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 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 Transitioning Toward Competency: A Resident-Faculty Collaborative Approach to Developing a Transitions of Care EPA in an Internal Medicine Residency Program

2014 ◽  
Vol 6 (4) ◽  
pp. 760-764 ◽  
Author(s):  
Brian Chan ◽  
Honora Englander ◽  
Kyle Kent ◽  
Sima Desai ◽  
Adam Obley ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Medical Center ◽  
Academic Medical Center ◽  
Transitions Of Care ◽  
Collaborative Approach ◽  
Internal Medicine Training ◽  
Faculty Collaboration ◽  
Professional Activities ◽  
Competency Based ◽  
Practice Methods

Abstract Background Residency training and evaluation are moving toward competency-based models. Managing transitions of care is 1 of 16 entrustable professional activities (EPAs) that signal readiness for independent internal medicine practice. Methods for developing EPAs are evolving within the medical education community. Objective We describe a process for developing a transitions-of-care EPA for internal medicine inpatient and ambulatory settings using an iterative, consensus-building, resident-faculty collaborative approach. Methods We used an independent rank-ordering process and successive consensus group meetings to cull an initial list of 142 developmental Milestones to the 15 most relevant to transitions of care for internal medicine patients in an academic medical center and affiliated Veterans Administration hospital. Four senior internal medicine residents and 4 internal medicine faculty members representing inpatient and ambulatory practice settings identified examples of specific tasks and evaluative techniques for each Milestone. Results We demonstrate a feasible resident-faculty collaboration to develop transitions of care as an EPA for an internal medicine training program. Inclusion of residents along with faculty provided broader insights as well as an important learning opportunity for trainees. Conclusions Our process demonstrated the feasibility of designing an EPA, but questions remain about how entrustment-based evaluation can be implemented in clinical settings. Our framework may serve as a foundation for EPA development in other areas of clinical practice.

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 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 Identifying Entrustable Professional Activities in Internal Medicine Training

2013 ◽  
Vol 5 (1) ◽  
pp. 54-59 ◽  
Author(s):  
Karen E. Hauer ◽  
Jeffrey Kohlwes ◽  
Patricia Cornett ◽  
Harry Hollander ◽  
Olle ten Cate ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Content Validity ◽  
Medical Training ◽  
Entrustable Professional Activities ◽  
Internal Medicine Training ◽  
Professional Activities ◽  
Delphi Approach ◽  
Validity Indices ◽  
Competency Based ◽  
Competency Based Assessment

Abstract Background Entrustable professional activities (EPAs) can form the foundation of competency-based assessment in medical training, focused on performance of discipline-specific core clinical activities. Objective To identify EPAs for the Internal Medicine (IM) Educational Milestones to operationalize competency-based assessment of residents using EPAs. Methods We used a modified Delphi approach to conduct a 2-step cross-sectional survey of IM educators at a 3-hospital IM residency program; residents also completed a survey. Participants rated the importance and appropriate year of training to reach competence for 30 proposed IM EPAs. Content validity indices identified essential EPAs. We conducted independent sample t tests to determine IM educator-resident agreement and calculated effect sizes. Finally, we determined the effect of different physician roles on ratings. Results Thirty-six IM educators participated; 22 completed both surveys. Twelve residents participated. Seventeen EPAs had a content validity index of 100%; 10 additional EPAs exceeded 80%. Educators and residents rated the importance of 27 of 30 EPAs similarly. Residents felt that 10 EPAs could be met at least 1 year earlier than educators had specified. Conclusions Internal medicine educators had a stable opinion of EPAs developed through this study, and residents generally agreed. Using this approach, programs could identify EPAs for resident evaluation, building on the initial list created via our study.

scholarly journals Workplace-based assessments of entrustable professional activities in a psychiatry core clerkship: an observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Severin Pinilla ◽  
Alexandra Kyrou ◽  
Stefan Klöppel ◽  
Werner Strik ◽  
Christoph Nissen ◽  
...  
Keyword(s):  
Clinical Encounter ◽  
Entrustable Professional Activities ◽  
Written Feedback ◽  
Professional Activities ◽  
Quality Feedback ◽  
Observational Prospective Cohort Study ◽  
Competency Based ◽  
Patient’S History ◽  
Indirect Supervision ◽  
Clerkship Rotation

