Practice-based Learning Research Articles

Lifestyle Medicine Intensivist Competencies: 2023 Expert Consensus Update.

The objective of this expert consensus process was to identify the competencies that lifestyle medicine (LM) Intensivists should be expected to have within their skill set. Expert panel members with experience in intensive, therapeutic lifestyle change (ITLC) updated and expanded a previously published set of competencies for this intensive LM practice, using an established process for developing consensus statements adapted for the topic. The previously published set of competencies was discussed for possible revision and expansion. Proposed changes were assessed for consensus using a modified Delphi process. The expert panel revised the original list of 34 competencies, maintaining the 6 initial proposed topics that were previously published as Specialist Competencies: (1) Practice-Based Learning and Improvement, (2) Patient Care and Procedural Skills (3) Systems-Based Practice, (4) Medical Knowledge, (5) Interpersonal and Communication Skills, and (6) Professionalism. After a series of meetings and an iterative Delphi process of voting and revision, a final set of 46 competency statements for LM Intensivists achieved consensus. These competencies define the scope of practice and desired skill set for LM Intensivists. Further, these competencies establish a standard for certification of LM Intensivists.

Many a Slip between Cup and Lip: Navigating Noncitizenship and School-to-Work Transitions in Kakuma Refugee Camp

Abstract This article draws from curricular analysis and ethnographic methods in school and community spaces where young people live, learn, and work in Kenya’s Kakuma Refugee Camp. We describe how formal citizenship education intended for Kenyan citizens is mediated by teachers working in refugee-serving schools. Our analysis shows how these messages, often scarce and decontextualized, orient refugees to project an imagined future of stability, obscuring the skills needed to navigate the uncertainty they will encounter as noncitizens enduring protracted exile. Examining refugee youth transitions after completing their schooling, we document ‘slips’ in the gaps between the civic knowledge, skills, and dispositions promoted in schools and those required within a limited opportunity structure dominated by a relief economy. Beyond school, we examine pathways that young refugees charted through apprenticeships within the informal economy, leveraging their social networks, gaining life skills, and enacting civic commitments while honing more sustainable livelihoods in exile. We argue that education’s value cannot be contingent on belonging or citizenship status and suggest that the contextualized nature of practice-based learning entailed through apprenticeships enables young refugees to create community through everyday participation, where social relationships both facilitate civic learning and are an outcome of that learning.

Development of obstetric anesthesia core competencies for USA residency programs through a Delphi process.

The standard for anesthesia residency training in the USA mainly relies on the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project, a framework that lacks specific directives for subspecialties including obstetric anesthesia. We aimed to identify core competencies in obstetric anesthesiology that can be adapted to different residency training programs to help improve the quality of training and accountability of the institutions within the USA. We identified a preliminary list of competencies from review of existing competency-based obstetric anesthesia training curricula and practice guidelines. We used a modified Delphi methodology to achieve expert consensus among members of the Society for Obstetric Anesthesia and Perinatology education committee. The panellists were asked to evaluate the importance of each competency using a five-point Likert scale, with consensus after two rounds defined at 80% agreement. The responders were also asked at which level of training each competency should be attained. The Delphi rounds had 75% response rate and derived 94 competencies that were categorized under the six ACGME domains: patient care (38), medical knowledge (45), system-based practice (two), practice-based learning and improvement (five), interpersonal communication skills (two), and professionalism (two). We generated a residency training competency list for obstetric anesthesiology through expert consensus. This list can be used by residency training programs to develop a structured competency-based curriculum with tangible milestones, thereby reducing heterogeneity in the standard of training.

Transition to Residency: National Study of Factors Contributing to Variability in Learner Milestones Ratings in Emergency Medicine and Family Medicine.

