Medical Learners Research Articles

Endoscopic ear examination improves self-reported confidence in ear examination skills among undergraduate medical students compared with handheld otoscopy.

Objectives: Handheld otoscopy is the standard tool used to teach ear examination in undergraduate and postgraduate medical education. Previous studies have shown that the undergraduate teaching of ear examination with handheld otoscopes is inadequate, resulting in low self-reported levels of student confidence in their diagnostic skills. With the increase in popularity of endoscopic ear surgery, an increasing number of otolaryngologists are using endoscopes for office examinations of the ear due to the method’s superior visualization and excellent image qualities. However, medical students usually do not receive exposure to endoscopic ear examination during their undergraduate curriculum. The aim of this study is to assess our preliminary experience with teaching endoscopic ear examination to undergraduate medical students.Methods: A two-hour-long pilot practical course on basic ear examination was administered to undergraduate medical students with little to no previous experience with ear examination. The course was designed to minimize the duration of campus attendance and patient contact during the COVID-19 pandemic. The course included theoretical didactics, exemplary digital endoscopic images and peer physical practice of ear examination with both a handheld otoscope and a 0-degree endoscope. At the end of the course, the students completed a survey questionnaire consisting of eight questions mainly relating to their subjective confidence level with ear examination using either handheld otoscopes or endoscopes and their overall preference for either examination tool.Results: Most students expressed a preference for ear examination with endoscopes over that with handheld otoscopes and reported an improved confidence level in their diagnostic ability with the former technique. The vast majority of students supported the teaching of endoscopic ear examination to future medical students.Conclusion: The findings of this pilot project report and survey study support the early exposure of novice medical learners to endoscopic ear examination, which may help improve the confidence and diagnostic skill of medical students with regard to ear examination. The findings may have implications for the undergraduate teaching of ear examination in the post-COVID-19 era.

Policies as barriers for disabled medical learners: exploratory study of learners’ perspectives

Disabled medical learners have unique accommodation needs, given their diverse and changing learning environments and direct contact with patient-care. However, there are very limited policies and resources available in Canada to inform medical learners and educators about what accommodations are available to them, and little is known about the usefulness of existing policies. This study explored the perspectives of disabled medical learners on existing policies in medical schools. We conducted interviews with eight disabled medical learners, focusing on their experiences with their institutions’ disability-related policies. Interviews were thematically analyzed. The analysis demonstrated that there are gaps in services for medical learners. Participants did not feel that pre-existing policies were helpful in addressing the existing barriers. In addition, participants felt that the responsibility for navigating the system falls primarily on them. This study addresses some needed changes to create more inclusive environments in medical education. Points of interest Disabled medical learners have unique accommodation needs. In Canada there are limited policies and resources available to inform medical learners and educators about what accommodations are available. This study focuses on what disabled medical learners think about existing policies in medical schools. Services and procedures for supporting disabled learners are complex and inconsistent. The support system and attitudinal barriers are challenging to navigate. Negative perceptions of disability in medicine are persistent. Attitudinal changes, simplified services and procedures, and an inclusive learning environment can improve the experiences of disabled medical learners.

Building a Community-Centered Public Health Advocacy Training Program for Medical Students.

Context:Public health advocacy is increasingly acknowledged as an essential component of practice in medicine. Medical schools, residency programs, and professional organizations have begun developing curricula in an effort to teach advocacy. This article describes the structuring and evolution of the Dr Pete Dehnel Public Health Advocacy Fellowship, an innovative program prioritizing a community-centered approach to teaching physician advocacy to medical students.Program:Created by the Twin Cities Medical Society (TCMS), the fellowship's curriculum adopts a cohort-based learning model organized around skills training, personalized physician-mentor pairing in a shared field of interest, and hands-on advocacy activities. The curriculum also centers insights and practical knowledge from community members who are outside of the health care sphere alongside those of experienced physician-advocates.Implementation:TCMS partnered with an independent research organization to conduct an ongoing developmental evaluation (DE) of the fellowship. DE focuses on rapid-cycle feedback and utilization of findings to inform the development of program components. This enables TCMS to customize the fellowship's curricular components to the local context and in response to student and mentor feedback.Evaluation:Early findings have allowed TCMS to refine curricular components while providing evidence of significant gains in 3 areas of growth among fellows: perceived knowledge and advocacy skills proficiency; perceived self-efficacy; and motivation for lifelong advocacy practice.Discussion:Key fellowship components, including a flexible curricular structure with built-in adaptability and emphasis on long-term health advocacy engagement, are associated with student growth. These core elements along with a focus on community-centeredness can be integrated into curricula of other programs seeking to train medical learners and physicians to embrace a lifelong commitment to public health advocacy.

