Evaluation of a Musculoskeletal Ultrasound Workshop in the Family Medicine Clerkship

Background and Objectives: The family medicine (FM) clerkship is appropriate for incorporating musculoskeletal ultrasound (MSKUS) education, as many outpatient visits in primary care occur for musculoskeletal (MSK) concerns. Despite rising popularity of point-of-care imaging in primary care, ultrasound (US) training in medical education is limited due to lack of resources and time. The purpose of this study is to evaluate the effects of an MSKUS workshop in the FM clerkship through student self-evaluations. Methods: Seventy-five medical students enrolled in the FM clerkship during the 2019-2020 academic year participated in hands-on MSKUS workshops staffed by faculty, residents, and a fellow. Workshops coincided with FM residency didactic teaching, allowing for protected time to host US training. Of workshop participants, 98.6% completed both pre- and postworkshop evaluations assessing confidence and acceptability of the workshop (rated on a 0-10 Likert scale, where higher scores represent more confidence or greater benefit, respectively). Results: Students noted increased confidence with use of ultrasound, recognition of MSK structures, and performance of landmark-guided procedures (preworkshop 2.6±1.6; postworkshop 7.4±1.1). Students endorsed high levels of agreement in the benefit of the workshop to their education (9.4±1.3) and MSK understanding (9.4±1.2). Conclusions: This study demonstrates the benefit of an MSKUS workshop as part of the FM clerkship and addresses previously identified challenges to providing US education. Results suggest a short-term benefit from an MSKUS workshop in confidence in MSKUS knowledge and satisfaction with the curriculum.

Nonclinical Time for Family Medicine Residency Faculty: National Survey Results

Introduction: Recent changes to the Accreditation Council for Graduate Medical Education (ACGME) requirements eliminated minimum standards for protected nonclinical time for core faculty. Faculty perform many nonclinical tasks to maintain family medicine residencies. The objective of this study is to describe the landscape of nonclinical time for family medicine residency faculty. Methods: Program directors at ACGME-accredited family medicine residencies were electronically surveyed in August 2019 to describe nonclinical time of their faculty. Survey information requested included program demographics, the amount of nonclinical time allocated, and the estimated amount of nonclinical time spent per year completing their faculty duties. Results: A total 156 of 635 program directors (24.6%) returned the survey and 58 (9.1%) completed the entire survey for analysis inclusion. An average of 3,394 hours per year, per program were estimated to be spent on nonclinical activities. The greatest amount of time was spent on program administration (39%) and the least amount of time on curriculum development (5%). There was variation in the use of nonphysician faculty to complete these tasks. Allocated faculty time was comparable to estimated time spent performing nonclinical tasks. On average, a 24-resident program devoted 1.9 full-time equivalent faculty salary support to complete nonclinical activities. Conclusions: Family medicine residency faculty spend significant time completing nonclinical tasks required to meet ACGME requirements and need the protected time to complete these necessary tasks. Direct data on the use of faculty nonclinical time is needed to more accurately define its use.

Development and Evaluation of a Faculty-Based Accredited Continuing Professional Development Route for Teaching and Learning

This article characterizes and evaluates the development of an accredited, in-house faculty-based teaching recognition scheme aimed at supporting clinicians and academics to achieve Advance HE Fellowship recognition. The scheme takes 6 to 24 months to complete and forms part of an institution-wide scheme. The evaluation covered 44 months collecting data on participation rates across the school and 21 semi-structured interviews across 16 staff participants. We describe the outcomes measured alongside key perceived benefits and challenges to support the implementation of similar schemes elsewhere. Across 130 academic staff, there was 61% engagement. In interviews, 11 participants characterized benefits in terms of changes to their teaching, such as adopting new strategies for differing class sizes, and highlighted the benefit of accessible and context-specific development opportunities designed specifically for STEMM (science, technology, engineering, mathematics, and medicine) practitioners and clinicians. Motivations for participating were mainly intrinsic (69%), with international professional recognition also featured (61%, n = 10). Of the 23 participants who withdrew, the largest subgroup (39%) withdrew because they had left the institution, and 35% withdrew because of a lack of time, which encompassed a range of issues. We outline recommendations for implementing similar schemes including protected time, accessible development opportunities, and support for mentors.