The developmental trajectory of learning during residency may be attributed to multiple factors, including variation in individual trainee performance, program-level factors, graduating medical school effects, and the learning environment. Understanding the relationship between medical school and learner performance during residency is important in prioritizing undergraduate curricular strategies and educational approaches for effective transition to residency and postgraduate training. This study explores factors contributing to longitudinal and developmental variability in resident Milestones ratings, focusing on variability due to graduating medical school, training program, and learners using national cohort data from emergency medicine (EM) and family medicine (FM). Data from programs with residents entering training in July 2016 were used (EM: n=1,645 residents, 178 residency programs; FM: n=3,997 residents, 487 residency programs). Descriptive statistics were used to examine data trends. Cross-classified mixed-effects regression were used to decompose variance components in Milestones ratings. During postgraduate year (PGY)-1, graduating medical school accounted for 5% and 6% of the variability in Milestones ratings, decreasing to 2% and 5% by PGY-3 for EM and FM, respectively. Residency program accounted for substantial variability during PGY-1 (EM=70%, FM=53%) but decreased during PGY-3 (EM=62%, FM=44%), with greater variability across training period in patient care (PC), medical knowledge (MK), and systems-based practice (SBP). Learner variance increased significantly between PGY-1 (EM=23%, FM=34%) and PGY-3 (EM=34%, FM=44%), with greater variability in practice-based learning and improvement (PBLI), professionalism (PROF), and interpersonal communication skills (ICS). The greatest variance in Milestone ratings can be attributed to the residency program and to a lesser degree, learners, and medical school. The dynamic impact of program-level factors on learners shifts during the first year and across the duration of residency training, highlighting the influence of curricular, instructional, and programmatic factors on resident performance throughout residency.

A theoretical and practical approach to quality improvement education

Quality Improvement (QI) knowledge and skills are required at all levels of physician training. System improvement efforts need to include understanding of health disparities and design of interventions to reduce those disparities, thus health equity needs to be integrated into QI education. Payors, accreditation bodies and health systems’ emphases on QI result in the need for QI curricula that meet the needs of diverse learners. This article presents a theoretical background and practical tools for designing, implementing, and evaluating a QI educational program across the spectrum of physician training with an emphasis on competency-based education and a goal of continuous practice improvement. Practice-based learning and improvement and systems-based practice are two core domains of competencies for readiness to practice. These competencies can be met through the health systems science framework for studying improvement in patient care and health care delivery coupled with QI science. Curricula should incorporate interactive learning of theory and principles of QI as well as mentored, experiential QI project work with multidisciplinary teams. QI projects often develop ideas and implement changes but are often inconsistent in studying intervention impacts or reaching the level of patient outcomes. Curriculum design should incorporate adult learning principles, competency based medical education, environmental and audience factors, and formats for content delivery. Key QI topics and how they fit into the clinical environment and teaching resources are provided, as well as options for faculty development. Approaches to evaluation are presented, along with tools for assessing learner's beliefs and attitudes, knowledge and application of QI principles, project evaluation, competency and curriculum evaluation. If the goal is to empower the next generation of change agents, there remains a need for development of scientific methodology and scholarly work, as well as faculty development and support by institutions.

Expanding your toolkit: teaching social work practice in the healthcare setting

ABSTRACT For social work education to remain current and responsive to the demands of the field, collaboration is required between those actively teaching, and those actively practicing. Examples, however, of co-construction of curriculums are minimal, with classroom subjects largely being taught as stand-alone components of the overall social work program, perhaps with occasional practitioners providing guest lectures about the practice context in which they work. Informed by transformational learning theory, relationship-based practice, and experiential education, practice-based learning requires social work students to engage with classroom content and skill development while at the same time building their job readiness through exposure to the modern workplace and current practitioners. To achieve this, a case example is given whereby academics and practitioners collaborated on developing advanced practice skills subject in the healthcare context, with a focus on developing empathy, authenticity and honoring the story as a core curriculum gap when teaching grief and loss skills. This case study demonstrates how experiential games, role plays and podcasts have been integrated into the teaching content and provides guidance as to the incorporation of experiential learning activities into formative and summative assessment tasks.

