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.

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 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 A Sustainable and Effective Mentorship Model for Graduate Medical Education Programs

2019 ◽  
Vol 11 (2) ◽  
pp. 221-225
Author(s):  
Thomas J. Caruso ◽  
Tiffany Kung ◽  
Nancy Piro ◽  
Jie Li ◽  
Laurence Katznelson ◽  
...  
Keyword(s):  
Medical Education ◽  
Graduate Medical Education ◽  
Training Programs ◽  
Clinical Skills ◽  
Full Time ◽  
Full Time Equivalent ◽  
Graduate Medical ◽  
Mentor Relationships ◽  
Group 2 ◽  
Group 1

ABSTRACT Background  Mentorship models rarely seek generalizability across training programs at the graduate medical education (GME) level. Objective  We examined the sustainability and effectiveness of an intervention to increase the number and usefulness of trainee mentorship. Methods  A 0.20 full-time equivalent GME faculty adviser position (MD, MEd) implemented mentorship programs in residencies and fellowships. In group 1, 6 GME programs implemented the mentorship strategies prior to 2014, which were used to measure whether the number of mentor relationships were longitudinally sustained. In group 2, 10 different GME programs implemented the mentorship strategies in 2016, which were used to measure whether the intervention immediately increased the number of mentor relationships. To measure mentorship usefulness, trainees rated mentors' ability to promote clinical skills and personal and professional development. The remaining programs were the comparison. Responses from the 2014 and 2016 annual institutional trainee survey were analyzed. Results  The incidence of group 1 reporting mentor relationships in 2014 compared to the incidence of group 1 in 2016 were 89% (41 of 46) and 95% (42 of 44), respectively, suggesting that the intervention was sustained for 2 years (P = .26). Group 2 showed a higher proportion of trainees reporting mentors in 2016 (88%, 149 of 170) compared to preintervention (66%, 71 of 108; P = .00001). Groups 1 and 2 reported significant increases in mentorship usefulness. Conclusions  A GME initiative to enhance mentoring across specialties in 16 GME training programs was self-sustaining and effective.

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