Postgraduate Medical Education Training Research Articles

Shared Decision-Making Training in Family Medicine Residency: A Scoping Review

Shared decisions, in which physicians and patients share their agendas and make clinical decisions together, are optimal for patient-centered care. Shared decision-making (SDM) training in family medicine residency is always provided, but the best training approach for improving clinical practice is unclear. This review aims to identify the scope of the literature on SDM training in family medicine residency to better understand the opportunities for training in this area. Four databases (Embase, MEDLINE, Scopus, and Web of Science) were searched from their inception to November 2022. The search was limited to English language and text words for the following four components: (1) family medicine, (2) residency, (3) SDM, and (4) training. Of the 522 unique articles, six studies were included for data extraction and synthesis. Four studies referenced three training programs that included SDM and disease- or condition-specific issues. These programs showed positive effects on family medicine residents’ knowledge, skills, and willingness to engage in SDM. Two studies outlined the requirements for SDM training in postgraduate medical education at the national level, and detailed the educational needs of family medicine residents. Purposeful SDM training during family medicine residency improves residents’ knowledge, skills, and willingness to engage in SDM. Future studies should explore the effects of SDM training on clinical practice and patient care.

Evaluation of postgraduate family medicine trainee's knowledge and attitude following an online Educational Module in Palliative Care: A descriptive study.

To identify improvement in knowledge and attitude of Family Medicine (FM) postgraduate trainees (PGT) towards Palliative care (PC) in order to provide effective care to the patients with advanced disease. A cross-sectional study was conducted over eight weeks from 1st July till 3rd September 2021 at Family Medicine Department, Aga Khan University Hospital (AKUH). PGT who willingly signed the written informed consent were enrolled in the study. Descriptive analysis, frequencies, proportions and thematic approach were used for data analysis. Data was analyzed using SPSS version 23. FM-PGT were included in the study. Improvement in knowledge was observed in posttest scores along with positive change in their attitude and improved perception of level of confidence for managing PC patients. Overall assessment of PCM was positive. This PCM seems to be a useful tool for PC training in postgraduate medical education (PGME). This highlights some useful aspects for future applications in PC education and training.

Exploring the Irish general practice training community’s perceptions on how an entrustable professional activities dashboard implementation could facilitate general practice training in Ireland

ABSTRACT Background The Irish General Practitioner Training (GP) Programme is currently moving to Competency-Based Medical Education (CBME), facilitated by Programmatic Assessment (PA) and Entrustable Professional Activities (EPAs). These new assessment and feedback mechanisms may provide a rich and much sought-after dataset. However, given the possible number of feedback and assessment events, and the variety of modalities used, aggregating and interpreting these can be costly and difficult. Dashboard implementations (DI) have been purposed as a solution to bridge the gap between the large datasets and the training community at all levels. Aims To explore the Irish GP training community’s perceptions on how an EPAs DI could facilitate the delivery of GP training in Ireland. Methods A qualitative approach was taken, using a focus group representative of different groups in the training community. Concurrently, an EPAs DI was developed. Focus group transcripts were analysed in an iterative fashion using Template Analysis to generate themes and subthemes. Results Numerous advantages were seen in relation to the implementation of an EPAs DI around entrustment decisions, constructive alignment and summative decision-making. These advantages, however, need to be tempered with the realisation that the EPAs DI is not and should not be misinterpreted as being the learning analytic panacea for GP training. Conclusion This paper outlines the perceptions from a postgraduate medical education training community on an EPAs DI, which would be applicable to other training communities considering introducing similar mechanisms.