From Lab to Market: Learning Entrepreneurial Marketing Through Multi-Semester, Stage-Gate, Capstone Project in STEM MBA

Entrepreneurs build successful businesses by taking innovative ideas from research labs to market. This article describes a pedagogical approach and its outcomes in utilizing a multi-stage, multi-course, and multi-semester capstone integrative project to teach entrepreneurial marketing (EM) of early-stage technologies. Herein we explain concepts and practices that enable the learning needed within STEM (Science, Technology, Engineering, Mathematics) MBA programs to commercialize and market products and services arising from new technologies. The pedagogy follows a four-course sequence that applies strategic frameworks and tools to develop opportunity space for a patented idea, develop the idea into product options, undertake customer discovery, build marketing and sales strategies, and translate opportunities into venture planning. These lab-to-market outcomes are accomplished by applying deliberate practice-based action learning methods to build students’ knowledge bases and problem-solving process skills that increase their entrepreneurial expertise. Through learner engagement in a sequence of innovative, data-driven, analytical processes that focus on identifying, validating, and strategizing around scalable new ideas, this pedagogy enables students to learn EM skills that can be applied to different industries and companies at various stages of development but with an emphasis on early-stage technologies.

Increasing capacity by moving away from one-to-one clinical supervision: using peer-assisted learning and a group model of student placements in community paediatric speech and language therapy to enable student-led service delivery.

Health Education England (HEE) and the Royal College of Speech and Language Therapists (RCSLT) have identified the need to increase placement capacity. Speech and language therapy is a shortage profession in the UK, so services need to consider innovative placement models to increase their placement offers without increasing the time burden on speech and language therapists (SLTs). To increase capacity for pre-registration practice-based learning by using peer-assisted learning (PAL) in a group model of student placement to enable student-led service delivery which provides high standards of clinical care and student experience and is an efficient use of SLT time. A paediatric speech and language therapy service hosted eight student speech and language therapists (SSLTs) for their final pre-registration placement. SSLTs completed pre- and post-placement confidence ratings for a range of clinical skills; SSLTs and SLTs rated how useful different types of support were, and education settings provided feedback about working with the SSLTs. The number of clinical sessions completed by the SSLTs and the percentage of outcomes achieved for children with speech, language and communication needs were calculated. SLTs completed time-trackers for placement-related activities. The impact of the placements was assessed using a tri-vector methodology consisting of: self-reporting by the student (using an evaluation form), feedback from the placement sites (schools) and analysis of targets set for individual children. SSLTs reported increased confidence in all clinical areas in their post-placement evaluation form. SLTs reported increased confidence in SSLTs working independently and an increase in the perceived benefit to the service for having SSLTs in comparison with the time invested in supporting SSLTs. SSLTs and SLTs found all types of support provided during the placement useful. Schools reported high levels of satisfaction for working with SSLTs. SSLTs completed more clinical sessions than an SLT would have been able to in the time SLTs invested in placement-related activities. Children achieved 60% of the targets set by SSLTs. This placement model increased the capacity for SSLT placements by using PAL in a group model of student placement to enable student-led service delivery. The model provided high standards of clinical care and student experience and was an efficient use of SLT time. Wider use of this placement model would increase placement capacity and could also address vacancies in services. What is already known on the subject SSLTs and SLTs are positive about the benefits of paired placements in comparison with individual placements. Other allied health professions have demonstrated that larger placements can be an effective way to support students and have used students to deliver student-led services. What this study adds to existing knowledge This paper is the first to look at whether PAL in a group model of student placements can be used in speech and language therapy to enable student-led service delivery which provides high standards of clinical care, maintains high standards of student experience and is an efficient use of SLT time. What are the potential or actual clinical implications of this work? This paper demonstrates that PAL can be used effectively in a group model of student placements in a paediatric SLT service to increase student capacity and enable student-led service delivery. The proposed placement model provides a high-quality placement for SSLTs and the children they work with, and is also an efficient use of SLT time.

An exploration of simulation-based education from other health professionals, to create an informed and effective simulation delivery in a new diagnostic radiography programme

IntroductionThe recent validation of three Diagnostic Radiography programmes in the south of England involved a rigorous approval process with multiple Professional and Statutory Regulatory Bodies (PSRB's). Part of the validation process was evidencing that approximately 50% of each programme is spent undertaking practice-based learning. As well as clinical placements, practice-based learning includes simulation-based education (SBE). MethodologyFrom May 2022 to June 2022, a questionnaire was sent to all 22 simulation education facilitators from health courses belonging to the University School Simulation Group. Ethical approval was reviewed and approved by the Learning and Teaching Hub Research Ethics Panel. ResultsOf the initial 22 participants invited, the response rate was 59% (13 participants). The main themes arising from the analysis was the use of a theoretical or conceptual framework, a breakdown of the simulation session components and the role of simulation training. ConclusionThis questionnaire study demonstrated that there was a need for a standardised guide on how to deliver SBE. There is also a lack of feedback, training, and reassurance for facilitators. However, facilitators would welcome training or further training and HEE and the University have taken steps to prioritise SBE. Implications for practiceThe study highlighted how health professionals are delivering SBE within their subjects in innovative and creative ways. These ideas have helped to structure SBE within the new diagnostic radiography courses at the University.

