Entrustable Professional Activities in Palliative Medicine: A Faculty and Learner Development Activity.

Background: Faculty development (FD) is critical to the implementation of competency-based medical education (CBME) and yet evidence to guide the design of FD activities is limited. Our aim with this study was to describe and evaluate an FD activity as part of CBME implementation. Methods: Palliative medicine faculty were introduced to entrustable professional activities (EPAs) and gained experience estimating a learner's level of readiness for entrustment by directly observing a simulated encounter. The variation that was found among assessments was discussed in facilitated debrief sessions. Attitudes and confidence levels were measured 1 week and 6 months following debriefs. Results: Participants were able to use the EPA framework when estimating the learner's readiness level for entrustment. Significant improvements in attitudes and level of confidence for several knowledge, skill, and behavior domains were maintained over time. Conclusions: Simulated direct observation and facilitated debriefs contributed to preparing both faculty and learners for CBME and EPA implementation.

What About Empathy? A Qualitative Study Exploring the Role of a Podcast as an Asynchronous Empathy Teaching Tool.

Purpose: Though medical education podcasts are fast gaining popularity, they are overwhelmingly focused on teaching the medical expert role of physicians. We explored how medical learners and educators engaged with and learned from an empathy and communication-focused podcast and sought their recommendations for integrating the podcast into medical curricula. Methods: Six virtual, semi-structured focus groups were conducted with educators and learners within a large urban hospital and university setting. Participants were asked to listen to pre-selected episodes of the About Empathy podcast in advance. Thematic analysis was used to explore experiences and perceptions of empathy teaching and learning. Results: There were 24 participants. We identified six themes related to the podcast and empathy learning: (1) forging connection through stories, (2) creating space to reflect on empathy, (3) shifting perspectives and biases, (4) feeling validated and enabling self-compassion, (5) gaining knowledge and building skills through empathetic communication, and (6) translating new knowledge and skills into practice. Participants highlighted that the podcast's portability and asynchronous nature allowed them to be more fully present, reflective, and intentional in their learning. Discussion: The About Empathy podcast was experienced as a flexible, just-in-time tool that promoted self-agency over one's learning, reflective practice, and knowledge and skill acquisition, particularly with respect to empathic communication. Benefits of asynchronous e-learning tools such as podcasts support a shift to a blended learning model. Challenges finding a curricular home for this empathy-focused podcast require further consideration.

When words are your scalpel, what and how information is exchanged may be differently salient to assessors.

PURPOSE: Variable assessments of learner performances can occur when different assessors determine different elements to be differently important or salient. How assessors determine the importance of performance elements has historically been thought to occur idiosyncratically and thus be amenable to assessor training interventions. More recently, a main source of variation found among assessors was two underlying factors that were differently emphasised: medical expertise and interpersonal skills. This gave legitimacy to the theory that different interpretations of the same performance may represent multiple truths. A faculty development activity introducing assessors to entrustable professional activities in which they estimated a learner's level of readiness for entrustment provided an opportunity to qualitatively explore assessor variation in the context of an interaction and in a setting in which interpersonal skills are highly valued. METHODS: Using a constructivist grounded theory approach, we explored variation in assessment processes among a group of palliative medicine assessors who completed a simulated direct observation and assessment of the same learner interaction. RESULTS: Despite identifying similar learner strengths and areas for improvement, the estimated level of readiness for entrustment varied substantially among assessors. Those who estimated the learner as not yet ready for entrustment seemed to prioritise what information was exchanged and viewed missed information as performance gaps. Those who estimated the learner as ready for entrustment seemed to prioritise how information was exchanged and viewed the same missed information as personal style differences or appropriate clinical judgement. When presented with a summary, assessors expressed surprise and concern about the variation. CONCLUSION: A main source of variation among our assessors was the differential salience of performance elements that align with medical expertise and interpersonal skills. These data support the theory that when assessing an interaction, differential salience for these two factors may be an important and perhaps inevitable source of assessor variation.

Use of wearable point-of-view live streaming technology for virtual physical exam skills training.

We piloted a virtual teaching tool comprised of a chest-mounted smartphone streaming point-of-view footage over videoconferencing software to deliver a physical exam skills session. Compared to medical students taught via third person view through pre-recorded video followed by preceptor-led discussion, a higher proportion of students taught via point-of-view wearable technology reported improved knowledge of demonstrated skills and feeling engaged, comfortable interacting with their tutor, and better able to visualize demonstrated exam maneuvers. This accessible, affordable, and easily replicable innovation can potentially enhance virtual clinical skills teaching and enable novel distant clinical learning opportunities for healthcare professions students and educators.