Improving Feedback for Hematology and Oncology Fellows Via Virtual Workshops: Sustainability Analysis

Background Effective feedback is an important tool in medical education for the learning and growth of trainees and for faculty development. It allows learners to remain on course in reaching competence in clinical, research, and interpersonal skills, yet the impact of teaching feedback during hematology-oncology training has not been studied in depth. To tackle the lack of effective constructive feedback within our hematology oncology fellowship program, we initiated a quality improvement (QI) project to identify barriers in delivering and receiving high-quality feedback in the program and to create a curriculum aimed at teaching fellows and faculty how to engage in more effective feedback conversations. In the initial phase of the pilot study, a pre-intervention survey identified the two main barriers for effective feedback in our program as discomfort in giving feedback and lack of protected time. A virtual workshop improved quality of feedback by addressing these barriers and providing tools necessary to give and receive constructive feedback. We aimed to highlight the sustainability of these interventions. Methods Utilizing the results of the pre-intervention survey, we built three 2-hour interactive virtual workshop sessions conducted through the ASCO Quality Training Program. Skills that were emphasized and practiced included appropriate set-up, low-inference observations, dialogic feedback conversations and a structured approach to reinforcing and modifying feedback. A follow up session was conducted three months later allowing for reinforcement of the skills. Post-intervention surveys were given immediately after the initial workshop and after the follow-up session. All surveys were identical employing Likert scale and open-ended questions. Weekly email reminders for protected feedback time were also set up. This project was developed through the ASH Medical Educators Institute. Results Eleven out of 15 attendees completed each of the questionnaires. At baseline, 81.8 % of the participants reported they do not have protected time to complete evaluations. This decreased to 63.6% immediately post-intervention and to 27.3% at the three-month point. Similarly, only 65.5% of the participants reported they were comfortable giving feedback prior to the workshop, increasing to 81.8% immediately after the intervention and was sustained at 81.8% at three months. Half of the participants reported that the feedback was not actionable in the initial questionnaire, decreasing to 10% post-intervention. Majority of the participants agreed that the workshop helped address barriers for effective feedback in our program. Conclusions This study showed the sustainability of positive changes, even during the COVID-19 pandemic, for giving and receiving quality feedback implemented in our fellowship program. Its outcomes are salient given that it utilizes a simple intervention that could be expanded to other training programs as feedback is a systemic problem in medicine. It also underscores the importance of formal workshops in overcoming barriers for effective feedback. Limitations of this QI study include the small sample size and single-institutional design. Our future goals include incorporating a formal yearly curriculum assigning weekly protected time for feedback to ensure these results are sustainable and reproducible with incoming fellows. Disclosures No relevant conflicts of interest to declare.

Is it feasible to learn research skills in addition to audit skills through clinical audit? A mixed methods study in general practice

Background Involving medical students in research in their undergraduate careers may increase the likelihood that they will be research active after graduation. To date, there has been a paucity of published research of students doing research in general practice. Aim The study aims to evaluate the impact of general practice clinical audits on early-stage graduate entry students’ audit and research self-efficacy and explore feasibility issues from the student and GP perspective. Methods Two student questionnaires (pre- and post-intervention), a qualitative GP survey of the 25 participating GPs and semi-structured interviews of a purposeful sample of GPs were conducted. Results Participating students who completed the follow-up survey found that it had a positive educational impact (55%), increased their understanding of the audit cycle (72%) and real-world prescribing (77%). Research confidence wise, there was a statistically significant difference in the student group who completed the audit project compared to those students who did not in knowledge of the audit cycle and the difference between research and audit (p = 0.001) but not in other research skills. Ninety-six percent of responding GPs would be happy for students to do future audits in their practice but some feasibility issues similar to other research initiatives in general practice were identified. Conclusion We found this audit initiative feasible and useful in helping students learn about audit skills, patient safety and real-world prescribing. GPs and students would benefit more if it were linked to a substantial clinical placement, focussed on a topic of interest and given protected time. Separate research projects may be needed to develop research skills confidence.

Optimising undergraduate medico-legal and professionalism teaching through a student-selected component

PurposeWe sought to understand how best to teach medico-ethics, law and professionalism to undergraduate medical students using a student selected component.Materials and methodsStudents received small-group, seminar-based teaching from the module organiser and external representatives from organisations such as the General Medical Council and Medical Protection Society. Experiential learning was also facilitated through attendance at fitness to practice tribunals and Coroner’s court, followed by structured debrief sessions. Two cohorts of medical students(n=40) from Manchester University were surveyed before and after undergoing the placement, with qualitative interviews and thematic analysis for a subset of this group(n=16) and course leaders(n=4).ResultsThere were significant (p<0.05) improvements in students’ self-reported understanding of key medicolegal organisations and accessing guidance on professionalism. Thematic analysis uncovered increasing confidence in the role of the medicolegal system, barriers to challenging unprofessional behaviour, and a desire for this to be placed in the curricula.ConclusionsThis placement was well received and demonstrates an importance for this content to be taught effectively in the medical curricula. Having protected time to attend sessions while an undergraduate may reduce anxiety felt by doctors fearing medicolegal proceedings and help challenge unprofessional behaviours. Further work could explore mechanisms into how best to incorporate this into the medical curricula.