Impact Of Communication Skills Training in Postgraduate Medical Education

Background: Effective communication is a key feature of optimal doctor-patient relationship. As the postgraduate curriculum lacks standardized teaching and assessment, this study aimed to assess effectiveness of training program on communication skills of postgraduate medical students. Materials and methods: A prospective interventional study was conducted among first year postgraduate medical students from different clinical specialty. Training program included introduction to principles of communication with basics of doctor-patient relationship, administering informed consent, breaking bad news and counselling patients with HIV/cancer. Pre-test and post-test skill assessment by Faculty and postgraduate (PG) self-rating was carried out using KEECC-A Assessment tool for seven core communication competencies. Perception of students on training program was collected via feedback questionnaire. Results: Forty-three postgraduate medical students participated. Statistically significant increase in communication skills scores post training was observed with mean post-test assessment scores of 24.26±2.94, p<0.001(faculty rating), 25.19±3.76, p<0.001(PG self-rating) and high degree of internal consistency was found. Students perceived the training program as valuable and highlighted its importance as a part of curriculum. Conclusion: Training program significantly enhanced communication skills of postgraduate medical students. Integration of standardized teaching and assessment of communication skills is essential for better healthcare practice and optimal doctor-patient relationship.

Evaluation of a Quality Improvement Experience for Family Medicine Clerkship Students.

There is emphasis on systems-based practice competencies and quality improvement (QI) training in postgraduate medical education. However, we lack effective approaches to provide experiences in these areas during undergraduate medical education. To address this, we developed a novel approach to providing didactic and experiential learning experiences in QI during a third-year family medicine clerkship. We implemented and evaluated a QI curriculum combining self-directed learning with real-world experience to increase knowledge and confidence in the plan-do-study-act (PDSA) process for family medicine clerkship students. Students collaborated and presented their change ideas in a "Shark Tank" format for practice leaders at the end of their rotation. We used pre- and postcurriculum surveys to assess knowledge of and comfort with completing QI projects. Three hundred eighty-nine students completed precurriculum surveys and 242 completed postcurriculum surveys. Pre- and postlearning evaluations revealed an increase in agreement or strong agreement with self-reported understanding of specific QI topic areas of 50%. Almost all (91.3%) reported feeling confident or reasonably confident in their ability to create change in health care after exposure to the curriculum, compared with 66.3% in the precurriculum survey. One-third of students (34%) reported intent to complete the Institute for Healthcare Improvement Open School curriculum in QI. Self-directed learning about QI, combined with practice observation, small-group discussion and presentation in a Shark Tank format was effective and engaging for learners. Students had limited preexisting knowledge of QI principles, suggesting a need for preclinical exposure to this topic. The family medicine clerkship provides an ideal environment for teaching QI.

Navigating the uncertainty of health advocacy teaching and evaluation from the trainee’s perspective

Background There may be no competency more shrouded in uncertainty than health advocacy (HA), raising questions about the robustness of advocacy training in postgraduate medical education. By understanding how programs currently train HA, we can identify whether trainees’ learning needs are being met. Methods From 2017 to 2019, we reviewed curricular documents across nine direct-entry specialties at all Ontario medical schools, comparing content for the HA and communicator roles to delineate role-specific challenges. We then conducted semi-structured interviews with trainees (n = 9) and faculty (n = 6) to review findings and discuss their impact. Data were analyzed using thematic content analysis. Results Curricular documents revealed vague objectives and ill-defined modes of assessment for both intrinsic roles. This uncertainty was perceived as more problematic for HA, in part because HA seemed both undervalued in, and disconnected from, clinical learning. Trainees felt that the onus was on them to figure out how to develop and demonstrate HA competence, causing many to turn their learning attention elsewhere. Discussion Lack of curricular focus seems to create the perception that advocacy isn’t valuable, deterring trainees—even those keen to become competent advocates—from developing HA skills. Such ambivalence may have troubling downstream effects for both patient care and trainees’ professional development.

Diagnostic Neuroradiology Subspecialty Training: 1 Versus 2 Years; the Canadian Perspective