Can cardiac auscultation accuracy be improved with an additional app-based learning tool?

IntroductionMany institutions use simulation ‘events’ to instruct cardiac auscultation. Research shows that these ‘one and done’ events limit repetition, are costly and do not incorporate learning science techniques, such as spaced learning and retrieval practice. The Littmann Learning™ mobile app, which has unlimited access to a large library of real patient heart sounds, is a cost‐effective tool that we considered could be leveraged by educators to provide this training.MethodsThis was a quasi‐experimental pre‐ and post‐design consisting of an intervention group (PA22) and a non‐equivalent comparator group (PA21). The intervention group used a novel mobile app cardiac auscultation curriculum (MACAC), while the comparator group received standard didactic instruction. One‐way analyses of variance were used to analyse the data.ResultsA total of 174 PA students participated in the study. There was a significant (p < 0.001) difference in knowledge and auscultation scores between those who did and did not complete the MACAC. PA22 didactic year knowledge scores were 4.11 and 2.96 points higher than PA21 didactic and clinical year knowledge scores (p < 0.001, d = 1.61 and p < 0.001, d = 1.32), respectively. On average, PA22 didactic year auscultation scores were 0.83 points higher than PA21 clinical year scores (p < 0.001, d = 0.6).ConclusionResults indicate that students in their didactic year achieved proficiency in clinically identifying heart sounds, despite not having access to a mannequin simulator and not having an opportunity to identify these sounds bedside. Overall, a MACAC may be an effective method to teach cardiac auscultation to medical learners.

A student‐led events accessibility policy spreads across Canada

Student‐led events are an important aspect of the medical school experience. We share our experiences as Canadian disabled medical learners developing and implementing successful local events accessibility policies. We map our collective efforts to disseminate the concept across the nation. Our experiences exemplify the power of student organizing and the deep relational work required to achieve this essential access.

An Innovative Skin Simulation Model to Augment Competency-based Training in Facial Plastic Surgery.

Introduction Competency-based medical education (CBME) approach in the medical curriculum has been introduced globally with the goal of providing flexibility, accountability, and learner-centeredness among medical learners. Traditional surgical skill training in most places has relied on “see one, do one, teach one model,” while simulation model-based training has been shown to improve competencies in surgical trainees. We wanted to assess the usefulness of a hydrophilic barrier adhesive foam wound dressing as a novel skin simulation model for learning biomechanics and practice of cutaneous flaps among plastic surgical resident trainees at our institute. Materials and Methods An absorbent, soft polyurethane foam pad located centrally upon a larger polyurethane membrane, coated with a hydrocolloid adhesive, forming an island dressing, was used as a simulation model for this study. It was obtained from the hospital store either after or nearing their expiry dates of clinical use. Plastic surgery residents in different years of training were invited to participate in a simulation workshop, using this novel model, and give their feedback. Results Seventeen residents in different plastic surgery training levels participated in the workshop and gave their feedback on the skin flap simulation model. The simulation model received extremely high (100%) scores on two parameters, namely, utility for flap and suture practice and high scores (88%–94%) for texture, ability to mark, and improving confidence among trainees. Conclusions Adhesive bilayer polyurethane foam can be used as a novel cutaneous skin flap simulation model for understanding the biomechanics of skin flaps and cutaneous flap practice.

Emotion Regulation and Burnout in Family Medicine Residents.

