A challenging and rewarding time: The early days of graduate medical education in dermatology

2017 ◽  
Vol 27 (3) ◽  
pp. 173-178
Author(s):  
Margaret Maria Cocks
Keyword(s):  
Medical Education ◽  
20Th Century ◽  
Residency Training ◽  
Graduate Medical Education ◽  
Training Programs ◽  
Subspecialty Training ◽  
Scientific Journals ◽  
Graduate Medical ◽  
Personal Reflections

Specialized residency training was still in its infancy in mid-20th century America. While specialty boards in various fields such as ophthalmology and otolaryngology had been established in the 1920s and 1930s, the details of training programs were still being fine-tuned and formal curricula were lacking. In dermatology, three prominent physicians including Harry L. Arnold Jr., J. Lamar Callaway and Walter B. Shelley trained during these experimental days of medical education. Each of them captured personal reflections of their own training experiences in brief memoirs published in scientific journals. A closer examination of these texts provides unique insights into how dermatology subspecialty training in particular and medical education more broadly evolved during this period.

scholarly journals ACGME Milestones Within Subspecialty Training Programs: One Institution's Experience

2019 ◽  
Vol 11 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Janae K. Heath ◽  
C. Jessica Dine
Keyword(s):  
Medical Education ◽  
Linear Regression ◽  
Graduate Medical Education ◽  
Communication Skills ◽  
Training Programs ◽  
Cohort Analysis ◽  
Subspecialty Training ◽  
Response Process ◽  
Graduate Medical ◽  
Fellowship Programs

ABSTRACT Background  The Accreditation Council for Graduate Medical Education Milestones were created as a criterion-based framework to promote competency-based education during graduate medical education. Despite widespread implementation across subspecialty programs, extensive validity evidence supporting the use of milestones within fellowship training is lacking. Objective  We assessed the construct and response process validity of milestones in subspecialty fellowship programs in an academic medical center. Methods  From 2014–2016, we performed a single center retrospective cohort analysis of milestone data from fellows across 5 programs. We analyzed summary statistics and performed multivariable linear regression to assess change in milestone ratings by training year and variability in ratings across fellowship programs. Finally, we examined a subset of Professionalism and Interpersonal and Communication Skills subcompetencies from the first 6 months of training to identify the proportion of fellows deemed “ready for independent practice” in these domains. Results  Milestone data were available for 68 fellows, with 75 933 unique subcompetency ratings. Multivariable linear regression, adjusted for subcompetency and subspecialty, revealed an increase of 0.17 (0.16–0.19) in ratings with each postgraduate year level increase (P < .005), as well as significant variation in milestone ratings across subspecialties. For the Professionalism and Interpersonal and Communication Skills domains, mean ratings within the first 6 months of training were 3.78 and 3.95, respectively. Conclusions  We noted a minimal upward trend of milestone ratings in subspecialty training programs, and significant variability in implementing milestones across differing subspecialties. This may suggest possible difficulties with the construct validity and response process of the milestone system in certain medical subspecialties.

scholarly journals Entrustable Professional Activities for Pathology

2017 ◽  
Vol 4 ◽  
pp. 237428951771428 ◽  
Author(s):  
Cindy B. McCloskey ◽  
Ronald E. Domen ◽  
Richard M. Conran ◽  
Robert D. Hoffman ◽  
Miriam D. Post ◽  
...  
Keyword(s):  
Medical Education ◽  
Residency Training ◽  
Graduate Medical Education ◽  
Clinical Pathology ◽  
Entrustable Professional Activities ◽  
Professional Activity ◽  
Entrustable Professional Activity ◽  
Accreditation Council ◽  
Graduate Medical ◽  
Professional Activities

