scholarly journals EPAs for the Ambulatory Internist in Translation: Findings from a Canadian Multi-Center Survey

2019 ◽  
Vol 14 (3) ◽  
pp. 9-15
Author(s):  
Rupal Shah ◽  
Lindsay Melvin ◽  
Rodrigo B Cavalcanti
Keyword(s):  
Internal Medicine ◽  
Learning Goals ◽  
Implementation Barriers ◽  
Professional Activities ◽  
University Of Toronto ◽  
General Internal ◽  
General Internists ◽  
Ambulatory Training ◽  
Competency Based ◽  
Context Specific

Background Increased demand for outpatient care has made defining the role of ambulatory general internists an educational priority. Canadian residency programs are transitioning towards competency-based education, where learning goals are articulated as entrustable professional activities (EPAs). Engaging frontline internists in the validation of context-specific EPAs is important for implementation.  Objective This study describes a consensus approach for developing EPAs for ambulatory general internal medicine (GIM) training and results of a Canada-wide survey seeking feedback from academic internists.  Methods In 2016, we reviewed Royal College of Physicians and Surgeons of Canada GIM accreditation documents, and systematic literature search results for internal medicine ambulatory training objectives, to draft EPAs. EPAs were revised via expert consensus at the University of Toronto. A survey was distributed to Canadian academic internists to determine level of agreement on proposed EPAs. Consensus was defined as greater than 80% inter-rater agreement. Open-ended questions explored reasons for disagreements, which were reviewed independently by authors and iteratively organized into categories.  Results Eight EPAs were generated. Survey response rate was 24.9% (63/253). Consensus was achieved on all EPAs except obstetrical medicine (49/63, 77.8%). Reasons for disagreements reflected variable understanding of EPA concepts by respondents. Where understood well, disagreements fell into 3 main categories: (1) further training required, (2) not within internal medicine scope, and (3) implementation barriers. Conclusions Frontline academic physicians are pivotal in validating proposed EPAs. Disagreements were either content or concept related and recognizing these diverse perspectives can help clinician-educators predict and prepare for challenges with EPA implementation.

scholarly journals Point-of-care ultrasound as a competency for general internists: a survey of internal medicine training programs in Canada

2016 ◽  
Vol 7 (2) ◽  
pp. e51-69 ◽  
Author(s):  
Jonathan Ailon ◽  
Maral Nadjafi ◽  
Ophyr Mourad ◽  
Rodrigo Cavalcanti
Keyword(s):  
Internal Medicine ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Clinical Use ◽  
Internal Medicine Training ◽  
Program Leaders ◽  
University Of Toronto ◽  
General Internal ◽  
General Internists ◽  
The University

Background: Point-of-care ultrasound (POCUS) is increasingly used on General Internal Medicine (GIM) inpatient services, creating a need for defined competencies and formalized training. We evaluated the extent of training in POCUS and the clinical use of POCUS among Canadian GIM residency programs.Method: Internal Medicine trainees and GIM Faculty at the University of Toronto were surveyed on their clinical use of POCUS and the extent of their training. We separately surveyed Canadian IM Program Directors and Division Directors on the extent of POCUS training in their programs, barriers in the implementation of POCUS curricula, and recommendations for POCUS competencies in IM.Results:  A majority of IM trainees (90/118, 76%) and GIM Faculty (15/29, 52%) used POCUS clinically. However, the vast majority of resident (111/117, 95%) and GIM Faculty (18/28, 64%) had received limited training. Of the Program Leaders surveyed, half (9/17, 53%) reported POCUS clinical use by their trainees; however only one quarter (4/16, 25%) reported offering formal curricula. Most respondents agreed that POCUS training should be incorporated into IM residency curricula, specifically for procedural guidance.Conclusions: A considerable discrepancy exists between the clinical use of POCUS and the extent of formal training among Canadian IM residents and GIM Faculty. We propose that formalized POCUS training should be incorporated into IM residency programs, GIM fellowships, and Faculty development sessions, and identify POCUS skills that could be incorporated into future IM curricula.

scholarly journals Rates and Types of Medication-Related Problems in Patients Rehospitalized Within 30 Days of Discharge From a Community Hospital

2019 ◽  
Vol 36 (2) ◽  
pp. 47-53
Author(s):  
Julie B. Cooper ◽  
Elizabeth Jeter ◽  
Cory John Sessoms
Keyword(s):  
Internal Medicine ◽  
Hospital Readmission ◽  
Adverse Drug Events ◽  
Community Hospital ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Readmission Rates ◽  
General Internal ◽  
Hospital Readmission Rates ◽  
Context Specific

