By exploring two distinct learner groups, we will identify contextual features that may inform what educators should consider when conceptualizing and designing CPD activities and what initial actions need to be taken before CPD activities can be optimized. This study will lead to the development of a framework reflective of barriers and facilitators that can be implemented when planning to use data in CPD activities to support data adoption for LLL.

Cleft Lip Standardized Patient Examinations: The Role in Plastic Surgery Resident Education.

Our institution has incorporated the use of objective structured clinical examinations (OSCE) in our residency curriculum. The OSCE provides trainee education and evaluation while addressing the six Accreditation Council for Graduate Medical Education (ACGME) core competencies required within training programs. We report our program's experience with the first cleft OSCE ever conducted. A validated method for administration of OSCEs currently used at our medical school was utilized for residents in postgraduate years (PGYs) 3 through 6. The video-recorded patient encounter involved a 1-month-old newborn with a unilateral cleft lip and palate and used standardized patient actors as parents. A post-encounter written exam assessed medical knowledge. A questionnaire regarding the utility of the exercise was administered to residents after the OSCE. Results were evaluated using analysis of variance (P < .05). There was a positive correlation with increasing level of training in terms of medical knowledge (P < .04). Residents in PGY-3 and PGY-4 demonstrated lower understanding of the surgical markings and details of the lip repair compared with those in PGY-5 and PGY-6 (P < .03). All residents performed similarly on evaluation of the remaining ACGME core competencies. All residents agreed that this was a realistic and useful encounter. Results of our cleft OSCE demonstrate that medical knowledge regarding the evaluation, management, and surgical repair of patients is less in midlevel residents. All residents expressed an interest in earlier exposure to pediatric patients in the training period. Although a cleft OSCE does not replace clinical rotations, it is a valuable adjunct to training and evaluation of trainees, particularly for junior residents.

Residency Training at the Front of the West African Ebola Outbreak: Adapting for a Rare Opportunity.

Medical trainees face multiple barriers to participation in major outbreak responses such as that required for Ebola Virus Disease through 2014-2015 in West Africa. Hurdles include fear of contracting and importing the disease, residency requirements, scheduling conflicts, family obligations and lack of experience and maturity. We describe the successful four-week deployment to Liberia of a first year infectious diseases trainee through the mechanism of the Global Outbreak Alert and Response Network of the World Health Organization. The posting received prospective approval from the residency supervisory committees and employing hospital management and was designed with components fulfilling the Accreditation Council for Graduate Medical Education (ACGME) core competencies. It mirrored conventional training with regards to learning objectives, supervisory framework and assessment methods. Together with Centers for Disease Control and Prevention and many other partners, the team joined the infection prevention and control efforts in Monrovia. Contributions were made to a 'ring fencing' infection control approach that was being introduced, including enhancement of triage, training and providing supplies in high priority health-care facilities in the capital and border zones. In addition the fellow produced an electronic database that enabled monitoring infection control standards in health facilities. This successful elective posting illustrates that quality training can be achieved, even in the most challenging environments, with support from the pedagogic and sponsoring institutions. Such experiential learning opportunities benefit both the outbreak response and the trainee, and if scaled up would contribute towards building a global health emergency workforce. More should be done from residency accreditation bodies in facilitating postings in outbreak settings.

A Practical Methodological Approach Towards Identifying Core Competencies in Medical Education Based on Literature Trends

Competency-based medical education (CBME) is gaining momentum in postgraduate residency and fellowship training. While randomized trials, consensus statements, and practice guidelines can help delineate some of the core competencies for CBME, they are not applicable to all clinical scenarios. To propose and assess the feasibility of a practical methodology for addressing this issue using radiosurgery for vestibular schwannoma (VS) science as an example. The Web of Science electronic database was searched using relevant terms. A 3-step review of titles and abstracts was used. Studies were classified independently and in duplicate as either efficacy or effectiveness analyses. Cohen's kappa score was used to assess inter-rater agreement. Overall, 1818 surgical and 943 radiosurgical publications were identified. The number of effectiveness studies surpassed that of efficacy studies in the late 1980s for surgical studies, and in the early-to-mid 1990s among radiosurgical studies. The publication rate was higher for radiosurgery in the mid 1990s, but it paralleled that of surgical studies beyond the early 2000s. Variations in this overall trend corresponded to the emergence of studies that assessed the role of endoscopy and the utility of dose reduction in radiosurgery. We have confirmed the feasibility and accuracy of this objective methodological approach. By understanding how the peer-reviewed literature reflects actual practice interests, educators can tailor curricula to ensure that trainees remain current. While further validation studies are needed, this methodology can serve as a supplemental strategy for identifying additional core competencies in CBME.

Automated Case Cancellation Review System Improves Systems-Based Practice.

Accreditation Council for Graduate Medical Education (ACGME) core competencies of systems-based practice and practice-based learning and improvement are difficult to assess, as they are often not directly measurable or observable. Reviewing day-of-surgery cancellations could provide resident learning opportunities in these areas. An automated system to facilitate anesthesiology resident review of cancelled cases was implemented on the Preoperative Evaluation Clinic (PEC) rotation at the authors' institution. This study aims to evaluate its impact on resident education. Residents on the PEC rotation during the 6 months preceding (n = 22) and following (n = 13) implementation in 2014 were surveyed about their experience performing cancelled case reviews in order to ascertain the effect of the intervention on their training. Significant changes were reported in the number of cases reviewed by each resident (p < 0.0001), perceived importance of review (p = 0.03), and ease of review (p = 0.03) after system implementation. There was also an increase in the proportion of cancelled cases reviewed from 17.3% (34 of 196) to 95.6% (194 of 203) (p < 0.0001). Non-significant trends were seen in perceived rotation effect on ACGME competencies, including systems-based practice. Several specific improvements to our clinical practice, including the creation of standardized guidelines, arose from these case reviews. Implementation of automated systems can improve compliance with educational goals by clarifying priorities and simplifying workflow. This system increased the number of cases reviewed by residents and the perceived importance of this review as a part of their educational experience.

Code R: Redesigning Hospital-wide Peer Review for Academic Hospitals.

In most health care institutions, physician peer review is the primary method for maintaining and measuring physician competency and quality of care issues. However, many teaching hospitals do not have a method of tracking resident trainees' involvement in adverse cases. At the study institution, Code R was introduced as a measure to capture resident trainee involvement in the hospital-wide peer review process. The authors conducted a retrospective review of all peer review cases from January 2008 to December 2011 in an academic medical center and determined the quantity and type of resident errors that occurred compared to attending faculty. The Accreditation Council for Graduate Medical Education's core competencies served as a framework to categorize quality of care errors. The addition of Code R to the peer review process can be readily adopted by other institutions to help improve resident education, facilitate faculty supervision, and potentially improve patient safety.