Graduate Medical Education Environment Research Articles

Assessment of Professionalism in the Graduate Medical Education Environment.

Assessment of Professionalism in the Graduate Medical Education Environment.

Teaching the Teachers With Milestones: Using the ACGME Milestones Model for Professional Development.

Teaching the Teachers With Milestones: Using the ACGME Milestones Model for Professional Development.

Calming Troubled Waters: A Narrative Review of Challenges and Potential Solutions in the Residency Interview Offer Process.

The rising numbers of residency applications along with fears of a constrained graduate medical education environment have created pressures on residency applicants. Anecdotal evidence suggests substantial challenges with the process of offering residency interviews. This narrative review is designed to identify and propose solutions for the current problems in the process of offering residency interviews. We used PubMed and web browser searches to identify relevant studies and reports. Materials were assessed for relevance to the current process of distributing residency interviews. There is limited relevant literature and the quality is poor overall. We were able to identify several key problem areas including uncertain timing of interview offers; disruption caused by the timing of interview offers; imbalance of interview offers and available positions; and a lack of clarity around waitlist and rejection status. In addition, the couples match and need for coordination of interviews creates a special case. Many of the problems related to residency interview offers are amenable to program-level interventions, which may serve as best practices for residency programs, focusing on clear communication of processes as well as attention to factors such as offer-timing and numbers. We provide potential strategies for programs as well as a call for additional research to better understand the problem and solutions.

Advancing an Academic Career in the Graduate Medical Education Environment.

Advancing an Academic Career in the Graduate Medical Education Environment.

A Narrative Review and Novel Framework for Application of Team-Based Learning in Graduate Medical Education.

Team-based learning (TBL) promotes problem solving and teamwork, and has been applied as an instructional method in undergraduate medical education with purported benefits. Although TBL curricula have been implemented for residents, no published systematic reviews or guidelines exist for the development and use of TBL in graduate medical education (GME). To review TBL curricula in GME, identify gaps in the literature, and synthesize a framework to guide the development of TBL curricula at the GME level. We searched PubMed, MEDLINE, and ERIC databases from 1990 to 2014 for relevant articles. References were reviewed to identify additional studies. The inclusion criteria were peer-reviewed publications in English that described TBL curriculum implementation in GME. Data were systematically abstracted and reviewed for consensus. Based on included publications, a 4-element framework-system, residents, significance, and scaffolding-was developed to serve as a step-wise guide to planning a TBL curriculum in GME. Nine publications describing 7 unique TBL curricula in residency met inclusion criteria. Outcomes included feasibility, satisfaction, clinical behavior, teamwork, and knowledge application. TBL appears feasible in the GME environment, with learner reactions ranging from positive to neutral. Gaps in the literature occur within each of the 4 elements of the suggested framework, including: system, faculty preparation time and minimum length of effective TBL sessions; residents, impact of team heterogeneity and inconsistent attendance; significance, comparison to other instructional methods and outcomes measuring knowledge retention, knowledge application, and skill development; and scaffolding, factors that influence the completion of preparatory work.

The Future of Plastic Surgery Resident Education.

The challenge of the current graduate medical education environment requires in plastic surgery acceptance of those contemporary pressures that cannot be substantially modified and address of those that can be successfully met. To do so implies an examination of conference didactics, intraoperative teaching, and a valid assessment of resident performance.

Initial Tests of the ACGME Self Study

All authors are with the Accreditation Council for Graduate Medical Education. Serge Martinez, MD, JD, is an Accreditation Field Representative; William W. Robertson Jr, MD, MBA, is an Accreditation Field Representative; and Ingrid Philibert, PhD, MBA, is Senior Vice President of Field Activities and Executive Managing Editor of the Journal of Graduate Medical Education. The authors would like to express their sincere appreciation to the program directors, institutional leaders, faculty, residents, and others across the institutions in the test visits for their assistance in arranging for these visits, their participation, and their thoughtful feedback on the process.