Background: Impact of medication-related problems (MRPs) on persistently high hospital readmission rates are not well described. Objective: The purpose of this study was to determine the rate and type of MRPs attributed to rehospitalization within 30 days of discharge from a general internal medicine hospitalists’ service at a nonacademic medical center. Methods: A retrospective cohort study was conducted evaluating consecutive patients readmitted within 30-days after discharge to home from an internal medicine hospitalist service. Readmissions attributed to MRPs in physician documentation were systematically classified as indication, effectiveness, adverse drug reaction, or nonadherence problems and evaluated for possible preventability. Descriptive statistics were used to describe the rate and type of MRP. Results: Evaluation of consecutive 30-day readmissions (n = 203) to a nonteaching community hospital identified 50.2% of admissions attributed to MRPs. MRPs (n = 102) were categorized as problems of indication (34.3%), efficacy (19.6%), adverse drug events (18.6%), and nonadherence (27.5%). One third of 30-day readmissions in this cohort were attributed to potentially preventable MRPs. Conclusion: MRPs are frequently implicated in 30-day hospital readmissions in a nonteaching community hospital representing an opportunity for context-specific improvements.

scholarly journals Scaffolding for assessment success: using gradual release of responsibility to support resident transition to competency-based medical education

2019 ◽  
Vol 10 (3) ◽  
pp. e110-112
Author(s):  
Rebecca P. Pero ◽  
Laura Marcotte
Keyword(s):  
Internal Medicine ◽  
Medical Education ◽  
Residency Training ◽  
Training Programs ◽  
Competency Based Medical Education ◽  
General Internal ◽  
Gradual Release Of Responsibility ◽  
Competency Based ◽  
Resident Assessment ◽  
Gradual Release

In competency-based medical education (CBME), assessment is learner-driven; learners may fail to progress if assessments are not completed. The General Internal Medicine (GIM) program at Queen’s University uses an educational technique known as scaffolding in its assessment strategy. The program applies this technique to coordinate early assessments with specific scheduled learning experiences and gradually releases the responsibility for assessment initiation to residents. Although outcomes of this innovation are still under investigation, we feel it has been valuable in supporting resident assessment capture and timely progression through stages of training.  Other residency training programs could easily implement this technique to support the transition to Competency by Design.

scholarly journals Found in transition: Applying milestones to three unique discharge curricula

2014 ◽  
Author(s):  
Lauren Meade ◽  
Christine Y Todd ◽  
Meghan M Walsh
Keyword(s):  
Internal Medicine ◽  
Educational Innovation ◽  
Transitions Of Care ◽  
Transition Of Care ◽  
Professional Activities ◽  
Lower Priority ◽  
Effective Discharge ◽  
Competency Based ◽  
Q Sort ◽  
Physician Competency

Introduction: A safe and effective transition from hospital to post acute care is a complex and important physician competency. Milestones and Entrustable Professional Activities (EPA) form the new educational rubric in Graduate Medical Education Training. ‘A safe and effective discharge from the hospital’ is an EPA ripe for educational innovation. Methods: The authors collaborated in a qualitative process called, mapping, to develop a Q-sort exercise to be distributed to participants at an Association for Program Directors in Internal Medicine (APDIM) workshop on milestones for transition of care. We analyzed the Q-sort results to rank the milestones in order of priority. We then applied this ranking to 3 innovative transitions of care curricula: Simulation (S), Discharge Clinic Feedback (DCF) and TRACER (T). Results: We collected 55 game boards from faculty units at the APDIM workshop. We report the prioritized milestones by Q-sort from the APDIM workshop. From the total 22 milestones, the simulation innovation identified 5/22 milestones, discharge clinic 9/22 milestones and tracer 7/22 milestones related to the EPA. Milestones identified in each innovation related back to one of the top eight prioritized milestones 75% of the time; thus more frequently than the milestones with lower priority. Discussion: We demonstrated that three unique innovations in transitions of care map to the top prioritized Q-sort milestones related to that EPA. Milestones for competency based assessment can be used to guide the development of innovative curricula in transition of care medicine.

scholarly journals COVID-19 and Canadian General Internists

2020 ◽  
Vol 15 (2) ◽  
pp. 4
Author(s):  
James Douketis
Keyword(s):  
Internal Medicine ◽  
General Internal Medicine ◽  
Canadian Journal ◽  
General Internal ◽  
General Internists

