Project description:BackgroundFeedback plays a pivotal role in graduate medical education, where medical residents are expected to acquire a wide range of practical and professional competencies. Assessing the feedback delivery status is a preliminary step for educators to enhance the quality of feedback provided. This study aims to develop an instrument to assess the various aspects of feedback delivery in medical residency training.MethodsThe fifteen-item REFLECT (Residency Education Feedback Level Evaluation in Clinical Training) questionnaire was developed. The content validity was evaluated according to a panel member consisting of fourteen clinical professors and medical education instructors. After evaluating the test-retest reliability, the questionnaire was distributed to a sample of 154 medical residents and was further assessed in terms of internal consistency and factor analysis.ResultsContent validity analysis resulted in an appropriate content validity ratio and content validity index for the final 15 items. The test-retest reliability resulted in an ICC of 0.949 (95% C.I. 0.870-0.980), indicating excellent reliability. The Cronbach's alpha for the 15-item questionnaire was α = 0.85, demonstrating good internal consistency. The factor analysis resulted in a four-factor structure: "attitude towards feedback", "quality of feedback", "perceived importance of feedback", and "reaction to feedback".ConclusionsREFLECT proved to a reliable tool that could be utilized as a quick assessment method of feedback delivery, making it a suitable aid for educational managers and faculties to design necessary interventions aiming to enhance the quantity and quality of feedback provided.
Project description:BACKGROUND: Multisource feedback (MSF) is emerging as a central assessment method for several medical education competencies. Planning and resource requirements for a successful implementation can be significant. Our goal is to examine barriers and challenges to a successful multisite MSF implementation, and identify the benefits of MSF as perceived by participants. METHODS: We analyzed the 2007-2008 field trial implementation of the Assessment of Professional Behaviors, an MSF program of the National Board of Medical Examiners, conducted with 8 residency and fellowship programs at 4 institutions. We use a multimethod analysis that draws on quantitative process indicators and qualitative participant experience data. Process indicators include program attrition, completion of implementation milestones, number of participants at each site, number of MSF surveys assigned and completed, and adherence to an experimental rater training protocol. Qualitative data include communications with each program and semistructured interviews conducted with key field trial staff to elicit their experiences with implementation. RESULTS: Several implementation challenges are identified, including communication gaps and difficulty scheduling implementation and training workshops. Participant interviews indicate several program changes that should enhance feasibility, including increasing communication and streamlining the training process. CONCLUSIONS: Multisource feedback is a complex educational intervention that has the potential to provide users with a better understanding of performance expectations in the graduate medical education environment. Standardization of the implementation processes and tools should reduce the burden on program administrators and participants. Further study is warranted to broaden our understanding of the resource requirements for a successful MSF implementation and to show how outcomes change as MSF gains broader acceptance.
Project description:The German graduate medical education system is going through an important phase of changes. Besides the ongoing reform of the national guidelines for graduate medical education (Musterweiterbildungsordnung), other factors like societal and demographic changes, health and research policy reforms also play a central role for the future and competitiveness of graduate medical education. With this position paper, the committee on graduate medical education of the Society for Medical Education (GMA) would like to point out some central questions for this process and support the current discourse. As an interprofessional and interdisciplinary scientific society, the GMA has the resources to contribute in a meaningful way to an evidence-based and future-oriented graduate medical education strategy. In this position paper, we use four key questions with regards to educational goals, quality assurance, teaching competence and policy requirements to address the core issues for the future of graduate medical education in Germany. The GMA sees its task in contributing to the necessary reform processes as the only German speaking scientific society in the field of medical education.