Abstract Background Entrustable professional activities (EPAs) in competency-based, undergraduate medical education (UME) have led to new formative workplace-based assessments (WBA) using entrustment-supervision scales in clerkships. We conducted an observational, prospective cohort study to explore the usefulness of a WBA designed to assess core EPAs in a psychiatry clerkship. Methods We analyzed changes in self-entrustment ratings of students and the supervisors’ ratings per EPA. Timing and frequencies of learner-initiated WBAs based on a prospective entrustment-supervision scale and resultant narrative feedback were analyzed quantitatively and qualitatively. Predictors for indirect supervision levels were explored via regression analysis, and narrative feedback was coded using thematic content analysis. Students evaluated the WBA after each clerkship rotation. Results EPA 1 (“Take a patient’s history”), EPA 2 (“Assess physical & mental status”) and EPA 8 (“Document & present a clinical encounter”) were most frequently used for learner-initiated WBAs throughout the clerkship rotations in a sample of 83 students. Clinical residents signed off on the majority of the WBAs (71%). EPAs 1, 2, and 8 showed the largest increases in self-entrustment and received most of the indirect supervision level ratings. We found a moderate, positive correlation between self-entrusted supervision levels at the end of the clerkship and the number of documented entrustment-supervision ratings per EPA (p < 0.0001). The number of entrustment ratings explained 6.5% of the variance in the supervisors’ ratings for EPA 1. Narrative feedback was documented for 79% (n = 214) of the WBAs. Most narratives addressed the Medical Expert role (77%, n = 208) and used reinforcement (59%, n = 161) as a feedback strategy. Students perceived the feedback as beneficial. Conclusions Using formative WBAs with an entrustment-supervision scale and prompts for written feedback facilitated targeted, high-quality feedback and effectively supported students’ development toward self-entrusted, indirect supervision levels.

scholarly journals Preparing for CBME: How often are faculty observing residents?

2020 ◽  
Author(s):  
Sheenagh J K George ◽  
Sarah Manos ◽  
Kenny K Wong
Keyword(s):  
Direct Observation ◽  
Assessment Tools ◽  
Inpatient Setting ◽  
Institutional Research ◽  
Professional Activities ◽  
Inpatient Settings ◽  
Competency Based ◽  
Resident Assessment ◽  
Outpatient Settings ◽  
Common Barriers

Abstract Background The Royal College of Physicians and Surgeons of Canada officially launched ‘Competence by Design’ in July 2017, moving from time-based to outcomes-based training. Transitioning to competency-based medical education (CBME) necessitates change in resident assessment. A greater frequency of resident observation will likely be required to adequately assess whether entrustable professional activities have been achieved. Purpose Characterize faculty and resident experiences of direct observation in a single paediatric residency program, pre-CBME implementation. Qualitatively describe participants’ perceived barriers and incentives to participating in direct observation. Methods Surveys were sent to paediatric residents and faculty asking for demographics, the frequency of resident observation during an average 4-week rotation, perceived ideal frequency of observation, and factors influencing observation frequency. Descriptive data were analyzed. Institutional research ethics board approval was received. Results The response rate was 54% (34/68 faculty and 16/25 residents). When asked the MAXIMUM frequency FACULTY observed a resident take a history, perform a physical examination, or deliver a plan, the median faculty reply was 1, 2, and 3, for outpatient settings and 0, 1, and 2, for inpatient settings. The median RESIDENT reply was 2, 4, and 10 for outpatient settings and 1, 2, and 20 for inpatient settings. When asked the MINIMUM frequency for each domain, the median FACULTY and RESIDENT reply was 0, except for delivering a plan in the inpatient setting. Faculty reported observing seniors delivering the plan more frequently than junior residents. Faculty and resident median replies for how frequently residents should be observed for each domain were the same, three to four, three to four, and five to six times. Four per cent of faculty reported regularly scheduling observations, and 77% of residents regularly ask to be observed. The most common barriers to observation were too many patients to see and both faculty and residents were seeing patients at the same time. Most faculty and resident responders felt that observation frequency could be improved if scheduled at the start of the rotation; faculty were provided a better tool for assessment; and if residents asked to be observed. Conclusions This study provides baseline data on how infrequent faculty observation is occurring and at a frequency lower than what faculty and residents feel is necessary. The time needed for observation competes with clinical service demands, but better scheduling strategies and assessment tools may help.

scholarly journals A collective case study of supervision and competence judgments on the inpatient internal medicine ward