In advance of our next issue of the Canadian Journal of General Internal Medicine, we are disseminating work by Dr. Irene Ma and colleagues on use of POCUS for the management of patients with suspected or confirmed COVID-19 illness.

scholarly journals P.100 A competency-based stroke curriculum for non-neurologists

2017 ◽  
Vol 44 (S2) ◽  
pp. S39-S39
Author(s):  
S Aberdour ◽  
A Henri-Bhargava
Keyword(s):  
Internal Medicine ◽  
Resident Education ◽  
Medical Specialty ◽  
Routine Care ◽  
Resident Training ◽  
Stroke Patients ◽  
Professional Activities ◽  
Modified Delphi ◽  
Medical Program ◽  
Competency Based

Background: Previously-identified deficiencies in stroke training for emergency and internal medicine trainees led us to develop a competency-based curriculum for a stroke rotation, based upon entrusbable professional activities (EPAs). EPAs are observable and measurable activities that are routine care within a given medical specialty. Methods: We surveyed stroke- and non-stroke neurologists using a modified Delphi process with two iterations. The survey sought input on the number and nature of EPAs considered most important and achievable during a one month stroke rotation. Results: Surveyed neurologists considered 5-10 EPAs as adequate and reasonable to achieve during a one month elective. A list of the most essential EPAs was obtained and will be used as the basis of a curriculum for rotating residents in Internal and Emergency medicine at the Island Medical Program in Victoria, BC. Conclusions: Our work highlights an approach to meeting an identified gap in resident training in an important area of neurology (stroke). A competency based approach to medical education, focusing on EPAs, offers an innovative way of approaching resident education that seeks to ensure residents develop skills that experts in the field have identified as most essential for the work at hand (in this case, the proper management of stroke patients).

scholarly journals Providing quality feedback to general internal medicine residents in a competency-based assessment environment

2019 ◽  
Vol 10 (4) ◽  
pp. e32-e47
Author(s):  
Laura Marcotte ◽  
Rylan Egan ◽  
Eleftherios Soleas ◽  
Nancy J Dalgarno ◽  
Matthew Norris ◽  
...  
Keyword(s):  
Internal Medicine ◽  
General Internal Medicine ◽  
Faculty Perceptions ◽  
Improvement Strategy ◽  
Clinical Teachers ◽  
General Internal ◽  
Quality Feedback ◽  
Specific Feedback ◽  
Competency Based ◽  
Assessment Environment

Construct: Competence Based Medical Education (CBME) is designed to use workplace-based assessment (WBA) tools to provide observed assessment and feedback on resident competence. Moreover, WBAs are expected to provide evidence beyond that of more traditional mid- or end-of-rotation assessments [e.g., In Training Evaluation Records (ITERs)]. In this study we investigate competence in General Internal Medicine (GIM), by contrasting WBA and ITER assessment tools.Background: WBAs are hypothesized to improve and differentiate written and numerical feedback to support the development and documentation of competence. In this study we investigate residents’ and faculty members’ perceptions of WBA validity, usability, and reliability and the extent to which WBAs differentiate residents’ performance when compared to ITERs.   Approach: We used a mixed methods approach over a three-year period, including perspectives gathered from focus groups, interviews, along with numerical and narrative comparisons between WBA and ITERs in one GIM program.Results: Residents indicated that the narrative component of feedback was more constructive and effective than numerical scores. They perceived the focus on specific workplace-based feedback was more effective than ITERs. However, quantitative analysis showed that overall rates of actionable feedback, including both ITERs and WBAs, were low (26%), with only 9% providing an improvement strategy. The provision of quality feedback was not statistically significantly different between tools; although WBAs provided more actionable feedback, ITERs provided more strategies. Statistical analyses showed that more than half of all assessments came from 11 core faculty.Conclusions: Participants in this study viewed narrative, actionable and specific feedback as essential, and an overall preference was found for written feedback over numerical assessments. However, quantitative analyses showed that specific actionable feedback was rarely documented, despite qualitative emphasis from both groups of its importance for developing competency. Neither formative WBAs or summative ITERs clearly provided better feedback, and both may still have a role in overall resident evaluation. Participant views differed in roles and responsibilities, with residents stating that faculty should be responsible for initiating assessments and vice-versa. These results reveal a disconnect between resident and faculty perceptions and practice around giving feedback and emphasize opportunities for programs adopting and implementing CBME to address how best to support residents and frontline clinical teachers.

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