Assessment of dental student education and preparedness in periodontics in two different models: Discipline-based and general practice-based learning.

To compare dental students' preparedness in clinical periodontal education following their participation in a discipline-based predoctoral periodontics clinic with dental students that received a general practice-based periodontal education. 114 third-year dental students and 112 fourth-year dental students at the University of Texas Health Science Center in San Antonio, were emailed an online survey consisting of questions on their proficiency and confidence levels in diagnosing periodontal diseases and conditions, treatment planning, performing non-surgical periodontal treatment, identifying the need for referral, and their perceived impediments on their clinical periodontics education. Approximately 97% of third-year dental students that participated in discipline-based predoctoral periodontics agree that they are overall confident in providing excellent periodontal care to their patients, and 91% of these students feel that their participation in the predoctoral periodontics clinic has enhanced their knowledge in periodontics as well as their confidence level when providing periodontal patient care. While 95% of fourth-year dental students agree that they feel confident in providing excellent periodontal care to their patients, only 83% felt that level of confidence during their third-year in dental school, and 77% believe that given the option to participate in the pre-doctoral periodontics clinic, their periodontal education would have been strengthened. Our results show that the integration of a discipline based predoctoral periodontics clinic has benefited the dental students and boosted their knowledge and confidence in diagnosing and treating periodontal patients. This model can be improved by addressing space and time limitations.

“They’re coming to us and we don’t have any training” - Professional learning approaches for secondary Australian school year advisors: a call for support

ABSTRACT Secondary school year advisors fulfil an important relationship-building, middle leadership position in schools. Although responsible for supporting the wellbeing of students with a range of academic, social, and emotional needs, there is limited research into year advisor’s role and the support provided for these educators. This qualitative study provides insight into year advisors’ perceptions of professional learning that prepared them to support student wellbeing. Semi-structured interviews were conducted with secondary school year advisors in New South Wales, Australia, investigating their training experiences and views on navigating the expectations of their role. Interpretive Phenomenological Analysis revealed key themes capturing the limited provision of formal training for year advisors and the perception that training was insufficient for responding to students’ mental health needs. Year advisors reported relying on self-sourced informal training methods including collaborative partnerships, practice-based learning and independent investigation, to manage situations encountered when supporting students. Findings reveal a disparity in formalised professional learning opportunities across schools and year advisors’ desire for systematic, role specific, formalised training, especially for supporting students’ mental health.

Postoperative urinary retention in colorectal surgery patients on an enhanced surgical recovery pathway

Abstract Introduction: Postoperative urinary retention (POUR) is a complication of surgery defined as the inability to empty a full bladder. POUR can prolong hospital length of stay and increase rates of urinary tract infection in the postoperative period. Risk factors for the development of POUR include male sex, older age, select medications, and certain comorbid conditions. Surgical factors may also increase the risk of POUR. POUR occurs in up to 50% of patients undergoing colorectal surgery. Materials and Methods: This retrospective, single-center cohort study evaluated the incidence of POUR in patients admitted for colorectal surgery and were enrolled in a Colorectal Enhanced Surgical Recovery (CERAS) protocol. Our primary objective was to determine the incidence of POUR in patients treated under the CERAS protocol. Secondary objectives included evaluating the incidence of POUR in patients receiving intrathecal anesthesia. Results: Two hundred and twenty-eight patients were included. Sixty-six patients (28.9%) developed POUR during their hospitalization. Patients who developed POUR were more likely to be male (61.6% vs. 44.4%, P = 0.029) and tended to be older (mean ± standard deviation age, 61.4 ± 17.7 years vs. 56.8 ± 16.4 years; P = 0.069) compared to the non-POUR group. Regional anesthesia did not affect the incidence of POUR. Conclusions: We identified a rate of POUR in our CERAS patients consistent with previous studies. The risk of POUR increased with increasing age, male sex, and history of benign prostatic hyperplasia and diabetes mellitus. We found no difference in POUR incidence with the type of regional anesthesia utilized. The following core competencies are addressed in this article: Practice-Based Learning and Improvement and Medical Knowledge.