Canada began a national reform of its post-graduate medical education training programs to a Competence By Design (CBD) model. Trends from accredited neuroradiology programs from the past 10 years were investigated to inform educators and stakeholders for this process. A 13-question electronic survey was sent to program directors of all 8 accredited neuroradiology training programs in Canada. Data was requested for each year on the 2008-2019 graduating classes. Questions pertained to program enrolment; program completion; post-training employment; and the sufficiency of 1-year training programs. Response rate was 100%. Over the timeframe studied, the 2-year programs increased in size (P = 0.007), while the 1-year programs remained steady (P = 0.27). 12.2% of trainees enrolled in the 2-year program dropped out after 1 year, and were considered 1-year trainees thereafter. A higher proportion of 2-year trainees obtain positions within academic institutions (89.5 vs 67.2%, P = 0.0007), whereas a higher proportion of 1-year trainees obtain positions within non-academic institutions (29.3 vs 8.1%, P = 0.0007). A higher proportion of those with Canadian board certification in diagnostic radiology who completed a 2-year program obtained a position within a Canadian academic institution compared to non-certified 2-year trainees (P < 0.001). 71.4% of program directors agreed that a 1-year program was sufficient for non-academic staff positions. The length of the training program has significant impact on employment in academic vs non-academic institutions. This information can be used to guide the upcoming CBD initiative for neuroradiology programs.

RESEARCH OF PSYCHOLOGICAL READINESS OF DOCTORS TO ADAPTIVE TRAINING

The aim: To empirically investigate the psychological readiness of physicians for adaptive learning during the acquisition of professional competences in the system of postgraduate medical education. Materials and methods: We surveyed a sample of 148 physicians who began studying the discipline of Psychology of Conflict, which was specially developed by us on the principles of adaptive learning. There were three occupational groups among doctors: surgeons (n = 47), therapists (n = 53) and pediatricians (n = 48).In the work a range of methods are used: content analysis, biblio-semantic, systematic approach, analysis of products of activity, psycho-diagnostic methods. Results: When characterizing the identified and calculated integral indicators, the most pronounced for the entire study sample is the desire for dominance (85%), adaptation and emotional comfort at 75%. The lowest percentage of self-perception - 65%, slightly higher internality (68%). Acceptance of others at 78%. In general, the dominant factor of the 148 physicians was service motived, indicating that this group is truly focused on the benefit of their patients and others. Our researchers perceive their work as a service, as a means of being useful to people, society and humanity as a whole. This is an indicator of high readiness for adaptive learning in the postgraduate medical education system. The results of the method of "Self-regulation style of behavior" by the doctors of the three medical specialties studied by us testify to their readiness for active inclusion in the system of adaptive training in postgraduate medical education. Conclusions: Based on the results of our empirical study, we are able state that the doctors who participated in the study are ready for adaptive training in the system ofpostgraduate medical education. The results of our research can be basis for drafting recommendations for adaptive education, which can be grounded on a competent approach.

Competency- Based Curriculum for Post- graduation in Community Medicine at a Medical College located in western India

This article was migrated. The article was marked as recommended. Introduction: Curriculum or course needs to be monitored and evaluated to ensure that it is working as planned and also to identify areas for improvement. Implementing competency-based training in postgraduate medical education poses many challenges, but ultimately requires a demonstration that the learner is truly competent to progress in training or to the next phase of a professional career. Purpose: The purpose of this document was to design a competency-based curriculum in Community Medicine teaching and training of post graduates so that they could efficiently play their roles as Community Physician, Public Health Specialist, Health Manager, Faculty, Researcher and Occupational Physician. Methods: A needs assessment study using cross-sectional design reinforced a strong need of developing a common &amp; structured curriculum in Community Medicine at the department studied and later to be scaled at state level. A Six-Step Approach to Curriculum Development was followed (Kern et al., 2009) to design and implement the competency based curriculum. Results: Relevant feedback from teachers and students has been incorporated to prepare this document. Almost all students and faculty strongly agreed for the need of introducing formative assessment. They strongly perceived that a formative assessment would be helpful to motivate students and should have weight- age in university exams. It is learnt that there are challenges involved in operationalzing competency-based curriculum viz; requires more time and effort from faculty, at least in the initial phases of development. Other challenges include; finding ways to include internal assessment marks in the university examination. Conclusions: Competency based curriculum is feasible within a conventional medical curriculum. Benefits of such learning include improving knowledge and skills of learner that would lead to improved quality of health care.

Competency- Based Curriculum for Post- graduation in Community Medicine at a Medical College located in western India.