Nous avons mis à l'essai un outil d'enseignement virtuel, notamment pour les cours de techniques d'examen physique, qui consiste dans le fait de porter un téléphone intelligent fixé sur la poitrine pour diffuser en direct, par le biais d'un logiciel de vidéoconférence, pour réaliser un examen physique plutôt que subjectif. Comparativement aux étudiants en médecine qui pour le cours ont visionné une vidéo préenregistrée prise par caméra objective, suivie d'une discussion dirigée par un précepteur, un plus grand nombre d'étudiants ayant suivi le cours par le biais d'une technologie portable avec par le biais d'un dispositif technologique portable déclarent avoir amélioré leurs connaissances sur les techniques présentées, se sentir engagés et à l'aise pour interagir avec l'enseignant, et avoir été en mesure de bien voir les gestes d'examen montrés. Cette innovation accessible, abordable et facilement reproductible pourrait permettre d'améliorer l'enseignement virtuel des habiletés cliniques et d'offrir de nouvelles possibilités d'enseignement.

Collective Wisdom in Faculty Development for Competency-Based Medical Education: A Needs Assessment and Survey.

This article was migrated. The article was marked as recommended. Background: As programs transition to competency-based medical education (CBME), faculty development (FD) will be a key component of supporting successful implementation. Methods: Faculty at the University of Toronto (UofT) with leadership roles in residency education were invited to complete an online survey to explore their experiences with FD for CBME. Descriptive statistics were collected. Results were analyzed using thematic, frequency and comparative analyses between respondent subgroups to identify trends and theme categories relevant to the perceived most effective FD activities, most helpful FD topics as well as program/department needs for future FD initiatives. Results: The overall survey response rate was 44.6%. The most effective FD activity identified by survey respondents was a small group format. Perceived top FD topics included implementing CBME, assessment tools, feedback and coaching along with competence committees. The majority of programs felt that the ideal timing for CBME implementation was 6-12 months prior to implementation. The main perceived barrier to FD was lack of time amongst faculty. Conclusions: This data helped drive FD at UofT by supporting strategic planning for implementing competency based curricular reforms. The results have also informed the need for additional resources and enable focused FD on barriers and needs.

Taking stock of what is known about faculty development in competency-based medical education: A scoping review paper.

Purpose: The primary objective was to inventory what is currently known about faculty development (FD) for competency-based medical educations (CBME) and identify gaps in the literature.Methods: A scoping review methodology was employed. Inclusion criteria for article selection were established with two reviewers completing a full-text analysis. Quality checks were included, along with iterative consultation on data collection and consensus decision making via a grounded theory approach.Results: The review identified 19 articles published between 2009 and 2018. Most articles (N = 15) offered suggestions as to what should happen with FD in CBME, but few (N = 4) adopted an experimental design. Six main themes were identified with three main features of FD noted across themes: (1) The importance of direct and timely feedback to faculty members on their teaching and assessment skills. (2) The role of establishing shared mental models for CBME curricula. (3) That FD is thought of longitudinally, not as a one-time bolus.Conclusion: This work illustrates that there is limited, high quality research in FD for CBME. Future FD activities should consider employing a longitudinal and multi-modal program format that includes feedback for the faculty participants on their teaching and assessments skills, including the development of faculty coaching skills.

A Public Health Approach to Palliative Care in the Canadian Context.

Palliative care helps improve the quality of life of individuals facing life-limiting illness throughout the course of their disease. In Canada, delivery and access to palliative care has been fraught with challenges including differential availability of services based on geography, funding, language, and socioeconomic status. Many groups, including the World Health Organization, have advocated for a public health approach to palliative care as an antidote to fragmented service delivery. Multiple scholars, academics, and public health advocates have suggested that a public health approach to palliative care can help with issues of access, equity, and cost. Through the lens of Kingdon's Multiple Streams Framework, this commentary will explore potential reasons why a public health approach to palliative care has not been adopted in the Canadian context and why this is an opportune time to consider this policy innovation. The Compassionate Communities concept is discussed as a potential solution to a public health approach to palliative care delivery.