Competency-based medical education has evolved over the past decades to include the Accreditation Council for Graduate Medical Education Accreditation System of resident evaluation based on the Milestones project. Entrustable professional activities represent another means to determine learner proficiency and evaluate educational outcomes in the workplace and training environment. The objective of this project was to develop entrustable professional activities for pathology graduate medical education encompassing primary anatomic and clinical pathology residency training. The Graduate Medical Education Committee of the College of American Pathologists met over the course of 2 years to identify and define entrustable professional activities for pathology graduate medical education. Nineteen entrustable professional activities were developed, including 7 for anatomic pathology, 4 for clinical pathology, and 8 that apply to both disciplines with 5 of these concerning laboratory management. The content defined for each entrustable professional activity includes the entrustable professional activity title, a description of the knowledge and skills required for competent performance, mapping to relevant Accreditation Council for Graduate Medical Education Milestone subcompetencies, and general assessment methods. Many critical activities that define the practice of pathology fit well within the entrustable professional activity model. The entrustable professional activities outlined by the Graduate Medical Education Committee are meant to provide an initial framework for the development of entrustable professional activity–related assessment and curricular tools for pathology residency training.

scholarly journals An Examination of Advocacy Education in Residency Training

2019 ◽  
Vol 144 (4) ◽  
pp. 497-499
Author(s):  
Candice C. Black ◽  
Amy Motta
Keyword(s):  
Medical Education ◽  
Residency Training ◽  
Graduate Medical Education ◽  
Chief Resident ◽  
Home Program ◽  
External Resources ◽  
Graduate Medical ◽  
The Past ◽  
Core Requirements ◽  
Selection Of

Context.— Pathology-related advocacy is best when performed directly by pathologists. Practicing advocacy is included in the Milestones 2.0 and should be introduced during residency training. Objective.— To understand advocacy education in residency training we surveyed pathologists to ask what training they had in residency, what resources were available, and what experiences were most impressionable. Design.— Two types of inquiry were performed. First, a survey to program graduates asking about leadership and advocacy activities during training and about leadership and advocacy activities since graduation. Secondly, focused email and telephone inquiries were made to 12 pathologists—4 in practice for more than 20 years, 4 within the first 10 years of practice, and to 4 PGY4 (postgraduate year 4) residents—asking what training and experiences were available to them, and how they became motivated to become active in practice. Results.— Our results showed that resources available outside of the home program have changed through the years and more national resident groups are available that were not available in the past. These groups may educate trainees in leadership and advocacy. Internally, opportunities to shadow faculty at interdepartmental leadership meetings, as well as selection of the chief resident, are enduring tools for honing these skills. Conclusions.— Teaching advocacy in training is important and part of the Accreditation Council for Graduate Medical Education core requirements as well as a level 5 Milestone. Education may require a balance of internal and external resources since different programs may offer different opportunities. Shadowing during real advocacy events was the most impressionable experience.

scholarly journals Mechanical Ventilation Training During Graduate Medical Education: Perspectives and Review of the Literature

2019 ◽  
Vol 11 (4) ◽  
pp. 389-401 ◽  
Author(s):  
Jonathan M. Keller ◽  
Dru Claar ◽  
Juliana Carvalho Ferreira ◽  
David C. Chu ◽  
Tanzib Hossain ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Medical Education ◽  
Critical Care ◽  
Best Practices ◽  
Graduate Medical Education ◽  
Assessment Tools ◽  
Critical Care Medicine ◽  
Subspecialty Training ◽  
Review Of The Literature ◽  
Graduate Medical

ABSTRACT Background Management of mechanical ventilation (MV) is an important and complex aspect of caring for critically ill patients. Management strategies and technical operation of the ventilator are key skills for physicians in training, as lack of expertise can lead to substantial patient harm. Objective We performed a narrative review of the literature describing MV education in graduate medical education (GME) and identified best practices for training and assessment methods. Methods We searched MEDLINE, PubMed, and Google Scholar for English-language, peer-reviewed articles describing MV education and assessment. We included articles from 2000 through July 2018 pertaining to MV education or training in GME. Results Fifteen articles met inclusion criteria. Studies related to MV training in anesthesiology, emergency medicine, general surgery, and internal medicine residency programs, as well as subspecialty training in critical care medicine, pediatric critical care medicine, and pulmonary and critical care medicine. Nearly half of trainees assessed were dissatisfied with their MV education. Six studies evaluated educational interventions, all employing simulation as an educational strategy, although there was considerable heterogeneity in content. Most outcomes were assessed with multiple-choice knowledge testing; only 2 studies evaluated the care of actual patients after an educational intervention. Conclusions There is a paucity of information describing MV education in GME. The available literature demonstrates that trainees are generally dissatisfied with MV training. Best practices include establishing MV-specific learning objectives and incorporating simulation. Next research steps include developing competency standards and validity evidence for assessment tools that can be utilized across MV educational curricula.