Project description:BackgroundPromoting residents' wellbeing and decreasing burnout is a focus of Graduate Medical Education (GME). A supportive clinical learning environment is required to optimize residents' wellness and learning.ObjectiveTo determine if longitudinal assessments of burnout and learning environment as perceived by residents combined with applying continuous quality Model for Improvement and serial Plan, Do, Study, Act (PDSA) cycles to test interventions would improve residents' burnout.MethodsFrom November 2017 to January 2020, 271 GME residents in internal medicine, general surgery, psychiatry, emergency medicine, family medicine and obstetrics and gynecology, were assessed over five cycles by Maslach Burnout Inventory (MBI), and by clinical learning environment factors (which included personal/social relationships, self-defined burnout, program burnout support, program back-up support, clinical supervision by faculty, and sleep difficulties). The results of the MBI and clinical learning environment factors were observed and analyzed to determine and develop indicated Institutional and individual program interventions using a Plan, Do, Study, Act process with each of the five cycles.ResultsThe response rate was 78.34%. MBI parameters for all GME residents improved over time but were not statistically significant. Residents' positive perception of the clinical supervision by faculty was significantly and independently associated with improved MBI scores, while residents' self-defined burnout; and impaired personal relations perceptions were independently significantly associated with adverse MBI scores on liner regression. For all GME, significant improvements improved over time in residents' perception of impaired personal relationships (p < 0.001), self-defined burnout (p = 0.013), program burn-out support (p = 0.002) and program back-up support (p = 0.028). For the Internal Medicine Residency program, there were statistically significant improvements in all three MBI factors (p < 0.001) and in clinical learning environment measures (p = 0.006 to < 0.001). Interventions introduced during the PDSA cycles included organization-directed interventions (such as: faculty and administrative leadership recruitment, workflow interventions and residents' schedule optimization), and individual interventions (such as: selfcare, mentoring and resilience training).ConclusionIn our study, for all GME residents, clinical learning environment factors in contrast to MBI factors showed significant improvements. Residents' positive perception of the clinical learning environment was associated with improved burnout measures. Residents in separate programs responded differently with one program reaching significance in all MBI and clinical learning environment factors measured. Continuous wellbeing assessment of all GME residents and introduction of Institutional and individual program interventions was accomplished.
Project description:A dissertation is a practical exercise that educates students about basics of research methodology, promotes scientific writing and encourages critical thinking. The National Medical Commission (India) regulations make assessment of a dissertation by a minimum of three examiners mandatory. The candidate can appear for the final examination only after acceptance of the dissertation. An important role in a dissertation is that of the guide who has to guide his protégés through the process. This manuscript aims to assist students and guides on the basics of conduct of a dissertation and writing the dissertation. For students who will ultimately become researchers, a dissertation serves as an early exercise. Even for people who may never do research after their degree, a dissertation will help them discern the merits of new treatment options available in literature for the benefit of their patients.
Project description:BackgroundACGME-I requires sponsoring institutions (SIs) to have systematic oversight of program performance. This was initially carried out through annual review, however, maintaining compliance became a challenge for a large SI like Singapore Health Services (SingHealth) as the number of residency programs grew from 5 to 34 in 3 years.ObjectiveWe assessed the impact of quarterly monitoring using a dashboard on graduate medical education (GME) program performance and institutional oversight.MethodsIn 2014, the SingHealth GME Committee (GMEC) approved the dashboard covering 13 indicators with implication on program performance, resident/faculty performance, and finance. Indicators were given color-coded scoring for compliance, borderline compliance, or concern. From annual reporting, periodicity was increased quarterly with reports distributed to program directors, head of department, and academic clinical programs.ResultsSince implementation, programs consistently met or exceeded compliance standards in 11 of 13 indicators (84%), with 7 indicators (63%) showing upward trends. Programs with borderline scores in particular quarters showed improvement in subsequent quarters. By 2015, percentage compliance for the 3 dimensions of residents' perspectives were 1 to 2 points higher than the national compliance average. Of 19 programs undergoing ACGME-I accreditation in 2014, only 4 had citations in the foundational requirement. Institutional citations were resolved, with 0 citations in the reaccreditation site visit in 2015.ConclusionsFor a large SI, increased periodicity of program performance reporting from annual to quarterly effectively addressed the gaps in a timely fashion. Institutional performance also improved through the use of quantitative data aligned with institution and national performance indicators.