Although burnout in medicine-particularly medical education-represents an ongoing problem, relatively few studies have established longitudinal connections between burnout and risk factors. Establishment of specific causal links and risk factors will determine important curriculum changes to reduce the risk of burnout in medical learners. Our study aimed to explore links between emotion regulation skill (strategies individuals use to regulate emotional experiences and responses to stress) and vulnerability to burnout using a longitudinal design in one family medicine residency program. Family medicine residents completed the Difficulties with Emotion Regulation Scale (DERS) and the Copenhagen Burnout Inventory (CBI) at the beginning of each year (July/August). The residency program collected data over the course of 5 years. All residents consented to participate. We used linear regression analyses to examine postgraduate year-1 DERS scores as a predictor of postgraduate year-2 burnout and postgraduate year-3 burnout. In this sample of residents, higher scores on the DERS at the first year of residency predicted personal and work-related burnout on the Copenhagen Burnout Inventory (CBI) at the beginning of the second and third years. Difficulties with emotion regulation predicted personal burnout in this small sample. This finding dovetails with cross-sectional data in the literature. Although further mechanisms contributing to burnout should be explored, this finding suggests that direct instruction in adaptive emotion regulation strategies delivered early in medical education could provide significant downstream benefits for family medicine residents.

Impostorism and anxiety contribute to burnout among resident physicians

Purpose Physician burnout is an issue that has come to the forefront in the past decade. While many factors contribute to burnout the impact of impostorism and self-doubt has largely been ignored. We investigated the relationship of anxiety and impostorism to burnout in postgraduate medical learners. Materials and methods Postgraduate learners in four diverse training programs: Family Medicine (FM), Paediatric Medicine (PM), Anesthesiology (AN), and General Surgery (GS) were surveyed to identify the incidence of impostorism (IP), anxiety, and burnout. IP, anxiety, and burnout were evaluated using the Clance Impostor Phenomenon Scale (CIPS), Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and the General Anxiety Disorder-7 (GAD-7) questionnaires, respectively. Burnout was defined as meeting burnout criteria on all three domains. Relationships between IP, anxiety, and burnout were explored. Results Two hundred and sixty-nine residents responded to the survey (response rate 18.8%). Respondents were distributed evenly between specialties (FM = 24.9%, PM = 33.1%, AN = 20.4%, GS = 21.6%). IP was identified in 62.7% of all participants. The average score on the CIPS was 66.4 (SD = 14.4), corresponding to ‘frequent feelings of impostorism.’ Female learners were at higher risk for IP (RR = 1.27, 95% CI: 1.03–1.57). Burnout, as defined by meeting burnout criteria on all three subscales, was detected in 23.3% of respondents. Significant differences were seen in burnout between specialties (p = 0.02). GS residents were more likely to experience burnout (31.7%) than PM and AN residents (26.7 and 10.0%, respectively, p = 0.02). IP was an independent risk factor for both anxiety (RR = 3.64, 95% CI:1.96–6.76) and burnout (RR = 1.82, 95% CI: 1.07–3.08). Conclusions Impostorism is commonly experienced by resident learners independent of specialty and contributes to learner anxiety and burnout. Supervisors and Program Directors must be aware of the prevalence of IP and the impact on burnout. Initiatives to mitigate IP may improve resident learner wellness and decrease burnout in postgraduate learners.

Patient involvement in assessment of postgraduate medical learners: A scoping review.

Competency-based assessment of learners may benefit from a more holistic, inclusive, approach for determining readiness for unsupervised practice. However, despite movements towards greater patient partnership in health care generally, inclusion of patients in postgraduate medical learners' assessment is largely absent. We conducted a scoping review to map the nature, extent and range of literature examining the inclusion (or exclusion) of patients within the assessment of postgraduate medical learners. Guided by Arskey and O'Malley's framework and informed by Levac et al. and Thomas et al., we searched two databases (MEDLINE® and Embase®) from inception until February 2021 using subheadings related to assessment, patients and postgraduate learners. Data analysis examined characteristics regarding the nature and factor influencing patient involvement in assessment. We identified 41 papers spanning four decades. Some literature suggests patients are willing to be engaged in assessment, however choose not to engage when, for example, language barriers may exist. When stratified by specialty or clinical setting, the influence of factors such as gender, race, ethnicity or medical condition seems to remain consistent. Patients may participate in assessment as a stand-alone group or part of a multi-source feedback process. Patients generally provided high ratings but commented on the observed professional behaviours and communication skills in comparison with physicians who focused on medical expertise. Factors that influence patient involvement in assessment are multifactorial including patients' willingness themselves, language and reading-comprehension challenges and available resources for training programmes to facilitate the integration of patient assessments. These barriers however are not insurmountable. While understudied, research examining patient involvement in assessment is increasing; however, our review suggests that the extent which the unique insights will be taken up in postgraduate medical education may be dependent on assessment systems readiness and, in particular, physician readiness to partner with patients in this way.

