Principios curriculares de un programa de residentes como docentes

Antecedentes. Parte de la enseñanza-aprendizaje en las residencias médicas se genera con los compañeros de residencia; los programas de residentes como docentes (PRCD) fortalecen esta práctica pedagógica. Objetivos. Analizar los principios curriculares de un PRCD siguiendo la postura de Tyler e identificar las estrategias educativas que cambian el comportamiento en el aprendizaje del residente y en la organización educativa según el modelo de Kirkpatrick. Métodos. Se realizó una revisión de revisiones sistemáticas en MEDLINE, EMBASE, ERIC, EPISTEMONIKOS, The Cochrane Database of Systematic Reviews y LILACS. La calidad global fue evaluada usando la herramienta AMSTAR. Por medio de la literatura publicada, se respondió a la postura curricular de Tyler al describir las estrategias educativas, su evaluación e impacto de la evaluación según Kirkpatrick. Resultados. Se incluyeron siete revisiones sistemáticas; una de ellas obtuvo alta calidad metodológica. Según la literatura, un PRCD requiere una valoración continua de sus participantes. Las estrategias educativas más usadas fueron el taller y el seminario. Los temas que pueden incluirse en el PRCD son liderazgo, habilidades de enseñanza al lado del paciente, evaluación y retroalimentación. En la práctica, actividades pedagógicas similares a One-minute preceptor pueden ser fomentadas. El seguimiento de los PRCD requiere de la observación directa por medio de los OSTE (ejercicios de enseñanza estructurados y objetivos). Conclusiones. El PRCD tiene como finalidad la generación de momentos de enseñanza que alimenten la reflexión de la práctica pedagógica. El PRCD debe contar con estrategias educativas que aumenten la confianza en la enseñanza, habilidades pedagógicas y evaluaciones válidas de la práctica docente. Background. Part of the teaching-learning in medical residences is generated with the residence partners; Programs of resident- as-teachers (PRAT) strengthen this pedagogical practice. Objectives. To analyze curricular principles of a PRAT according to Tyler's posture and to identify educational strategies that change behavior in resident learning and educational organization according to Kirkpatrick model. Methods. A review of systematic reviews was conducted in MEDLINE, EMBASE, ERIC, EPISTEMONIKOS, The Cochrane Database of Systematic Reviews and LILACS. The overall quality was evaluated using the AMSTAR tool. Through the published literature, Tyler's curriculum posture was answered by describing educational strategies, their evaluation and impact of evaluation according to Kirkpatrick. Results. Seven systematic reviews were included; one of them obtained high methodological quality. According to the literature, a PRAT requires continuous evaluation of its participants. The most used educational strategies were the workshop and the seminar. Topics that can be included in PRAT are leadership, bedside teaching skills, evaluation, and feedback. In practice, pedagogical activities similar to One-minute preceptor can be encouraged. The monitoring of the PRCD requires direct observation through OSTE (Objective Structured Teaching Exercises). Conclusions. The PRAT aims to generate teaching moments that feed the reflection of pedagogical practice. The PRAT must have educational strategies that increase confidence in teaching, pedagogical skills, and valid assessments of teaching practice.