Pap smear changes and cervical inflammation in women with infertility in correlation to clinical and microbiological findings

Abstract Introduction: One of the prime causes of infertility is reproductive tract infections as they can produce marked cervical inflammation. These can be seen in Pap smears at various stages as cervical health plays an imperative role in blocking ascending infections. This study assesses infections and related changes in Pap smears from women with infertility and its association with clinical and microbiological findings. Materials and Methods: A prospective observational study was done for 3.5 years. Pap smears of women with infertility were taken, and those showing significant inflammation (>50%) were studied. Relevant history and “per-speculum” findings were noted. Pap smear changes, infections or intraepithelial changes, and lactobacilli were studied. High vaginal swab culture was done, and follow-up conception data were correlated. Results: Almost 50% of women with inflammatory smears showed the presence of an infection; of which the most common was candidiasis followed by bacterial vaginosis. Out of the 12 women whose culture reports were available, 11 showed growth (90%). Most women showed depleted lactobacilli. On follow-up, the conception rate despite assisted reproductive technology was significantly lower in women with Pap smear changes (P = 0.0002). Conclusion: These observations show a strong and significant association between inflammatory Pap smears, infections in the reproductive tract, depleted lactobacilli, and conception. It is advisable that a Pap smear should be done in all cases of infertility to look for infections and inflammation, and a follow-up with high vaginal swab culture should be done in cases where inflammation is detected in a Pap smear. The following core competencies are addressed in this article: Patient care and procedural skills, Medical knowledge, Practice-based learning and improvement.

Association between cumulative fluid balance and clinical outcome in patients with septic shock: A retrospective observational study

Abstract Introduction: Aggressive fluid replacement is done in septic shock to compensate for the decreased stressed volume in view of peripheral vasodilatation. However, excessive fluid administration may lead to fluid overload, edema formation, and organ damage such as renal congestion and acute kidney injury. Hence, this study was conducted to estimate the effect of fluid balance in the 1st week of septic shock on mortality. Materials and Methods: We conducted a retrospective analysis of the use of intravenous fluids and cumulative fluid balance (CFB) during the first 7 days of septic shock in a 25-bed multidisciplinary intensive care unit (ICU) in Northern India at a tertiary care teaching hospital. Results: Based on the CFB, we classified patients as low CFB when CFB is <20 mL/kg and high CFB when it is >20 mL/kg. The 28-day mortality in the low CFB group was 4.7% and in the high CFB group 26.15%, which was statistically significant. With an odds ratio of 7.17, CFB in septic shock was a predictor of ICU mortality (confidence interval of 3.87–13). The length of stay between the two groups was also found to be statistically significant (11.7 ± 3.2 vs. 12.6 ± 3.8; P = 0.02). Conclusions: In patients with septic shock, a higher CFB on day 7 of ICU admission is independently associated with an increased risk of mortality and a longer ICU stay. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.

Levelling the learning ground for healthcare professionals across the world through SIMBA: a mixed-methods study

ObjectivesTo compare the acceptance, strengths and limitations of Simulation via Instant Messaging-Birmingham Advance (SIMBA) in low/middle-income countries (LMICs) and high-income countries (HICs), on healthcare professionals’ professional development and learning.DesignCross-sectional study.SettingOnline...