A Four-Year Longitudinal Curriculum to Improve Feedback-Seeking Behaviors for Medical Students

Introduction: Feedback is essential for performance improvement and plays a pivotal role in competency-based medical education. Medical learners need training to acquire skills to effectively seek feedback for their unique situations. Methods: We developed a 4-year longitudinal curriculum designed to encourage feedback-seeking by medical students. The 4.5-hour curriculum consisted of interactive lectures, feedback-seeking surveys, trigger videotapes, and peer-group discussions in small- and large-group formats. A volunteer study cohort (n = 14/37, 38%) was interviewed in 4 separate waves in individual and focus-group formats to explore perceptions about feedback-seeking and effectiveness of the curriculum. Results: Themes and student quotes related to the learning objectives were summarized. The students expressed appreciation for the value of seeking feedback. They appreciated the techniques they learned and the frequent reminders. They particularly appreciated the opportunities to share successes and failures related to feedback-seeking with their peers. Discussion: Our novel feedback-seeking curriculum supported students’ understanding of the importance of feedback and their effective use of multiple feedback-seeking techniques. The longitudinal component supports greater opportunity for building space in the curriculum, incorporating reflection and reinforcement, and creating capacity for student application and technique refinement. Conclusions: Teaching students feedback-seeking through various techniques tailored for their unique situations, rather than waiting to potentially receive feedback, is important for their professional development and overall medical education.

Evaluating Virtual Patient Interaction Fidelity With Advanced Communication Skills Learners

Previous research in educational medical simulation has drawn attention to the interplay between a simulation’s fidelity and its educational effectiveness. As virtual patients (VPs) are increasingly used in medical simulations for education purposes, a focus on the relationship between virtual patients’ fidelity and educational effectiveness should also be investigated. In this paper, we contribute to this investigation by evaluating the use of a virtual patient selection interface (in which learners interact with a virtual patient via a set of pre-defined choices) with advanced medical communication skills learners. To this end, we integrated virtual patient interviews into a graduate-level course for speech-language therapists over the course of 2 years. In the first cohort, students interacted with three VPs using only a chat interface. In the second cohort, students used both a chat interface and a selection interface to interact with the VPs. Our results suggest that these advanced learners view the selection interfaces as more appropriate for novice learners and that their communication behavior was not significantly affected by using the selection interface. Based on these results, we suggest that selection interfaces may be more appropriate for novice communication skills learners, but for applications in which selection interfaces are to be used with advanced learners, additional design research may be needed to best target these interfaces to advanced learners.

War on Ukraine: Impact on Ukrainian Medical Students.

The ongoing Russian invasion of Ukraine has taken a tremendous toll on the physical and mental wellbeing of the Ukrainian people. Accordingly, medical trainees and institutions must adapt to a high degree of uncertainty and turmoil. In 2022, Ukraine has 23 medical institutions filled with not only Ukrainian nationals but medical students from around the world. It is estimated that approximately 18,000 students from India alone study in Ukraine, many of whom are medical learners. Many of these national and foreign medical students are now displaced refugees looking to escape to Western Europe or their country of origin. Even by escaping the ongoing conflict, the question remains as to how many of these students will complete their medical education and cope with the trauma of political unrest. This is the first time that the International Journal of Medical Students Editorial Team has commented on a political conflict. We have learned in our tenure that medical students and their education worldwide is affected by many factors, including global warming and conflict. We have raised our voice before for actions to prevent climate change. We are adding our voice of support to those suffering from political unrest and acts of violence globally, with specific focus on the Ukraine. The path of war and vengeance is an easy one when compared to political dialogue and collaboration. We, the new generation of scientists of the world, claim for the use of reason over emotions to keep us all safe and promote progress worldwide.