This article was migrated. The article was marked as recommended. Introduction: Curriculum or course needs to be monitored and evaluated to ensure that it is working as planned and also to identify areas for improvement. Implementing competency-based training in postgraduate medical education poses many challenges, but ultimately requires a demonstration that the learner is truly competent to progress in training or to the next phase of a professional career. Purpose: The purpose of this document was to design a competency-based curriculum in Community Medicine teaching and training of post graduates so that they could efficiently play their roles as Community Physician, Public Health Specialist, Health Manager, Faculty, Researcher and Occupational Physician. Methods: A needs assessment study using cross-sectional design reinforced a strong need of developing a common & structured curriculum in Community Medicine at the department studied and later to be scaled at state level. A Six-Step Approach to Curriculum Development was followed ( Kern et al., 2009) to design and implement the competency based curriculum. Results: Relevant feedback from teachers and students has been incorporated to prepare this document. Almost all students and faculty strongly agreed for the need of introducing formative assessment. They strongly perceived that a formative assessment would be helpful to motivate students and should have weight- age in university exams. It is learnt that there are challenges involved in operationalzing competency-based curriculum viz; requires more time and effort from faculty, at least in the initial phases of development. Other challenges include; finding ways to include internal assessment marks in the university examination. Conclusions: Competency based curriculum is feasible within a conventional medical curriculum. Benefits of such learning include improving knowledge and skills of learner that would lead to improved quality of health care.

The state of health advocacy training in postgraduate medical education: a scoping review.

Health advocacy is an essential component of postgraduate medical education, and is part of many physician competency frameworks such as the Canadian Medical Education Directives for Specialists (CanMEDS) roles. There is little consensus about how advocacy should be taught and assessed in the postgraduate context. There are no consolidated guides to assist in the design and implementation of postgraduate health advocacy curricula. This scoping review aims to identify and analyse existing literature pertaining to health advocacy education and assessment in postgraduate medicine. We specifically sought to summarise themes from the literature that may be useful to medical educators to inform further health advocacy curriculum interventions. MEDLINE, Embase and ERIC were searched using MeSH (medical student headings) and non-MeSH search terms. Additional articles were found using forward snowballing. The grey literature search included Google and relevant stakeholder websites, regulatory bodies, physician associations, government agencies and academic institutions. We followed a stepwise scoping review methodology, followed by thematic analysis using an inductive approach. Of the 123 documents reviewed in full, five major themes emerged: (i) conceptions of health advocacy have evolved towards advocating with rather than for patients, communities and populations; (ii) longitudinal curricula were less common but appeared the most promising, often linked to scholarly or policy objectives; (iii) hands-on, immersive opportunities build competence and confidence; (iv) community-identified needs and partnerships are increasingly considered in designing curriculum, and (v) resident-led and motivated programmes appear to engage residents and allow for achievement of stated outcomes. There remain significant challenges to assessment of health advocacy competencies, and assessment tools for macro-level health advocacy were notably absent. There is considerable heterogeneity in the way health advocacy is taught, assessed and incorporated into postgraduate curricula across programmes and disciplines. We consolidated recommendations from the literature to inform further health advocacy curriculum design, implementation and assessment.

Is Canada's Post-Graduate Medical Education Curricula Producing Physicians who can Provide Culturally Safe Care?

Indigenous peoples living in Canada experience significant health inequities relative to non-Indigenous people, which stem largely from experiences of colonization, past and present. An important contributor to such inequities is the paucity of culturally safe healthcare available to Indigenous people. A lack of relevant educational experiences for healthcare professionals has been implicated in both creating culturally unsafe healthcare environments and in perpetuating these healthcare-related inequities (Guerra &amp; Kurtz, 2017). The Truth and Reconciliation Commission of Canada (TRC, 2015) calls for improved cultural safety training for healthcare professionals treating Indigenous patients. Recently, post-graduate medical education training programs have shifted to a competency-based model (CBME) whereby specific learning objectives must be attained to graduate, compared to the historical time-based model (Iobst et al., 2010). However, it is unknown whether the CBME programs sufficiently fulfill the TRC calls to action pertaining to Indigenous health. The objective of this study is to determine the extent to which Canada’s CBME curricula provide cultural safety training regarding Indigenous health. An environmental scan of the publically available national CBME curricula will assess the content of the core portions of the training programs. A self-report mixed-methods survey will be distributed to medical residents at Queen’s University to determine the extent to which they perceive that such training is provided to them. This research aims to identify gaps in the CBME curricula pertaining to Indigenous health, so as to contribute to improved cultural safety training, and thus health equity, in the future.