Comparison of liquid-based cytology and conventional preparations in nongynecological cytology

Abstract Introduction: The liquid-based cytology (LBC) has shown significant advantages over conventional preparation in cervical cytology. The use of LBC in aspiration and exfoliative nongynecologic cytology has been on the rise since the last few years with relatively few studies being available depicting its role in fine-needle aspiration cytology (FNAC) from other sites. The study aimed to determine the diagnostic efficacy of LBC in nongynecological exfoliative as well as FNAC samples and compare the conventional and LBC methods for cytomorphological differences. Materials and Methods: This is a cross-sectional, analytical study that included the samples collected from two tertiary care centers over 8 months (January 2022 to August 2022). A total of 168 consecutive samples of aspiration and exfoliative nongynecological cytology were included. In each case, two passes were carried out one for a conventional smear (CS) and the other for LBC by Eziprep/Thin Prep (TP) method followed by smear staining with H and E stain and Leishman’s stain. The slides were studied by two observers for cellularity, background (blood and necrotic cell debris), informative background (such as colloid, stromal fragments, etc.), presence of monolayer cells, and cell architecture with nuclear and cytoplasmic details by a semiquantitative scoring system. Statistical analysis was performed using Wilcoxon signed-rank test on the SPSS program and histopathology correlation was attempted wherever available by using OpenEpi software version 3. Results: The mean age was 40 years, with the majority being females (70%). The TP smears were qualitatively superior to CS with statistical differences observed in fluid cytology. There was no statistical difference observed at other sites; except TP being superior to CS with regard to the background in breast cytology. The arithmetic mean in TP was higher than CS in all the parameters. Conclusions: The cytology smears of TP were qualitatively superior to CS in aspiration and nongynecological cytology. Overall diagnostic accuracy was comparable in both techniques. The core competencies addressed in this article are: Medical knowledge, Procedural skills, Practice-based learning and improvement, and Professionalism.

Transdisciplinarity / cross-disciplinarity / multidisciplinarity in language teaching projects for future translators

The article discusses the role of transdisciplinary, cross-disciplinary, multidisciplinary approach in translators' training. The paper provides an overview of this cluster of terms, underlining, on the one hand, their problematic ambiguity and, on the other, their conceptual similarity a better match either between a professional environment and academia or borrowing from (lending to) the knowledge and skills from different disciplines to solve a problem. The paper dwells on the educational potential of transdisciplinary education and the direction it has taken in recent decades. The authors claim the academic translator training can benefit from a suchlike approach. The transdisciplinary / cross-disciplinary project is outlined as the way by which a better practice-oriented and practice-based cumulative knowledge and learning can be formed. Specifically, the paper focuses on some academic translator projects aimed at students' dealing with audiovisual translation of video, infographics and multimedia resources for academic purposes and international events support. The paper illustrates how these projects can be implemented. The authors have stepped up their efforts towards including more transdisciplinary / cross-disciplinary / multidisciplinary projects in their curricula to show how the constructive correlations between educational and professional environment can be built providing more practice-focused knowledge and skills integration for students.

Trainee Love and Breakup Letters to NephSIM: A Free, Mobile-Optimized, Nephrology Teaching Tool.

It is not known how learners feel about free open access medical education (FOAMed) as they progress through their training from medical school to fellowship. Love and breakup letter methodology (LBM) is a technique that has been used extensively in user experience technology-based research but has not previously been used in evaluating medical education tools. LBM asks participants to creatively write a "love" or "breakup" letter to a product under study to capture their thoughts and emotions when engaging with it. We conducted qualitative analysis of data from focus groups to explore how attitudes toward a learning platform change at various training stages and to broaden our understanding of how we meet learners' needs through a nephrology FOAMed tool, NephSIM. Three virtual, recorded focus groups were conducted with second-year medical students, internal medicine residents, and nephrology fellows ( N =18). At the start of the focus group, participants composed and read their love and breakup letters. Semistructured discussions were then led by facilitator-driven questions and peer comments. After transcription, inductive data analysis was conducted using Braun and Clarke's six-step thematic analysis. Four main themes were seen across all groups: attitudes toward teaching tool, perception of nephrology, learning needs and approach, and application to practice. Preclinical students positively viewed the opportunity to simulate the clinical setting and unanimously wrote love letters. Reactions from residents and fellows were mixed. Residents were interested in brevity and speed of learning, preferring algorithms and succinct approaches to meet their practice-based learning needs. Fellows' learning needs were driven by a desire to prepare for the nephrology board examination and review cases uncommonly seen in practice. LBM provided a valuable methodology through which to identify trainee reactions to a FOAMed tool and highlighted the challenges of meeting learning needs of a continuum of trainees with a single learning platform.