E-learning during the COVID-19 Pandemic in Various Healthcare Institutes of India.

A multicentric study on the benefits and outcomes of e-learning was lacking during the pandemic. This study aimed to find out the participation, satisfaction, and insights of dental and medical undergraduate learners toward digital learning during the COVID-19 pandemic in various healthcare institutes of India. A questionnaire-based cross-sectional study was conducted using Google Forms online on e-learning among students from the first to the final year of MBBS and BDS courses in five healthcare institutions. Most participants (72.7%) reported cellular data as their mode of internet connection. Seventy point eight percent of participants stated online classes did not affect health. Eyestrain (54.6%) was the most common, followed by headache and fatigue, whereas only 21.2% chose obesity and disturbed sleep as a consequence of e-learning. Most students had experience in digital learning, in which the use of smart phones with cellular data was the most common mode of digital learning during the pandemic.

A parent-led, patient-centered medical home model instruction for interprofessional undergraduate and graduate learning opportunities

ABSTRACT Introduction Despite national efforts to establish patient-centered medical homes (PCMH), 57.3% of children with special health care needs are receiving care that does not meet medical home criteria. Project DOCC, a national curriculum designed by parents of children with disabilities or chronic disease, has shown documented strengths in medical resident learner education of children with special health care needs from the parent perspectives for over a decade. Because of the importance of PCMH and the need to provide compassionate care, our team adapted the curriculum to incorporate team-based learning in the rural setting. Materials and Methods Reading materials were distributed to learners prior to an in-person workshop at which time, learners reviewed a video and discussed PCMH materials to identify elements of the PCMH. Learners then engaged with parent mentors across three breakout sessions. A final group reflection was completed to review and discuss efforts providers would take to establish and maintain the PCMH in their own practice. Baseline and post-workshop PCMH perceptions and parent mentor reflections were collected and compared using t-test comparisons. Results Learner knowledge, perceptions, and comfort significantly increased after the workshop. Parent mentor comments also highlighted an increased understanding for the provider. Discussion: The adapted PCMH curriculum significantly impacted learner outcomes using a feasible approach that fit nicely within health professional curricula and limited resources of the rural setting. Parents enjoyed the opportunity to serve as mentors and valued the instruction format.

Medical Students and the Drive for a Single Right Answer: Teaching Complexity and Uncertainty.

The arrival of Generation Z, the next generation of medical learners, has been accompanied by efforts to adapt teaching practices for this new group of students. Many have identified challenges associated with addressing the needs of modern medical learners. One particular trend we have observed is that medical students are increasingly requesting an “answer key” for all aspects of their medical education. Students often expect to have the correct answers readily available to them to ensure they have reached the correct conclusion and to determine the precise knowledge they need to master. Yet, for much of medicine, and particularly in the care of critically ill patients with multisystem disease in intensive care units, answers are uncertain, and the body of knowledge is ever-growing. Students’ regular requests for solutions to be provided to them threaten to undermine their development into critically thinking, self-sufficient physicians. We outline three potential contributors to this multifactorial problem and offer corresponding pedagogical solutions. Specifically, we address how prioritizing outcomes over process, discomfort with uncertainty, and fear of faltering can cause students to seek excessive levels of support that may ultimately do more harm than good. Addressing students’ concerns in these three key areas will not only serve students well during their undergraduate medical training but will also equip them with the skills needed to succeed in the clinical realm. To produce physicians capable of navigating an increasingly uncertain world, medical educators will need to help students appreciate that finding the answer is more complex than being provided an answer key.

To the Editor: Actions More Powerful Than Words-An Impactful Approach to Overcoming Page Burden.

