Specialty-Specific Entrustable Professional Activities: A Bridge to Internship.

Background Undergraduate medical education aims to prepare learners to become capable residents. New interns are expected to perform clinical tasks with distant supervision reliant on having acquired a medical degree. However, there is limited data to discuss what entrustment residency programs grant versus what the medical schools believe they have trained their graduates to perform. At our institution, we sought to foster an alliance between undergraduate medical education (UME) and graduate medical education (GME) toward specialty-specific entrustable professional activities (SSEPAs). These SSEPAs create a bridge to residency and help students structure the final year of medical school while striving for entrustability for day one of residency. This paper describes the SSEPA curriculum development process and student self-assessment of competence. Methodology We piloted an SSEPA program with the departments of Family Medicine, Internal Medicine, Neurology, and Obstetrics & Gynecology. Utilizing Kern's curriculum development framework, each specialty designed a longitudinal curriculum with a post-match capstone course. Students participated in pre-course and post-course self-assessments utilizing the Chen scale for each entrustable professional activity (EPA). Results A total of 42 students successfully completed the SSEPA curriculum in these four specialties. Students' self-assessed competence levels rose from 2.61 to 3.65 in Internal Medicine; 3.23 to 4.12 in Obstetrics and Gynecology; 3.62 to 4.13 in Neurology; and 3.65 to 3.79 in Family Medicine. Students across all specialties noted an increase in confidence from 3.45 to 4.38 in Internal Medicine; 3.3 to 4.6 in Obstetrics and Gynecology; 3.25 to 4.25 in Neurology; and 4.33 to 4.67 in Family Medicine. Conclusions A specialty-specific curriculum utilizing a competency-based framework for learners traversing the UME to GME journey in the final year of medical school improves learner confidence in their clinical abilities and may lead to an improved educational handoff between UME and GME.

Perceived Barriers to Gynecologic Care by Women Who Use Wheelchairs.

Objective The aim of this study was to evaluate the current barriers associated with gynecologic care as perceived by women who use wheelchairs. Methods This qualitative study evaluated the barriers to gynecologic healthcare as described by female wheelchair users. We recruited English-speaking female participants aged 18 years and older who primarily used a wheelchair for mobility through flyer and email distribution. Interviews were conducted by three investigators using a semi-structured interview guide and recorded for transcription. Two investigators reviewed all transcriptions for accuracy which were then coded to identify emergent themes. Results The thematic saturation was achieved with 16 interviews. The most common barrier cited was transferring to the exam table (n=16). Women reported that their providers lacked knowledge and experience with women who use wheelchairs (n= 11). Conclusion There are many barriers to gynecologic care for women who use wheelchairs. Interventions are needed to improve accessibility to care for women who use wheelchairs.

Everyday Resilience: Equipping Faculty With Practical Exercises to Promote Resilience Among Medical Students.

Introduction: Burnout is prevalent in health care. As professionals advocate to increase resilience training as a strategy to reduce burnout, few examples exist of practical resilience programs that equip faculty to help students build and sustain well-being over time. Method: We developed two straightforward, skills-based resilience exercises. Breaking Down Easy taught individuals to identify personal strengths. My Resilience Practice helped individuals identify strategies to cope with daily stressors. We taught these exercises to international faculty in a train-the-trainer workshop format, at two medical education conferences. Faculty applied the exercises, performed pair-share reflections, and discussed opportunities to introduce the exercises in their own institutions. Postsession surveys evaluated the workshop quality and the exercises' ease of use and applicability. Results: Thirty-five faculty and five students participated across two international conferences. Of participants, 83% (33 of 40) completed postsession surveys. On a 5-point Likert scale, participants rated the workshop on average 4.4 for usefulness, 4.6 for applicability, 4.4 for ease of instruction, 4.5 for clarity, and 4.8 for overall quality. Participants found the exercises to be straightforward to use and planned to use them at their institutions with students, residents, and faculty. Discussion: Participants found our workshop to be relevant and effective and shared their intention to incorporate these materials into their teaching with medical students, residents, and faculty. Implementing effective programs to build resilience is critical to increasing well-being and reducing burnout. This, in turn, may enhance patient safety and improve health system outcomes.

A Consensus Guideline to Support Resident-as-Teacher Programs and Enhance the Culture of Teaching and Learning.