ОБРІЇ РОЗВИТКУ АДАПТИВНОГО НАВЧАННЯ

The possibility of significant increase in the quality of learning in postgraduate medical education by directed reorder of knowledge modules, its size and shape of educational material supply, etc. complementary to the knowledge of the student is investigated. The modular platform training in postgraduate medical education is proposed.

A landscape analysis of leadership training in postgraduate medical education training programs at the University of Ottawa

There is growing recognition of the importance of physician leadership in healthcare. At the same time, becoming an effective leader requires significant training. While educational opportunities for practicing physicians exist to develop their leadership skills, there is a paucity of leadership opportunities for post graduate trainees. In response to this gap, both the Royal College of Physicians and Surgeons of Canada and the Association of Faculties of Medicine of Canada have recommended that leadership training be considered a focus in Post Graduate Medical Education (PGME). However, post-graduate leadership curricula and opportunities in PGME training programs in Canada are not well described. The goal of this study was to determine the motivation for PGME leadership training, the opportunities available, and educational barriers experienced by PGME programs at the University of Ottawa. An electronic survey was distributed to all 70 PGME Program Directors (PDs) at the University of Ottawa. Two PDs were selected, based on strong leadership programs, for individual interviews. The survey response rate was 55.7%. Seventy-seven percent of responding PDs reported resident participation in leadership training as being "important," while only 37.8% of programs incorporated assessment of resident leadership knowledge and/or skills into their PGME program. Similarly, only 29.7% of responding residency programs offered chief resident leadership training. While there is strong recognition of the importance of training future physician leaders, the nature and design of PGME leadership training is highly variable. These data can be used to potentially inform future PGME leadership training curricula.

Evaluation of sex- and gender-based medicine training in post-graduate medical education: a cross-sectional survey study.

BackgroundAddressing healthcare disparities is a national priority for initiatives in precision and individualized medicine. An essential component of precision medicine is the understanding that sex and gender influence health and disease. Whether these issues are addressed in post-graduate medical education curricula is unknown.MethodsA questionnaire was designed and administered to residents across the Mayo Clinic enterprise to assess current knowledge of sex and gender medicine in a large program of post-graduate medical education and to identify barriers and preferred teaching methods for addressing sex and gender issues in health and disease. Descriptive and qualitative thematic analyses of the survey responses were compiled and analyzed.ResultsResponses were collected from 271 residents (response rate 17.2 %; 54 % female; 46 % male). A broad cross-section of training programs on all Mayo Clinic campuses (Arizona, Minnesota, and Florida) was represented. Sixteen percent of the respondents reported they had never had an instructor or preceptor discuss how a patient’s sex or gender impacted their care of a patient; 55 % said this happened only occasionally. Of medical knowledge questions about established sex- and gender-related differences, 48 % were answered incorrectly or “unsure.” Qualitative thematic analysis showed that many trainees do not understand the potential impact of sex and gender on their clinical practice and/or believe it does not pertain to their specialty. A higher percentage of female participants agreed it was important to consider a patient’s sex and gender when providing patient care (60.4 vs. 38.7 %, p = 0.02), and more male than female participants had participated in research that included sex and/or gender as a variable (59.6 vs. 39.0 %, p < 0.01).ConclusionsCurriculum gaps exist in post-graduate medical training regarding sex- and gender-based medicine, and residents often do not fully understand how these concepts impact their patients’ care. Reviewing the definition of sex- and gender-based medicine and integrating these concepts into existing curricula can help close these knowledge gaps. As the practice of medicine becomes more individualized, it is essential to equip physicians with an understanding of how a patient’s sex and gender impacts their health to provide the highest value care.Electronic supplementary materialThe online version of this article (doi:10.1186/s13293-016-0097-3) contains supplementary material, which is available to authorized users.