86 Virtual MacPeds: Leveling up to the new virtual reality of medical education

Primary Subject area Medical Education Background The COVID-19 pandemic and physical distancing measures limited in-person learning experiences for resident postgraduate learners through mandated social distancing measures. Our training program responded by creating online synchronous and asynchronous learning opportunities to supplement learning and replace lost experiences. Virtual MacPeds is an online curriculum created using Kern’s six-step approach to curriculum development to supplement resident learning during COVID-19. The curriculum included online lectures, a live teaching calendar that includes links to sessions across rotations and subspecialties, and a resource rolodex with links to online learning materials. Objectives The purpose of this study is to evaluate the components of the Virtual MacPeds curriculum that were most useful to residents. Design/Methods Virtual MacPeds was piloted from March 2020 to June 2020 to 51 core pediatric residents in PGY1-4. The Kirkpatrick Model for learning evaluation was used to assess resident reaction to the implementation of the curriculum. A voluntary online survey was emailed to residents with the opportunity to respond from June to July 2020. Descriptive statistics were used to assess learner engagement and perception of the curriculum. Results Resident response rate was 38.2% (n=20, PGY1 =8, PGY2 =6, PGY3=5, PGY4=1). 95% of respondents had reduced in-person teaching sessions during COVID-19 and 80% had impacted clinical rotations (self-isolation, virtual care, patient volumes). Prior to Virtual MacPeds, 65% used online educational resources. 95% used the curriculum, all of whom found it helpful in fulfilling Royal College learning objectives. 85% of participants attended the online lectures - those who did not attend noted schedule conflict. 100% would use Virtual MacPeds in the future. Participants noted that Virtual MacPeds should include a live teaching schedule (100%), online lectures (84.2%), self-study modules (73.7%), resource rolodex (52.6%) with suggestions for recorded lectures (89.5%) and simulations (57.9%). Conclusion Virtual MacPeds is an acceptable and useful supplement to resident learning during COVID-19. Useful elements of the curriculum include online lectures, a live teaching schedule, resource rolodex and self-study modules.

Preparing for the PICU: A Qualitative Study of Residents as They Prepare for Their First Pediatric Critical Care Rotation

Learning critical care medicine in the pediatric intensive care unit (PICU) can be stressful. Through semistructured interviews (n = 16), this study explored the emotions, perceptions, and motivations of pediatric medicine (PM) and emergency medicine (EM) residents, as they prepared for their first PICU rotation. Qualitative data were collected and analyzed using the grounded theory method. Three resultant themes emerged: (1) residents entered the PICU with a range of intense emotions and heightened expectations; (2) they experienced prior history of psychologically traumatic learning events (adverse learning experiences or ALEs); and (3) informed by ALEs, residents prepared for their rotation by focusing heavily on their most basic level of physiological needs and adopting a survival mindset prior to the start of the rotation. These three themes led to a substantive, or working, theory that ALE-associated events may affect how residents approach upcoming learning opportunities. Consequently, adapting a trauma-informed approach as a component of medical education may improve resident learning experiences in the PICU and beyond.

PICU Passport: Pilot study of a handheld resident curriculum

Background To explore the impact of an educational tool designed to streamline resident learning during their pediatric intensive care (PICU) rotations. Methods Topics and procedures were chosen for inclusion based on national requirements for pediatric residents. Residents received a PICU Passport at the beginning of their rotations. PICU faculty were provided learning objectives for each topic. Residents and faculty were surveyed before and after starting use of the Passport. Results Twenty-two residents pre-Passport and 38 residents post-Passport were compared. Residents were more satisfied with their educational experiences (27 % vs. 79 %; P < 0.001), more likely to report faculty targeted teaching towards knowledge gaps (5 % vs. 63 %; P < 0.001) and felt more empowered to ask faculty to discuss specific topics (27 % vs. 76 %; P = 0.002). The median number of teaching sessions increased from 3 to 10 (Z = 4.2; P < 0.001). Most residents (73 %) felt the Passport helped them keep track of their learning and identify gaps in their knowledge. Conclusions The PICU Passport helps residents keep track of their learning and identify gaps in their knowledge. Passport use increases resident satisfaction with education during their PICU rotation and empowers residents to ask PICU faculty to address specific knowledge gaps.

