Milestones as a Faculty Development Tool for Career Academic Physicians.

BACKGROUND AND OBJECTIVES: The Accreditation Council for Graduate Medical Education (ACGME) has implemented milestones for progression of residents. Career academic physicians would benefit from similar concrete guidance for scholarly activity and faculty development. After developing milestones across six recognized competencies among our family medicine academicians, we acknowledged the potential benefit of expanding the development of milestones throughout the academic medical center. METHODS: Milestones that we previously developed were modified by departmental leaders within our institution reflecting levels of career development based on benchmarks in each field. These objective measures for guiding maturation of clinical and academic skill sets were then circulated to clinicians in five residency programs throughout our academic medical center for self-evaluation. We analyzed the completed surveys to determine if an association exists between years in academics and rank across each area of competency. RESULTS: We received fifty-three responses from the 91 faculty invited. We noted a significant association in the competency of medical knowledge with progression from assistant to full professor, and we noted a trend toward significance in professionalism and progression from assistant to full professor. These objective measures of clinician development and competency suggest association with levels of academic career development by rank within the institution. CONCLUSIONS: This rubric can be helpful for directing faculty development and faculty mentorship. These milestones are general enough that other physician specialties may be able to adopt them for their own needs.

Milestones as a Guide for Academic Career Development.

BACKGROUND AND OBJECTIVES: Faced with a limited supply of applicants for faculty positions, increasing demands for residency faculty, and a growing number of programs, our program has increasingly filled ranks with recent residency graduates with broad scope but limited experience and training in academics. These early-career clinicians often require further mentorship as they seek advancement in clinical skills and development of teaching and scholarly activity skill sets. METHODS: To educate our recent residency graduates in teaching/scholarly activity skills, and to provide a career trajectory, we created a process to guide their maturation with milestones using the six core competencies from the Accreditation Council for Graduate Medical Education. The milestones consist of four levels of clinician/academician maturation. Each competence has goals and activities for each level of development. We validated the milestones using our physician faculty assessing time spent in academic medicine and academic rank. RESULTS: Faculty of higher academic rank scored higher in all competencies than faculty of lower academic rank. Correlation between systems-based practice and years in academics demonstrated statistical significance, and all other categories showed nonsignificant associations. CONCLUSIONS: The milestones are consistent with faculty academic development and career progression, and may serve as a guide for career advancement and as a guideline for professional progression for residency clinicians. Further testing for validation in other family medicine programs is necessary, but preliminary findings indicate this milestone project may be of service to our profession.

Residency program solutions: making a difference in quality residency education.

BACKGROUND: Residency Program Solutions (RPS) consultants assist family medicine residency programs in solving issues perceived as limiting quality resident education. Residencies ask RPS to assist in preparing for accreditation site visits by the Residency Review Committee-Family Medicine (RC-FM). The RPS Criteria for Excellence in Family Medicine Education (RPS Criteria) may have influenced the accreditation standards of the RC-FM. RPS consultations also may affect accreditation visit cycle length and number of RC-FM citations. METHODS: The authors reviewed the RC-FM Program Requirements for Family Medicine Residency Education and the RPS Criteria from 1978 to 2007, comparing statements between the two documents for "nearly verbatim" and equivalent "must" or "should" requirements. The average number of citations and cycle length for programs seeking a Comprehensive Accreditation Program (CAP) Consultation from 2004--2010 were compared to cohort programs evaluated at the same RC-FM meeting using an independent samples t test. RESULTS: The strongest relationship between the RC-FM requirements and the RPS criteria occurred in 1983--1984. Nine "nearly verbatim" statements, 15 "must-should" or "must-must" statements, and 11 "should-should" statements existed. Over time, additional concurrences between organizational statements occurred. Residency programs with CAP consultations benefited significantly by both a decrease in number of citations and an increase in the length of accreditation cycle. CONCLUSIONS: The RPS Criteria have positively impacted iterations of RC-FM requirements. Family medicine residency programs concerned about successful accreditation by the RC-FM will likely benefit from RPS CAP consultations by increased length of accreditation cycle and/or a decreased number of citations.

Suitability and readability of consumer medical information accompanying prescription medication samples.

OBJECTIVE: To examine readability and formatting characteristics of consumer medication information (CMI) accompanying prescription medication samples. METHODS: We collected the most commonly used prescription medication samples (n=100) from four out-patient clinics at a large teaching hospital in the Southeastern US. Seventeen percent of samples were not pills/tablets and of such diverse nature (e.g., injections, drops, and creams) that there were not enough in any category to draw conclusions. Therefore, our analyses were limited to 83pill/tablet samples, belonging to 11 drug classes (e.g., cardiovascular, and psychiatric). We noted if CMI was present, and if so we assessed it for how instructions were presented, reading level, text size, format/layout, and comprehensibility. RESULTS: No CMI was present in 39 (46.9%) samples. In 19 (22.9%), CMI was contained in a package insert and in 25 (30.2%) it was printed on the medication package. Average reading difficulty of CMI was at the 10th grade level (range=6-15) using the Fry formula, and text point size was small (mean 9.9+/-2.2 on package inserts and 9.4+/-2.6 when printed on packages). CONCLUSIONS: Almost half of samples did not include any type of CMI. For those that had CMI, it was often written at a reading difficulty level higher than the average reading skills of American adults, and the format of most CMI was not optimal for comprehensibility. It is likely that many patients do not understand the instructions accompanying medication samples they receive from clinicians. PRACTICE IMPLICATIONS: Clinicians should be cognizant of the shortcomings of CMI accompanying medication samples and thereby, distribute them to patients with caution. Manufacturers too should consider revising CMI to comply with low-literacy guidelines.

Development and content validation of family practice residency recruitment questionnaires.

BACKGROUND AND OBJECTIVES: The residency recruitment process involves a substantial time and financial commitment on the part of medical students and residency programs. This paper describes the development and content validation process of two written questionnaires designed to assess the application and interview process at our family practice residency program. METHODS: Two written questionnaires were developed after completion of a literature review and from areas deemed important by our academic faculty. Drafts of each questionnaire were sent to nine jurors to assess content validity. Content reviewers provided both a qualitative and a quantitative assessment of each questionnaire. RESULTS: The inclusion of both open- and closed-ended questions/items was deemed necessary and appropriate by the panel of content jurors. Assessing faculty, residents, curriculum, program's reputation, geographic location, and spouse/family influence were considered the most important factors to include on the questionnaires when assessing a family practice residency program. CONCLUSIONS: With increasing pressure to fill positions across many family practice residency programs, it is important for faculty involved in the recruitment process to recognize that both factors within and out of their control contribute to the selection process.