Project description:BACKGROUND: Cultural competency is an important skill that prepares physicians to care for patients from diverse backgrounds. OBJECTIVE: We reviewed Accreditation Council for Graduate Medical Education (ACGME) program requirements and relevant documents from the ACGME website to evaluate competency requirements across specialties. METHODS: The program requirements for each specialty and its subspecialties were reviewed from December 2011 through February 2012. The review focused on the 3 competency domains relevant to culturally competent care: professionalism, interpersonal and communication skills, and patient care. Specialty and subspecialty requirements were assigned a score between 0 and 3 (from least specific to most specific). Given the lack of a standardized cultural competence rating system, the scoring was based on explicit mention of specific keywords. RESULTS: A majority of program requirements fell into the low- or no-specificity score (1 or 0). This included 21 core specialties (leading to primary board certification) program requirements (78%) and 101 subspecialty program requirements (79%). For all specialties, cultural competency elements did not gravitate toward any particular competency domain. Four of 5 primary care program requirements (pediatrics, obstetrics-gynecology, family medicine, and psychiatry) acquired the high-specificity score of 3, in comparison to only 1 of 22 specialty care program requirements (physical medicine and rehabilitation). CONCLUSIONS: The degree of specificity, as judged by use of keywords in 3 competency domains, in ACGME requirements regarding cultural competency is highly variable across specialties and subspecialties. Greater specificity in requirements is expected to benefit the acquisition of cultural competency in residents, but this has not been empirically tested.
Project description:ImportanceClosing the diversity gap is critical to ensure equity in medical education and health care quality. Nevertheless, evidence-based strategies and best practices to improve diversity, equity, and inclusion (DEI) in the biomedical workforce remain poorly understood and underused. To improve the culture of DEI in graduate medical education (GME), in 2020 the Accreditation Council of Graduate Medical Education (ACGME) launched the Barbara Ross-Lee, DO, Diversity, Equity, and Inclusion Award to recognize exceptional DEI efforts in US residency programs.ObjectiveTo identify strategies and best practices that exemplary US GME programs use to improve DEI.Design and settingThis qualitative study performed an exploratory content analysis of award applications submitted to the ACGME over 2 cycles in 2020 and 2021, using the constant comparative method. The research team first acknowledged their own biases related to DEI, used caution to not overinterpret the data, and performed several cross-checks during data analysis to ensure confirmability of the results. A preliminary codebook was developed and used during regular adjudication sessions. Disagreements were discussed until agreements were reached.Main outcomes and measuresFoundational (ie, commonly cited, high-impact, and small-effort strategies considered achievable by all programs) and aspirational (ie, potential for high impact but requiring greater effort and investment) DEI strategies used by exemplary GME programs.ResultsThis qualitative study included 29 award applications submitted between August 17, 2020, and January 11, 2022. Strategies spanned the education continuum from premedical students through faculty. Foundational strategies included working with schools, community colleges, and 4-year college campuses; providing structured support for visiting students; mission-driven holistic review for admissions and selection; interviewer trainings on implicit bias mitigation and on how racism and discrimination impact admission processes and advancement; interview-day DEI strategies; inclusive selection and DEI committees; mission statements that include DEI; and retention efforts to improve faculty diversity. Aspirational strategies included development of longitudinal bidirectional collaborations (eg, articulation agreements, annual workshops, funded rotations and/or research) with organizations working with applicants who were historically excluded and underrepresented in medicine, blinding metrics in residency applications, longitudinal curricula on DEI and health equity, and faculty mentoring such as affinity groups, mentored research, and joint academic-community recruitments. Findings provide residency program leadership with a menu of options at various inflection points to foster DEI within their programs.Conclusions and relevanceThe findings of this qualitative study suggest that GME programs might adopt strategies of exemplary programs to improve DEI in residency, ensure compliance with accreditation standards, and improve health outcomes for all.