I would like to thank Armendariz et al for their contribution to understanding the root characteristics of rounding interruptions inherent to medical learners in the inpatient teaching environment.1 As noted in the study conclusion, proactive communication with nursing staff holds merit for most team-based improvement strategies. However, based on anecdotal experience, simple discussions with nursing staff resulted in trivial long-term change. An effective, actionable plan is needed for residency programs to address inappropriately timed pages and improve paging etiquette during inpatient rounding.Inpatient medicine has trended toward algorithmic-based patient care under the banners of improved patient outcomes and hospital efficiency. Examples within this trend include antibiotic prescribing practices, pathology-directed power plans, and sepsis triage goals.2 Standardization for interprofessional communication, however, remains largely unchanged and differs across the spectrum of the US health care system. This leads to increased stress, burnout rates, and frustrations during rounding periods among medical trainees.3An algorithm-based text page system for nursing staff would improve communication and rounding efficiency by utilizing a decision tree model. This tree would include the initial decision of page appropriateness during rounding times. If it meets criteria for paging, the algorithm will require important triaging information for the text page, including urgency level (routine, urgent, emergent); patient room number; paging staff role and name; category (lab, clinical status change, medication question, disposition, diet request, family request, etc); and time requested for response (within 1 hour, 30 minutes, 5 minutes, or ASAP). Similar interventions in the pediatric ICU setting demonstrated a 42% reduction in pages per patient, improved resident well-being and nursing satisfaction, and maintained patient safety while using a text page system.4Implementing standardized, algorithm-based text page systems can improve the resident learning experience while decreasing page burden during inpatient rounds.

SBIRT training: how do social work students compare to medical learners?

ABSTRACT Background: SBIRT (Screening, Brief Intervention, and Referral to Treatment) is an effective early intervention approach for individuals with substance misuse. The purpose of this study was to determine if medical learners are more adept at learning a brief substance use intervention compared to non-medical learners (e.g., social work students). The dissemination of SBIRT training among many helping professions can increase service delivery for substance use problems. Methods: A total of 2,488 participants completed SBIRT training, representing 15 different disciplines and over 20 different institutions. General linear models and paired t-tests were used to investigate the effects of SBIRT training on changes in knowledge and attitude of alcohol and drug use and satisfaction. Results: There were no statistical differences in the change of satisfaction, knowledge, and attitude between medical and non-medical discipline participants. Both medical and non-medical participants had greater improvement in attitude and knowledge scores post-training. Similar improvements in attitude, knowledge, and satisfaction were observed in all the health-care discipline participants. Discussion: SBIRT skills may be transferable to disciplines including non-prescribing professionals (e.g., social work, nursing, physical therapy, rehabilitation science, and pharmacy). In an effort to expand treatment, health-care training institutions adopt SBIRT as a core competency for professional practice.

Evaluation of an occupational medicine patient consultation note assessment tool.

Medical education focuses on assessment, diagnosis and management of various clinical entities. The communication of this information, particularly in the written form, is rarely emphasized. Though there have been assessment tools developed to support medical learner improvement in this regard, none are oriented to occupational medicine (OM) practice. This study was aimed to develop and evaluate an assessment tool for consultation letters, by modifying a previously validated assessment tool to suit practice in OM. Using an iterative process, OM specialists added to the Consultation Letter Rating Scale (CLRS) of the Royal College of Physicians and Surgeons of Canada (henceforth abbreviated as RC) additional questions relevant to communication in the OM context. The tool was then used by two OM specialists to rate 40 anonymized OM clinical consultation letters. Inter-rater agreement was measured by percent agreement, kappa statistic and intraclass correlation. There was generally good percent agreement (>80% for the majority of the RC and OM questions). Intraclass correlation for the five OM questions total scores was slightly higher than the intraclass correlations for the five RC questions (0.59 versus 0.46, respectively), suggesting that our modifications performed at least as well as the original tool. This new tool designed specifically for evaluation of patient consultation notes in OM provides a good option for medical educators in a variety of practice areas in providing non-summative, low-stakes assessment and/or feedback to nurture increased competency in written communication skills for postgraduate trainees in OM.

