"It Changed How I Think"-Impact of Programmatic Assessment Upon Practicing Physicians: A Qualitative Study.

Programmatic assessment is a systematic approach used to document and assess learner performance. It offers learners frequent formative feedback from a variety of contexts and uses both high- and low-stakes assessments to determine student progress. Existing research has explored learner and faculty perceptions of programmatic assessment, reporting favorable impact on faculty understanding of the importance of assessment stakes and feedback to learners while students report the ability to establish and navigate towards goals and reflect on their performance. The Cleveland Clinic Lerner College of Medicine (CCLCM) of Case Western Reserve University adopted programmatic assessment methods at its inception. With more than 18 years' experience with programmatic assessment and a portfolio-based assessment system, CCLCM is well-positioned to explore its graduates' perceptions of their programmatic assessment experiences during and after medical school. In 2020, the investigators interviewed 26 of the 339 physician graduates. Participants were purposefully sampled to represent multiple class cohorts (2009-2019), clinical specialties, and practice locations. The investigators analyzed interview transcripts using thematic analysis informed by the frameworks of self-determination theory and professional identity formation. The authors identified themes and support each with participant quotes from the interviews. Based on findings, the investigators compiled a series of recommendations for other institutions who have already or plan to incorporate elements of programmatic assessment into their curricula. The authors concluded by discussing future directions for research and additional avenues of inquiry.

"What do you think about nephrology?" A national survey of internal medicine residents.

BACKGROUND: Interest in nephrology has been declining among internal medicine residents but the reasons behind this observation are not well characterized. Our objective was to evaluate factors influencing residents' choice of subspecialty. METHODS: This is a mixed-method QUAL-QUAN design study that used the results of our previously published qualitative analysis on residents' perception of nephrology to create and pilot a questionnaire of 60 questions. The final questionnaire was distributed to 26 programs across the United States and a total of 1992 residents. We calculated response rates and tabulated participant characteristics and percentage of participant responses. We categorized choice of fellowship into 2 medical categories (Highly Sought After vs. Less Sought After) and fitted a logistic regression model of choosing a highly vs. less sought after fellowship. RESULTS: Four hundred fifteen out of 1992 (21%) US residents responded to the survey. Of the 268 residents planning to pursue fellowship training, 67 (25%) selected a less sought after fellowship. Female sex was associated with significantly higher odds of selecting a less sought after fellowship (OR = 2.64, 95% CI: 1.47, 4.74). Major factors deterring residents from pursuing nephrology were perception of inadequate financial compensation, broad scope of clinical practice and complexity of patient population. We observed a decline in exposure to nephrology during the clinical years of medical school with only 35.4% of respondents rotating in nephrology versus 76.8% in residency. The quality of nephrology education was rated less positively during clinical medical school years (median of 50 on a 0-100 point scale) compared to the pre-clinical years (median 60) and residency (median 75). CONCLUSION: Our study attempts to explain the declining interest in nephrology. Results suggest potential targets for improvement: diversified trainee exposure, sub-specialization of nephrology, and increased involvement of nephrologists in the education of trainees.

Best Practices for Building and Supporting Effective ACGME-Mandated Program Evaluation Committees.

Introduction: The Accreditation Council for Graduate Medical Education (ACGME) mandates that residency training programs form program evaluation committees (PECs) to monitor program delivery and outcomes, generate annual program evaluations (APEs), facilitate strategic planning, and implement continuous quality improvement projects. Though PECs provide essential documentation to position programs for successful accreditation decisions, few resources exist in the literature for PEC members. Methods: Employing Kern's model for curriculum development, we conducted a needs assessment in 2016 that resulted in adding a 2-hour workshop on building and supporting effective PECs to a certificate program for residency program directors. The workshop used a flipped classroom model with prework readings and guiding questions to familiarize participants with ACGME requirements for PECs and APEs. Several activities helped participants identify best practices for PECs and discuss authentic examples of mission statements, APEs, and action plans. Results: From 2017 to 2019, we offered this workshop on three different occasions to a total of 42 participants (34 residency program directors/associate program directors and eight program coordinators). In 2019, 14 participants completed a web-based evaluation after the session. All agreed or strongly agreed that the workshop met the learning objectives, utilized interactive teaching methods, included useful APE examples, and provided valuable resources. Discussion: This workshop addresses a gap in the literature by helping program directors identify best practices for PECs. The APE template and workshop examples can be adjusted to fit the needs of individual institutions.