Shorter and Stronger: Revision of a Resident Performance Evaluation Survey

In order to evaluate the outcomes of a USU School of Medicine (SOM) education, a program director (PD) evaluation survey was developed in 2005 and is completed annually by PDs regarding trainees who graduated from USU and are in their first post-graduate training year (PGY-1) and their third post-graduate training year (PGY-3). The survey was last reviewed and revised in 2010 to better align with the competencies established by the Accreditation Council for Graduate Medical Education but has not been further evaluated or revised. The objective of the study was to utilize 12 years of aggregated data to improve the psychometric properties of the survey, with an emphasis on shortening the survey. A secondary objective was to refine the verbiage of the existing questions and add new items to assess health systems science competencies.The survey was sent out to PDs who supervised USU SOM graduates in the classes of 2008 to 2019 (n = 1,958) with 997 responses for the PGY-1 PD survey and 706 responses to the PGY-3 PD survey. Exploratory factor analysis (EFA) was conducted on 334 complete responses of the PGY-1 survey and 327 responses of the PGY-3 survey. A working group of PDs, USU Deans, and health professions education scholars reviewed the results from the EFA and from a survey of experienced PDs and, in an iterative process, developed a proposed revised survey.The EFA for both the PGY-1 data and the PGY-3 data yielded three factors, and a total of 17 items were identified with cross-loading across the factors in the PGY-1 and/or PGY-3 surveys. Items without clean loadings or that were determined to be unclear, redundant, or difficult to assess by PDs were revised or removed. Items were revised or added to address needs within the SOM curriculum, including the new health systems science competencies. The proposed revised survey had 36 items in place of the original 55 items and contained at least four items for each of the six competency domains (patient care, communication and interpersonal skills, medical knowledge, professionalism, system-based practice and practice-based learning and improvement, and military-unique practice, deployment, and humanitarian missions).The USU SOM has benefited from over 15 years of results from the PD surveys. We identified those questions that performed well, and these were refined and augmented in order to optimize the performance of the survey and fill gaps in our knowledge of graduates' performance. To determine how well the revised set of questions performs, efforts will be made to increase the response rate and completion of 100% of items on the survey, and the EFA should be repeated after about 2-4 years. Furthermore, the USU graduates should continue to be tracked longitudinally past residency to determine if PGY-1 and PGY-3 survey measures predict long-term performance and patient outcomes.

“Primum Non Nocere”—First, Do No Harm: A Retrospective Review of the Impact of Curricular Reform on USUHS Graduates’ Performance During Their PGY-1 Year

To determine whether medical school curricular change impacted the assessment of graduates in their first year of postgraduate training.The authors examined for differences in the survey of postgraduate year one (PGY-1) program directors for Uniformed Services University (USU) medical school graduates from the Classes of 2011 and 2012 (pre-curriculum reform, pre-CR), Classes of 2015, 2016, and 2017 (curriculum transition), and Classes of 2017, 2018, and 2019 (post-curriculum reform, post-CR). Multivariate analysis of variance was used to explore for differences among the cohorts in the 5 previously identified factors on the PGY-1 survey (Medical Expertise; Professionalism; Military Unique Practice, Deployments and Humanitarian Missions; System-Based Practice and Practiced-Based Learning; Communication and Interpersonal Skills). Nonparametric tests were used when the error variance between cohorts was found to be unequal across samples. Kruskal-Wallis (a rank ordered analysis of variance) and Tamhan's T2 were used to characterize specific differences.There were 801 students included: 245 (pre-CR); 298 (curricular transition); and 212 (post-CR). Multivariate analysis of variance demonstrated significant differences in all survey factors among the comparison groups. From pre-CR to the curricular transition, ratings in all factors declined, but none reached the level of a statistical significance. Ratings of all 5 factors showed significant improvement from the curricular transition to post-CR, and scores from pre-CR to post-CR trended in the positive direction with Practice-Based Learning (effect size 0.77), showing significant gains.Ratings by PGY-1 program directors of USU graduates over time demonstrated a very small decline soon after curriculum reform but later showed a large improvement in domains reflecting areas of emphasis in the curriculum. In the eyes of a key stakeholder, the USU curriculum reform did no harm and led to improved PGY-1 assessments.