A survey on Canadian pediatric hospital clinical/medical teaching unit implementation during the first and second wave of the COVID-19 pandemic

BackgroundAs the COVID-19 pandemic heightened, infection control and prevention experts recommended clinical training opportunities be modified or discontinued, substantially impacting the function of clinical or medical teaching units (CTU). A CTU is structured to involve medical learners such that they become active participants of the health care team. Since a review of the literature demonstrates a paucity of data to guide pediatric CTU implementation during pandemic phases, we developed and disseminated a survey to assess Canadian practices.MethodA group of infectious disease specialists and pediatric hospitalists developed, tested, and disseminated surveys to understand CTU clinical rounding and teaching practices during the waves of the COVID-19 pandemic.ResultOur surveys demonstrate the variability in adapting rounding practices during this pandemic and highlights the opportunities to share our approaches and lessons learned to optimize learner experience and patient centered care during unprecedented times in our academic hospitals. We also show the pragmatic implementation of our new pediatric hospital CTU process that was informed by our survey results.ConclusionOur study demonstrates the variability in adapting rounding practices during this pandemic and highlights the opportunities to share our approaches and lessons learned to optimize learner experience and patient centered care during unprecedented times in our academic hospitals.

The Development of a Set of Coaching Competencies for Medical Education Using a Modified Delphi Approach.

Purpose: Coaching is emerging as a way to support learners’ academic, professional identity, and well-being goals in medical education. 1,2 To date, there is scant literature on ways to assess coaches and evaluate coaching programs so that the benefits of coaching can be quantified and investments into coaching justified. 3 One piece of this gap is to identify the core competencies of a coach. The International Coaching Federation (ICF) has published coaching competencies, 4 though these relate to leadership and executive coaching. The National Board of Health and Wellness Coaches, in collaboration with the National Board of Medical Examiners, has developed coaching competencies and national certification for health care providers to support patients and providers. These have more basis in science and incorporate positive psychology, self-determination theory, and are aligned with intentional change theory, which academic coaching often incorporates. However, neither of these competency frameworks were specifically designed for coaching in medical education. Coaching competencies specific to medical education can allow for better program evaluation and also guide the hiring and training of individual coaches. We describe the creation of a set of coaching competencies for medical education using a modified Delphi approach. 5 Methods: The expert panel study team comprises 7 national experts in the field of coaching and/or assessment, 4 of whom are certified coaches. A modified Delphi approach was taken with the following steps: (1) A national American Medical Association Thematic Coaching Meeting was held in October 2018. Attendance was open to the AMA Accelerating Change in Medical Education Consortium schools and we also solicited and invited experts in the fields of coaching, adaptive learning, neuroscience, and medical education. At the conference, an initial discussion was held, led by the study team and informed by our review of the literature. The discussion allowed participants to brainstorm categories and individual competencies, using the ICF model as a starting point. (2) Three rounds of consensus process followed among members of the expert panel in which 4 domains were identified and competencies were finalized. Results: All 7 members participated in the 3 Delphi rounds. Panelists were asked to focus on expected competencies for a coach working with learners across the medical education continuum. This process resulted in 13 competencies in 4 domains: (1) Coaching process and structure: establishing the coaching agreement, meeting management, managing process and accountability, and coach self-monitoring. (2) Relational skills: establishing meaningful coaching relationships, emotional intelligence, adaptability, and effective communication. (3) Coaching skills: fostering development of master adaptive learners, facilitating coachee well-being and professional fulfillment, and emphasizing cocreative collaboration. (4) Coaching theories and research: identifying current coaching models and tools to support learning and flexibility. Discussion: We identified competencies for coaches working with medical learners. They share overlap with the ICF competencies but have important differences that reflect the unique learning environment in medicine and needs of these learners. Future directions would include identifying more granular ways to assess coaches based on each competency, creating tools to support coach development across the competencies, and assessing how each competency affects the effectiveness of the coach. Significance: These competencies can be used to develop learning objectives and coach development curricula. They can also form the basis of coach assessment and evaluation of individual coaches and coaching programs, which are essential components to demonstrating efficacy and value.