Residencies Roll Out New Training System

MEDICAL RESIDENCY PROGRAMS are about to undergo substantial changes in the ways the physicians of tomorrow are trained. Beginning in July, the Accreditation Council for Graduate Medical Education (ACGME) will implement the Next Accreditation System to oversee training residents in 7 specialties: emergency medicine, internal medicine, neurological surgery, orthopedic surgery, pediatrics, diagnostic radiology, and urological surgery. In July 2014, the Next Accreditation System will be implemented by all remaining specialties and ultimately cover more than 9000 medical residency programs throughout the country. The aims of the new system are to “enhance the ability of the peerreview system to prepare physicians for practice in the 21st century, to accelerate the ACGME’s movement toward accreditation on the basis of educational outcomes, and to reduce the burden associated with the current structure and process-based approach” (Nasca TJ et al. N Eng J Med. doi:10 .1056/NEJMsr1200117 [published online March 15, 2012]). The ACGME was founded in 1981 when the graduate medical education environment faced 2 major stresses: variability in the quality of resident education and the emerging formalization of subspecialty education. The ACGME emphasized program structure and increased the amount and quality of teaching. But while the group believed it was successful, new stresses emerged, such as an increasingly prescriptive nature of program requirements that reduced opportunities for innovation. Acknowledging the new stresses, the ACGME pushed for the Next Accreditation System. Under this approach, each medical residency program accredited by the ACGME will have to demonstrate that its residents have the core competencies and clinical skills to provide quality patient care and the ability to respond to ongoing developments in health care delivery. Competency will be assessed in 6 core areas: patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication. To measure such competencies, each specialty is developing educational milestones with collaboration among American Board of Medical Specialties certifying boards, review committees, medical-specialty organizations, program-director associations, and residents. Milestones may be measured by levels of competence. For example, for practice-based learning and improvement, a resident with level 1 competency would be able to describe basic concepts in clinical practice, epidemiology, biostatistics, and clinical reasoning. The resident would also be able to categorize the study design of a research study. To achieve level 3 competency, the resident would need to be able to apply a set of critical appraisal criteria to different types of research, including synopses of original research findings, systematic reviews and meta-analyses, and clinical-practice guidelines, and to critically evaluate information from others, such as colleagues, experts, pharmaceutical representatives, and patients. Level 5 competency would find the resident independently teaching and assessing evidence-based medicine and information-mastery techniques and citing evidence supporting several common practices. Changes in resident training mean changes in the teaching of medical students as well. Carol Aschenbrener, MD, chief medical officer at the Association of American Medical Colleges, said her member institutions are working with the ACGME, but they are also adopting their own competency-based medical education systems. “Basically, the difference between competency-based education and the way we have always done it is that competency means that what the public needs, good health outcomes, is what a physician should actually be able to do, and each specialty has to decide how to achieve this,” said Aschenbrener, who has also held dean’s office positions at the University of Iowa College of Medicine in Iowa City and who served as chancellor of the University of Nebraska Medical Center in Omaha. “And we need faculty members who can help students learn how to ask questions or read a research article. It’s not about giving them a lecture but teaching them how to think.”

Reply

We agree that as urologic workforce needs increase in a challenging graduate medical education environment, so too must the options for urologic education. High-quality private practices can greatly broaden the urologic postgraduate training experience. Editorial CommentUrologyVol. 81Issue 3PreviewThis is an interesting attempt to assess the efficacy and quality of training urology residents to perform transurethral laser prostate procedures in the semiacademic, private practice setting. This report attempts to address the question of whether residents can master the laser vaporization technique in this clinical setting. Full-Text PDF

Feasibility of Implementing a Standardized Multisource Feedback Program in the Graduate Medical Education Environment

Multisource feedback (MSF) is emerging as a central assessment method for several medical education competencies. Planning and resource requirements for a successful implementation can be significant. Our goal is to examine barriers and challenges to a successful multisite MSF implementation, and identify the benefits of MSF as perceived by participants. We analyzed the 2007-2008 field trial implementation of the Assessment of Professional Behaviors, an MSF program of the National Board of Medical Examiners, conducted with 8 residency and fellowship programs at 4 institutions. We use a multimethod analysis that draws on quantitative process indicators and qualitative participant experience data. Process indicators include program attrition, completion of implementation milestones, number of participants at each site, number of MSF surveys assigned and completed, and adherence to an experimental rater training protocol. Qualitative data include communications with each program and semistructured interviews conducted with key field trial staff to elicit their experiences with implementation. Several implementation challenges are identified, including communication gaps and difficulty scheduling implementation and training workshops. Participant interviews indicate several program changes that should enhance feasibility, including increasing communication and streamlining the training process. Multisource feedback is a complex educational intervention that has the potential to provide users with a better understanding of performance expectations in the graduate medical education environment. Standardization of the implementation processes and tools should reduce the burden on program administrators and participants. Further study is warranted to broaden our understanding of the resource requirements for a successful MSF implementation and to show how outcomes change as MSF gains broader acceptance.

A Counseling Practicum Curriculum to Teach and Assess ACGME Core Competencies

Abstract Introduction Providing students with feedback about their strengths and areas for improvement for ACGME competencies is often challenging in the busy graduate medical education environment...

Preparation, Conduct, Follow-Up, and Evaluation of a Departmental Retreat on Residency Education

Psychiatric residency training programs must continually respond to a changing graduate medical education environment. In the following, the authors discuss their use of an educational retreat as a mechanism to help faculty and residents analyze and plan responses to these challenges in a medical center located in an underserved inner-city area. Specific strategies for preparing for a retreat, such as evaluating attitudes of residents and faculty, conducting the retreat itself, following-up to incorporate recommendations into a course of action, and evaluating the success of the retreat, are presented. The results of the retreat are shared.

Making sense of federal GME reforms: The impact on osteopathic medicine

Physician workforce issues, particularly the generalist/specialist mix, surfaced as a major component of the healthcare reform debate in the last Congress. Both of the major bills before the Congress at the end of the session would have legislated reforms in graduate medical education designed to control the cost, mix, and supply of physician manpower. This article examines the graduate medical education reform measures proposed in the Gephardt (House) and Mitchell (Senate) bills and identifies elements of agreement. Discussion focuses on the potential for reforms that could be enacted in the new Congress, with a look at the implications for the osteopathic medical profession. A second article, to appear in next month's issue, will focus on recommendations for secondary reforms to prepare osteopathic medical institutions for the changing graduate medical education environment. Such a changing environment requires comprehensive reevaluation in all of the institutions of osteopathic medicine--the colleges, the hospitals, and the American Osteopathic Association.