Simulation-based training for burr hole surgery instrument recognition.

BackgroundThe use of simulation training in postgraduate medical education is an area of rapidly growing popularity and research. This study was designed to assess the impact of simulation training for instrument knowledge and recognition among neurosurgery residents.MethodsThis was a randomized control trial of first year residents from neurosurgery residency training programs across Canada. Eighteen neurosurgery trainees were recruited to test two simulation-based applications: PeriopSim™ Instrument Trainer and PeriopSim™ for Burr Hole Surgery. The intervention was game-based simulation training for learning neurosurgical instruments and applying this knowledge to identify correct instruments during a simulated burr hole surgery procedure.ResultsParticipants showed significant overall improvement in total score (p < 0.0005), number of errors (p = 0.019) and time saved (p < 0.0005), over three testing sessions when using the PeriopSim™ Instrument Trainer. Participants demonstrated further performance-trained improvements when using PeriopSim™ Burr Hole Surgery.ConclusionsTraining in the recognition and utilization of simulated surgical instruments by neurosurgery residents improved significantly with repetition when using PeriopSim™ Instrument Trainer and PeriopSim™ for Burr Hole Surgery.

Design and Implementation of a Competency-Based Transfusion Medicine Training Program in Canada.

Transfusion medicine training in Canada is currently undergoing a transformation from a time- and process-based curriculum to a competency-based medical education framework. Transfusion medicine is the first accredited postgraduate medical education training program in Canada to adopt a purely competency-based curriculum. It is serving as an example for a number of other postgraduate medical training programs undergoing a similar transition. The purpose of this review is to highlight the elements of competency-based medical education, describe its application to transfusion medicine training, and report on the development and implementation of the new transfusion medicine curriculum in Canada.

Preparedness for practice: A systematic cross-specialty evaluation of the alignment between postgraduate medical education and independent practice

Background: Postgraduate medical education training programs strive to prepare their trainees optimally for independent practice. Several studies have shown, however, that new consultants feel inadequately prepared for practice, and that this increases the risk of stress and burnout.Aim: To analyze across specialties for which tasks and themes new consultants feel inadequately prepared. And, to identify themes that need improved attention in postgraduate medical education programs or after registration.Methods: 330 New consultants from all hospital specialities with accredited training programs who completed their training in the north-eastern educational region of The Netherlands between 2004 and 2010 received a questionnaire which was based on a previously validated generic task inventory.Results: 143 respondents (43%) returned the questionnaire. They felt excellently prepared for 40 tasks, well prepared for 25 tasks, marginally sufficiently prepared for 18 tasks and insufficiently prepared for 8 tasks. Preparedness scores were lowest for tasks concerning management administration and leadership, research, end-of-life care, and patient safety-related communication. Surgical specialists felt better prepared for practice than medical specialists, which could not be explained by differences in general self-efficacy.Conclusion: Although new consultants felt well prepared for medical tasks, the scores of more generic tasks indicate that the alignment between the different phases of the medical education continuum and independent practice needs improvement.

A Review of Competency Based Orthopaedic Training in the UK: A Trainee’s Perspective

This review explores the concepts and methodology in competency based education, with reference to orthopaedic training in the United Kingdom. In 2006, a new competency based curriculum for postgraduate training in Trauma and Orthopaedics was approved by the Postgraduate Medical Education Training Board. Though the curriculum is now widely accepted, few surgeons have a theoretical knowledge of the basis for competency-based medical education, beyond their own area of involvement. This paper explores the theory and concepts behind competency based education in UK orthopaedic training, which is also of relevance to comparable international orthopaedic training systems and the wider surgical specialities.

Looking to the Future of Obstetrics and Gynaecology Training in Canada: A Resident's Perspective

Looking to the Future of Obstetrics and Gynaecology Training in Canada: A Resident's Perspective