BACKGROUND: Methods for assessing residents as teachers are limited, and it can be difficult to discern optimal curricula for training residents as educators. A guideline may be a tool to assess resident-as-teacher programs and to help enhance a culture of teaching and learning. OBJECTIVE: We developed a consensus guideline to assess academic medical centers' resident-as-teacher programs and teaching environments. METHODS: Faculty representing 8 specialties from 5 teaching hospitals created a guideline for resident-as-teacher programs through an iterative expert consensus development process. To assess local resident-as-teacher practices, the guideline was administered as an online survey to program directors from 47 residency programs at 5 hospitals. The survey included 26 items addressing curricula, educational climate, financial support, assessment, professional development, and promotion. RESULTS: Forty-nine percent of residency programs surveyed completed the questionnaire, representing 65% of specialties (17 of 26). Respondents reported that residents were required to participate in a teaching orientation in 78% of programs (18 of 23) and were evaluated on teaching in 91% (21 of 23). There were special educational programs and teaching awards in 91% of programs (21 of 23), respectively. All programs included evaluations of faculty teaching, which were linked to faculty annual reviews in 52% of programs (12 of 23), but to faculty promotion or salary in only 22% of programs (5 of 23). CONCLUSIONS: We developed a resident-as-teacher consensus guideline that could provide a road map for program directors and institutions to think broadly about how they educate residents and fellows as teachers.

Effects of a Short Video-Based Resident-as-Teacher Training Toolkit on Resident Teaching.

OBJECTIVE: To pilot a short video-based resident-as-teacher training toolkit and assess its effect on resident teaching skills in clinical settings. METHODS: A video-based resident-as-teacher training toolkit was previously developed by educational experts at Beth Israel Deaconess Medical Center, Harvard Medical School. Residents were recruited from two academic hospitals, watched two videos from the toolkit ("Clinical Teaching Skills" and "Effective Clinical Supervision"), and completed an accompanying self-study guide. A novel assessment instrument for evaluating the effect of the toolkit on teaching was created through a modified Delphi process. Before and after the intervention, residents were observed leading a clinical teaching encounter and scored using the 15-item assessment instrument. The primary outcome of interest was the change in number of skills exhibited, which was assessed using the Wilcoxon signed-rank test. RESULTS: Twenty-eight residents from two academic hospitals were enrolled, and 20 (71%) completed all phases of the study. More than one third of residents who volunteered to participate reported no prior formal teacher training. After completing two training modules, residents demonstrated a significant increase in the median number of teaching skills exhibited in a clinical teaching encounter, from 7.5 (interquartile range 6.5-9.5) to 10.0 (interquartile range 9.0-11.5; P<.001). Of the 15 teaching skills assessed, there were significant improvements in asking for the learner's perspective (P=.01), providing feedback (P=.005), and encouraging questions (P=.046). CONCLUSION: Using a resident-as-teacher video-based toolkit was associated with improvements in teaching skills in residents from multiple specialties.

Surgery residency training programmes have greater impact on outcomes after pancreaticoduodenectomy than hospital volume or surgeon frequency.

BACKGROUND: Hospital volume of pancreaticoduodenectomy (PD) and surgeon frequency of PD have been shown to impact outcomes. The impact of surgery residency training programmes after PD is unknown. This study was undertaken to determine the impact of surgery training programmes on outcomes after PD, as well as their importance relative to hospital volume and surgeon frequency of PD. METHODS: The State of Florida Agency for Healthcare Administration Database was queried for patients undergoing PD during 2002-2007. Measures of outcome were compared for patients undergoing PD at centres with vs. without surgery residency training programmes. RESULTS: A total of 2345 PDs were identified, of which 1478 (63%) were undertaken at training centres and 867 (37%) were performed at non-training centres. Patients undergoing PD at training centres had shorter lengths of stay, lower hospital charges and lower in-hospital mortality. Relative to surgeon frequency of PD, training centres had a greater favourable impact on hospital length of stay, hospital charges and in-hospital mortality (P < 0.001 for each, ancova). Relative to hospital volume of PDs undertaken, training centres had a greater impact on hospital charges (P < 0.001, ancova). CONCLUSIONS: Surgery residency training programmes have a favourable effect on outcomes following PD and their impact on outcome is greater than the impact of hospital volume or surgeon frequency of PD.