Graduate Medical Education Office Research Articles

The university of washington pediatric alaska track: a novel approach to training primary care pediatricians.

The University of Washington School of Medicine (UWSOM) has been a leading medical school in training primary care physicians. Yet due to the small number of residency positions in the Pacific Northwest, the 5-state region of Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) has some of the lowest physician-to-population, graduate medical education (GME) positions-to-population ratios in the nation, and has the lowest pediatrician-to-child ratio in the country. The UW Pediatric Alaska Track was designed to increase the number of primary care pediatricians serving rural and underserved populations. The goals are to increase quality and access to health care for children and families throughout the WWAMI region, and to improve the learning environment for residents with a career interest in primary care pediatric practice.The Alaska Track is a primary care track within the UWSOM categorical pediatrics residency. The Alaska Track enrolls 4 residents each year for a total of 12 residents in the program. Each year, Alaska Track residents complete 2 four-week block rotations in a community practice in Anchorage, Alaska, and 2 four-week block rotations in a community practice in either Bethel or Fairbanks, Alaska. To maintain continuity, residents return to the same Alaska sites each year. Over the course of 3 years, each resident completes 12 four-week block rotations devoted exclusively to ambulatory, primary care training, and newborn nursery experiences with both Alaska Native and non-native populations. In Seattle, each Alaska Track resident completes 9 four-week block rotations each year for a total of 27 rotations that include the inpatient, intensive care unit, subspecialty, emergency department, and supervisory rotations specified by the Accreditation Council for Graduate Medical Education requirements.The Alaska Track rotations extended, community-based ambulatory experiences allow residents to see well-child, acute illness, follow-up, and posthospital discharge visits in a manner identical to that of the pediatricians in their assigned practices. Each site also allocates time for residents to develop ongoing quality improvement projects and health advocacy projects in the local community.Didactic education occurs weekly by video conference between the 4 Alaska Track residents, the program director, and selected faculty. Alaska Track faculty have clinical appointments in the UWSOM, and GME oversight is provided by the UWSOM GME office. Resident salaries are assessed monthly according to site of rotation. Cost of travel, housing, and transportation during the Alaska rotation is provided by the Alaska sites. To maximize the time for shared experiences and class cohesion with their categorical track colleagues, R1s do not begin their Alaska block rotations until March of the R1 year. Alaska Track residents have some interaction with residents from the Alaska Family Medicine Residency.The first group of first-year residents began training in the Alaska Track in July 2012. We have recruited exceptional trainees whose medical school credentials equal their colleagues in the categorical program. Based on the first 18 months of faculty evaluations, the performance of Alaska Track is indistinguishable from that of categorical residents (table).We anticipate that long-term outcomes for the Alaska Track residents will include increased likelihood of practice in rural or underserved areas and increased readiness for primary care practice. Preliminary results for these outcomes will be available with the first graduating class in July 2016.A widely accepted method for meeting the nation's goal of increased numbers of primary care providers is to develop more primary care training sites in community settings. Many elements of the UW Pediatric Alaska Track are generalizable to other primary care residency programs, although specific structural components likely will vary by location.

Programmatic assessment of level 1 milestones in incoming interns.