Self-reported positive impact of mentored clinical research training is associated with academic success in hematology

The American Society of Hematology Clinical Research Training Institute (CRTI) is a mentored training program for hematology fellows and junior faculty. Our objective was to determine whether the self-reported impact of CRTI on research retention, career development, and connectedness to hematology investigators was associated with academic success. A survey was distributed in January 2020 to alumni who participated in the program from 2003 to 2019. It focused on the impact of CRTI on retention in research, facilitation of career development, understanding of requirements to succeed, and feelings of connectedness to investigators. These questions were scored on a 5-point Likert scale ranging from strongly disagree to strongly agree. Outcomes were grants, publications, and invited lectures; these were abstracted from a submitted curriculum vitae. Of 334 eligible alumni, 321 responded (response rate of 96.1%). Of these, 250 (77.9%) agreed that CRTI was instrumental to research retention, 268 (83.5%) agreed that CRTI facilitated career development, 296 (92.2%) agreed that CRTI allowed a better understanding of requirements to succeed in research, and 289 (90.0%) agreed that CRTI increased connectedness to hematology investigators. Those who agreed with these CRTI impacts had significantly more first-author publications. Those who agreed that CRTI was instrumental to retention, facilitated career development, and increased connectedness had significantly more protected time for research. Self-reported perception that CRTI had an impact on research retention, career development, and connectedness to hematology investigators was significantly associated with more publications and percent effort in research. Clinical research training programs should identify and implement approaches to enhance these characteristics.

Joint Guidelines for Protected Nonclinical Time for Faculty in Family Medicine Residency Programs

Background and Objectives: Family medicine faculty face increasing expectations for clinical productivity. These expectations impinge on academic and education time and make it difficult to pursue research or scholarly activities. A task force convened by the Society of Teachers of Family Medicine created national guidelines to protect nonclinical time for family medicine faculty. Methods: The task force reviewed existing guidelines for protected time, as well as data on current and past distribution of time for faculty in academic medicine, including a specific look at family medicine. Based on the evidence and expert opinion from task force members and leaders of family medicine organizations, the task force developed eight consensus recommendations. Results: The guidelines include recommendations for allocation of protected time for program directors, associate program directors, and core faculty. These represent best practices to ensure programs have appropriate time to devote to the nonclinical duties of training and educating residents, while also promoting innovation in education, faculty well-being, and faculty retention. discussion: Faculty require nonclinical time for resident development, curriculum creation and maintenance, program assessment, and scholarship. Without these functions, programs can’t meet accreditation requirements or fulfill their responsibility to develop strong family physicians. Residency programs, sponsoring institutions, universities, health care systems, and accrediting bodies should use these recommendations to develop budgets that provide appropriate time allocation to enhance faculty wellness, reduce turnover, and meet organizational missions and objectives around education and providing care for communities.

Multi-source Qualitative Analysis of Emergency Medicine Residency Programmes in Chile: A Case Study

Background: Emergency Medicine (EM) is a developing specialty worldwide. In Chile, it has been developing for 25 years, however, there is a need for further progress. Aim: We aimed to explore the current postgraduate curriculum in Chile and identify ways to standardise and improve it.Methods: A qualitative case study approach was used to explore perspectives on EM curriculum development via interviewing residents, graduates and programme directors and documentary analysis of academic and governmental guidelines. Both data sets were evaluated through Thematic Analysis.Results: Four documents were analysed, and eight interviews conducted. Three main themes emerged from both data sets: curriculum structure, influence of context and expectations of an Emergency Physician. Additionally, interviews offered a fourth theme: perspectives of EM. They convey how current programmes focus on workplace learning and protected time for learning strategies, however, they differ in clinical exposure and quality of training. As a priority, collaboration was identified, emphasising a need for programmes to work together towards ensuring quality Conclusion: Overall, this study identifies similarities and differences among programmes, and common areas for improvement. There is agreement on the need for a standardized curriculum, considering local context and societal needs. This study assesses curriculum development, understanding cultural, social and educational influences.