scholarly journals Leadership Training Programs in Graduate Medical Education: A Systematic Review

2019 ◽  
Author(s):  
Bharat Kumar ◽  
Melissa Swee ◽  
Manish Suneja
Keyword(s):  
Medical Education ◽  
Graduate Medical Education ◽  
Leadership Training ◽  
Training Programs ◽  
Leadership Skills ◽  
Chief Resident ◽  
Case Series ◽  
The United States ◽  
Cochrane Central Register ◽  
Graduate Medical

Abstract Background : With the increasing recognition that leadership skills can be acquired, there is a heightened focus on incorporating leadership training as a part of graduate medical education. However, there is considerable lack of agreement regarding how to facilitate acquisition of these skills to resident, chief resident, and fellow physicians. Methods : Articles were identified through a search of Ovid MEDLINE, EMBASE, CINAHL, ERIC, PsycNet, Cochrane Systemic Reviews, and Cochrane Central Register of Controlled Trials from 1948 to 2019. Additional sources were identified through contacting authors and scanning references. We included articles that described and evaluated leadership training programs in the United States and Canada. Methodological quality was assessed via the MERSQI (Medical Education Research Study Quality Instrument). Results : 15 studies, which collectively included 639 residents, chief residents, and fellows, met the eligibility criteria. The format, content, and duration of these programs varied considerably. The majority focused on conflict management, interpersonal skills, and stress management. Twelve were prospective case series and three were retrospective. Seven used pre- and post-test surveys, while seven used course evaluations. Only three had follow-up evaluations after six months to one year. MERSQI scores ranged from 6 to 9. Conclusions : Despite interest in incorporating structured leadership training into graduate medical education curricula, there is a lack of evidence evaluating its effectiveness. High-quality well-designed studies are required in order to determine if these programs have a lasting effect on the acquisition of leadership skills.

scholarly journals Teaching Health Center Graduate Medical Education Locations Predominantly Located in Federally Designated Underserved Areas

2016 ◽  
Vol 8 (2) ◽  
pp. 241-243 ◽  
Author(s):  
Songhai C. Barclift ◽  
Elizabeth J. Brown ◽  
Sean C. Finnegan ◽  
Elena R. Cohen ◽  
Kathleen Klink
Keyword(s):  
Primary Care ◽  
Medical Education ◽  
Health Center ◽  
Residency Training ◽  
Graduate Medical Education ◽  
Rural Areas ◽  
Clinical Training ◽  
Community Based ◽  
Underserved Area ◽  
Graduate Medical

ABSTRACT  The Teaching Health Center Graduate Medical Education (THCGME) program is an Affordable Care Act funding initiative designed to expand primary care residency training in community-based ambulatory settings. Statute suggests, but does not require, training in underserved settings. Residents who train in underserved settings are more likely to go on to practice in similar settings, and graduates more often than not practice near where they have trained.Background  The objective of this study was to describe and quantify federally designated clinical continuity training sites of the THCGME program.Objective  Geographic locations of the training sites were collected and characterized as Health Professional Shortage Area, Medically Underserved Area, Population, or rural areas, and were compared with the distribution of Centers for Medicare and Medicaid Services (CMS)–funded training positions.Methods  More than half of the teaching health centers (57%) are located in states that are in the 4 quintiles with the lowest CMS-funded resident-to-population ratio. Of the 109 training sites identified, more than 70% are located in federally designated high-need areas.Results  The THCGME program is a model that funds residency training in community-based ambulatory settings. Statute suggests, but does not explicitly require, that training take place in underserved settings. Because the majority of the 109 clinical training sites of the 60 funded programs in 2014–2015 are located in federally designated underserved locations, the THCGME program deserves further study as a model to improve primary care distribution into high-need communities.Conclusions

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