With the Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System, emergency medicine (EM) residency programs will be required to report residents' progress through the EM milestones. The milestones include five progressively advancing skill levels, with Level 1 defining the skill set of a medical school graduate and Level5, that of an attending physician. The ACGME stresses that multiple forms of assessment should be used to ensure capture of the multifaceted competencies. The objective of this study was to determine the feasibility and results of programmatic assessment of Level 1 milestones using multisource assessments for incoming EM interns in July. The study population was interns starting in 2012 and 2013. Interns' Level1 milestone assessment was done with four distinct methods: 1) the postgraduate orientation assessment (POA) by the Graduate Medical Education Office for all incoming interns (this multistation examination covers nine of the EM milestones and includes standardized patient cases, task completion, and computer-based stations); 2) direct observation of patient encounters by core faculty using a milestones-based clinical skills competency checklist; 3) the global monthly assessment at the end of the intern orientation month that was updated to reflect the EM milestones; and 4) faculty assessment during procedural labs. These occurred during the July orientation month that included the POA, clinical shifts, didactic sessions, and procedure labs. In the POA, interns were competent in 48% to 93% of the milestones assessed. Overall, competency was 70% to 80%, with low scores noted in aseptic technique (patient care Milestone 13 [PC13]) and written and verbal hand-off (interpersonal communications skills [ICS]2). In overall communication, 70% of interns demonstrated competency. In excess of 80% demonstrated competency in critical values interpretation (PC3), informed consent (PC9), pain assessment (PC11), and geriatric functional assessment (PC3). On direct observation, almost all Level 1 milestones were achieved (93% to 100%); however, only 78% of interns achieved competency in pharmacotherapy (PC5). On global monthly evaluations, all interns met Level 1 milestones. A multisource assessment of EM milestones is feasible and useful to determine Level 1 milestones achievement for incoming interns. A structured assessment program, used in conjunction with more traditional forms of evaluation such as global monthly evaluations and direct observation, is useful for identifying deficits in new trainees and may be able inform the creation of early intervention programs.

Institutional Incorporation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Residency Training: Achieving a Sustainable Curriculum

ABSTRACT The success of implementing a screening, brief intervention and referral to treatment (SBIRT) program within a medical residency program for sustainability is contingent upon a well-crafted training curriculum that incorporates substance abuse education and clinical practice skills. The goal of the Howard University (HU) SBIRT program is to train residents in providing culturally competent evidence-based screening, brief intervention and referral to treatment for patients who have a substance use disorder or who are at risk for developing the disorder. Utilizing the Office of Graduate Medical Education (GME) allows all residents to be trained in SBIRT techniques and receive continuing education in SBIRT and SBIRT-related topics through new resident orientation and the core lecture series. The utilization of Graduate Medical Education office has allowed a robust SBIRT training program to be implemented into medical residency education, contributing to the sustainability of SBIRT as a component of patient care.

Educational Experiences Residents Perceive As Most Helpful for the Acquisition of the ACGME Competencies

The Accreditation Council for Graduate Medical Education (ACGME) requires physicians in training to be educated in 6 competencies considered important for independent medical practice. There is little information about the experiences that residents feel contribute most to the acquisition of the competencies. To understand how residents perceive their learning of the ACGME competencies and to determine which educational activities were most helpful in acquiring these competencies. A web-based survey created by the graduate medical education office for institutional program monitoring and evaluation was sent to all residents in ACGME-accredited programs at the David Geffen School of Medicine, University of California-Los Angeles, from 2007 to 2010. Residents responded to questions about the adequacy of their learning for each of the 6 competencies and which learning activities were most helpful in competency acquisition. We analyzed 1378 responses collected from postgraduate year-1 (PGY-1) to PGY-3 residents in 12 different residency programs, surveyed between 2007 and 2010. The overall response rate varied by year (66%-82%). Most residents (80%-97%) stated that their learning of the 6 ACGME competencies was "adequate." Patient care activities and observation of attending physicians and peers were listed as the 2 most helpful learning activities for acquiring the 6 competencies. Our findings reinforce the importance of learning from role models during patient care activities and the heterogeneity of learning activities needed for acquiring all 6 competencies.