2021 ◽  
Author(s):  
Tristen Gilchrist ◽  
Rose Hatala ◽  
Andrea Gingerich
Keyword(s):  
Internal Medicine ◽  
Clinical Supervision ◽  
Clinical Teaching ◽  
Senior Resident ◽  
Structured Interviews ◽  
Collective Case Study ◽  
Teaching Unit ◽  
Competency Based ◽  
Trainee Competence

Abstract Introduction Workplace-based assessment in competency-based medical education employs entrustment-supervision scales to suggest trainee competence. However, clinical supervision involves many factors and entrustment decision-making likely reflects more than trainee competence. We do not fully understand how a supervisor’s impression of trainee competence is reflected in their provision of clinical support. We must better understand this relationship to know whether documenting level of supervision truly reflects trainee competence. Methods We undertook a collective case study of supervisor-trainee dyads consisting of attending internal medicine physicians and senior residents working on clinical teaching unit inpatient wards. We conducted field observations of typical daily activities and semi-structured interviews. Data was analysed within each dyad and compared across dyads to identify supervisory behaviours, what triggered the behaviours, and how they related to judgments of trainee competence. Results Ten attending physician-senior resident dyads participated in the study. We identified eight distinct supervisory behaviours. The behaviours were enacted in response to trainee and non-trainee factors. Supervisory behaviours corresponded with varying assessments of trainee competence, even within a dyad. A change in the attending’s judgment of the resident’s competence did not always correspond with a change in subsequent observable supervisory behaviours. Discussion There was no consistent relationship between a trigger for supervision, the judgment of trainee competence, and subsequent supervisory behaviour. This has direct implications for entrustment assessments tying competence to supervisory behaviours, because supervision is complex. Workplace-based assessments that capture narrative data including the rationale for supervisory behaviours may lead to deeper insights than numeric entrustment ratings.

scholarly journals Creative Solution for Implementation of Experiential, Competency-Based Palliative Care Training for Internal Medicine Residents

2011 ◽  
Vol 26 (3) ◽  
pp. 436-443 ◽  
Author(s):  
Douglas D. Ross ◽  
Deborah W. Shpritz ◽  
Susan D. Wolfsthal ◽  
Ann B. Zimrin ◽  
Timothy J. Keay ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Palliative Care ◽  
Internal Medicine Residents ◽  
Competency Based ◽  
Care Training

scholarly journals Use of the Flugelman index for identifying patients who are difficult to discharge from the hospital

2013 ◽  
pp. 103-108
Author(s):  
Chiara Bozzano ◽  
Ilario Lancini ◽  
Elena Mei ◽  
Maida Lucarini ◽  
Roberta Mastriforti ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Hospital Stay ◽  
Discharge Planning ◽  
District General Hospital ◽  
Feeding Problems ◽  
Care Needs ◽  
Socioeconomic Condition ◽  
Factors Affecting ◽  
Effective Discharge ◽  
Medical Wards

Introduction: To evaluate the use of multidimensional assessment based on the Fluegelman Index (FI) to identify internal medicine patients who are likely to be difficult to discharge from the hospital. Materials and methods: Have been evaluated all patients admitted to the medical wards of the District General Hospital of Arezzo from September 1 to October 31, 2007. We collected data on age, sex, socioeconomic condition, cause of admission, comorbidity score preadmission functional status (Barthel Index), incontinence, feeding problems, length of hospitalization, condition at discharge, and type of discharge. The FI cut off for difficult discharge was > 17. Results: Of the 413 patients (mean age 80 + 11.37 years; percentage of women, 56.1%) included in the study, 109 (26.39%) had Flugelman Index > 17. These patients were significantly older than the patients with lower FIs (85 + 9.35 vs 78 + 11.58 years, p < 0.001), more likely to be admitted for pneumonia (22% vs. 4.9% of those with lower FIs; p < 0,001). They also had more comorbidity, loss of autonomy, cognitive impairment, social frailty, and nursing care needs. The subgroup with FIs>17 had significantly higher in-hospital mortality (30.28% vs 6.25%, p < 0.001), longer hospital stay (13 vs. 10 days, p < 0.05), and higher rates of discharge to nursing homes. Conclusions: Evaluation of internal medicine patients with the Flugelman Index may be helpful for identifying more critical patients likely to require longer hospitalization and to detect factors affecting the hospital stay. This information can be useful for more effective discharge planning.

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