A Family Systems Curriculum: Evaluating Skills and Empathy

Background and Objectives: Training residents in family-centered approaches offers an opportunity to investigate how learners translate skills to real clinical encounters. Previous evaluations of a family systems curriculum have relied on self-assessment and narrative reflection to assess resident learning. Assessment of learning using encounter observation and objective tools, including evaluation of empathy, allows for a deeper understanding of how residents transform curricular education into clinical practice. Methods: We evaluated resident learning from a longitudinal family systems curriculum delivered during the third year of a four-year residency training program. Using the Family-Centered Observation Form (FCOF), we analyzed seven pre- and postcurriculum videotaped encounters for changes in family-centered interviewing skills. We assessed changes in empathy before and after the curriculum using the Jefferson Empathy Scale. Results: There was a trend toward improvement in all family-centered skills, as measured by the FCOF, though the improvements were only statistically significant in the area of rapport building. Statistically significant improvement in empathy occurred for all participants. Narrative reflection demonstrated that residents found the curriculum valuable in ways that we were unable to objectively measure. Conclusions: Training in family systems can enhance patient interactions and may improve empathy. Evaluation of family-centered skills is challenging and takes a significant amount of time and planning. The FCOF can help learners identify how to use family-centered concepts and skills in a typical family medicine outpatient visit. Further study is needed to determine whether patients seen by doctors who use family-oriented skills have better experiences or outcomes.

El uso del portafolio electrónico en evaluación educativa en Medicina.

La educación médica se encuentra en una profunda transformación, que exigirá a los docentes reconsiderar las prácticas habituales de enseñanza y desarrollar estrategias innovadoras para optimizar el aprendizaje de los estudiantes y residentes. Se ha llevado a cabo una búsqueda bibliográfica en las bases de datos PubMed y ERIC, entre los años 2000-2019. Ningún instrumento individual de evaluación educativa provee todos los elementos que se requieren para evaluar a un individuo, necesitándose analizar suficientes tareas y que sean representativas de los diferentes aspectos que comprenden el aprendizaje. El uso del portafolio electrónico ayuda a recoger la evidencia del progreso del aprendizaje del alumno con un propósito determinado, brindando al profesor las herramientas necesarias para una evaluación más amplia y variada. Para su uso se requiere tener en cuenta aspectos inherentes al profesor, estudiante y a su entorno para lograr los objetivos de las intervenciones educativas. Medical education is undergoing a profound transformation, which will require teachers to reconsider current teaching practices and develop innovative strategies to optimize student and resident learning. No single educational assessment instrument provides all the elements required to evaluate an individual; sufficient tasks representative of the different aspects that comprise learning need to be analyzed. The use of the e-portfolio helps to collect evidence of student learning progress for a given purpose, providing the teacher with the necessary tools for a broader and more varied assessment. Its use requires taking into account aspects inherent to the teacher, student and their environment in order to achieve the objectives of educational interventions.

COVID-19 and Canadian Gastroenterology Trainees

Background The coronavirus disease 2019 (COVID-19) pandemic has impacted endoscopy services and education worldwide. This study aimed to characterize the impact of COVID-19 on gastroenterology trainees in Canada. Methods An analysis of Canadian respondents from the international EndoTrain survey, open from April 11 to May 2 2020 and distributed by program directors, trainees, and national and international gastroenterology societies’ representatives, was completed. The survey included questions on monthly endoscopy volume, personal protective equipment availability, trainee well-being and educational resources. The primary outcome was change in procedural volume during the COVID-19 pandemic. Secondary outcomes included trainee’s professional and personal concerns, anxiety and burnout. Results Thirty-four Canadian trainees completed the survey. Per month, participants completed a median of 30 esophagogastroduodenoscopies (interquartile range 16 to 50) prior to the pandemic compared to 2 (0 to 10) during the pandemic, 20 (8 to 30) compared to 2 (0 to 5) colonoscopies and 3 (1 to 10) compared to 0 (0 to 3) upper gastrointestinal bleeding procedures. There was a significant decrease in procedural volumes between the pre-COVID-19 and COVID-19 time periods for all procedures (P &lt; 0.001). Thirty (88%) trainees were concerned about personal COVID-19 exposure, 32 (94%) were concerned about achieving and/or maintaining clinical competence and 24 (71%) were concerned about prolongation of training time due to the pandemic. Twenty-six (79%) respondents experienced some degree of anxiety, and 10 (31%) experienced some degree of burnout. Conclusion The COVID-19 pandemic has substantially impacted gastroenterology trainees in Canada. As the pandemic eases, it important for gastrointestinal programs to adapt to maximize resident learning, maintain effective clinical care and ensure development of endoscopic competence.