Development of an Institutional Resident Curriculum in Communication Skills

We describe a collaboration between the graduate medical education office and the Henry Ford Health System's Office of Clinical Quality and Safety to create an institution-wide communication skills curriculum pertinent to the institution's safety and patient- and family-centered care initiatives. A multidisciplinary committee provided oversight for the curriculum design and used sentinel event and other quality and safety data to identify specific target areas. The curriculum consisted of 3 courses: "Informed Consent," "Sharing Bad News," and "Disclosure of Unanticipated Events." Each course included 3 components: a multimedia online module; small group discussions led by the program director that focused on the use of communication scripts; and 2 objective structured clinical examinations (OSCEs) requiring residents to demonstrate use of the communication scripts. All first-year residents (N = 145) and faculty (N = 30) from 20 residency programs participated in this initiative. Evaluation of the residents consisted of a self-assessment; the standardized patients' assessment of the residents' performance; and faculty assessment of resident performance with verbal feedback. Survey data showed that residents found the courses valuable, with residents identifying communication scripts they would use in clinical settings. Focus groups with faculty highlighted that the resident debriefing sessions provided them with insight into a resident's communication skills early in their training. Our institutional curriculum was developed in a collaborative manner, and used an evidence-based approach to teach communication skills relevant to institutional safety and quality initiatives. Other institutions 5 wish to adopt our strategy of departmental collaboration and alignment of resident education with institutional initiatives.

Problem neurology residents

Problem residents are found across most medical specialties at a prevalence of about 10%. This study was designed to explore the prevalence and causes of problem neurology residents and to compare neurology programs' responses and outcomes. Directors of 126 US neurology residency programs were sent an electronic survey. We collected data on demographics, first and all "identifiers" of problem residents, and year of training in which the problem was found. We asked about observable signs, etiology, and who performed remediation. We asked what resources were used and what outcomes occurred. Ninety-five program directors completed surveys (75% response rate). Almost all neurology programs have problem residents (81%). Age, sex, marital status, being a US native, or attending a US medical school had no effect on problem status. Being a parent carried a lower likelihood of problems (32%). Most commonly the problem is acted on during the first year of training. Faculty members without defined educational roles were the most frequent first identifiers. Program directors were the most common remediators. The most common remediation techniques were increasing supervision and assigning a faculty mentor. Graduate medical education office and psychiatric or psychological counseling services were most often used. Eleven percent of problem residents required a program for impaired physicians and 14% required a leave of absence. Sixteen percent were dismissed from their programs. The prevalence of problem residents in neurology is similar to other disciplines, and various resources are available to remediate them.

Beyond Must: Supporting the Evolving Role of the Designated Institutional Official

Beyond Must: Supporting the Evolving Role of the Designated Institutional Official

An Institutional Approach to Assist Program Directors and Coordinators With Meeting the Challenges of Graduate Medical Education

To investigate whether a multimethod approach, including a new position dedicated to graduate medical education (GME) educator, online education modules, and program file audits, was associated with quality improvement in our residency programs. Data related to GME audits, residency review committee citations and cycle lengths were entered into a database. We conducted statistical analyses and calculated effect sizes to explore whether these resources were associated with program quality, as measured by maintaining necessary program policies and files, implementation of multiple assessments, increased residency review committee cycle lengths, and reductions in the number of citations. The statistical analyses support the implementation of the GME educator, file audits, and online courses designed to improve the quality of residency education. The GME office will continue to conduct audits, develop online learning resources, and provide one-on-one communication between the GME educator and program coordinators and directors. Our approach could serve as a model for other institutions interested in enhancing institutional oversight and the quality of their programs.

Resident Evaluation and Remediation: A Comprehensive Approach

A comprehensive evaluation and remediation program is an essential component of any residency program. The evaluation system should identify problems accurately and early and allow residents with problems to be assigned to a remediation program that effectively deals with them. Elements of a proactive remediation program include a process for outlining deficiencies, providing resources for improvement, communicating clear goals for acceptable performance, and reevaluating performance against these goals. In recognition of the importance of early detection and prompt remediation of the struggling resident, we sought to develop a multifaceted approach to resident evaluation with the aim of early identification and prompt remediation of difficulties. This article describes our comprehensive evaluation program and remediation program, which uses resources within our radiology department and institutional graduate medical education office. An effective evaluation system should identify problems accurately and early, whereas a proactive remediation program should effectively deal with issues once they are identified.

Electronic Evaluation Systems for Radiology Residency and Fellowship

Electronic evaluation systems are becoming more commonplace in radiology residencies. This article describes the authors' experience in the development of such a system and a method that a residency program or graduate medical education office could use to evaluate commercially available programs.