Is feedback to medical learners associated with characteristics of improved patient care?

Our Research Question: What is the association of medical learner feedback with characteristics of improved patient care

Using Design Thinking to Spread iPACE™: An Interprofessional Medical Education Innovation in an Academic Medical Center

Problem Statement: The Interprofessional Partnership to Advance Care and Education (iPACE™) model and its core principles are spreading across the MaineHealth system. Thus, there is a need for a standardized approach that is adaptable and incorporates the requirements of diverse patient care settings. Background: In 2017, the original iPACE™ model was designed and piloted on a new teaching unit for adult internal medicine at Maine Medical Center. Analysis of the pilot data showed improved teaming, care team experiences, interprofessional collaborations, and patient satisfaction. Because the pilot model will require adaptation to be successfully implemented in other disciplines, the authors sought a framework to facilitate implementation of core iPACE™ principles in diverse clinical care settings. Application/Recommendation: The Design Thinking (DT) framework was selected as a structured, standardized approach to accelerate innovation and implementation of the iPACE™ model in a new patient care setting. The DT framework consists of 6 consecutive process steps and iteration loops: Understand, Observe, Point of View, Ideate, Prototype, and Test. This paper outlines specific metrics and activities in each step, as well as opportunities for tailoring each step based on the care setting

Organizing graduate medical education programs into communities of practice.

BACKGROUND: A new organizational model of educational administrative support was instituted in the Department of Medical Education (DME) to better meet increasing national accreditation demands. Residency and fellowship programs were organized into four \u27Communities of Practice\u27 (CoOPs) based on discipline similarity, number of learners, and geographic location. Program coordinator reporting lines were shifted from individual departments to a centralized reporting structure within the DME. The goal of this project was to assess the impact on those most affected by the change. METHODS: This was a mixed methods study that utilized structured interviews and the Organizational Culture Assessment Instrument (OCAI). Eleven members of the newly formed CoOPs participated in the study. RESULTS: Three major themes emerged after review and coding of the interview transcripts: improved group identity, improved availability of resources, and increased opportunity for professional growth. OCAI results indicated that respondents are committed to the DME and perceived the culture to be empowering. The \u27preferred culture\u27 was very similar to the culture at the time of the study, with some indication that DME employees are ready for more creativity and innovation in the future. CONCLUSION: Reorganization within the DME of residency programs into CoOPs was overwhelmingly perceived as a positive change. Improved resources and accountability may position our DME to better handle the increasing complexity of graduate medical education

Organizing graduate medical education programs into communities of practice

Background: A new organizational model of educational administrative support was instituted in the Department of Medical Education (DME) to better meet increasing national accreditation demands. Residency and fellowship programs were organized into four ‘Communities of Practice’ (CoOPs) based on discipline similarity, number of learners, and geographic location. Program coordinator reporting lines were shifted from individual departments to a centralized reporting structure within the DME. The goal of this project was to assess the impact on those most affected by the change. Methods: This was a mixed methods study that utilized structured interviews and the Organizational Culture Assessment Instrument (OCAI). Eleven members of the newly formed CoOPs participated in the study. Results: Three major themes emerged after review and coding of the interview transcripts: improved group identity, improved availability of resources, and increased opportunity for professional growth. OCAI results indicated that respondents are committed to the DME and perceived the culture to be empowering. The ‘preferred culture’ was very similar to the culture at the time of the study, with some indication that DME employees are ready for more creativity and innovation in the future. Conclusion: Reorganization within the DME of residency programs into CoOPs was overwhelmingly perceived as a positive change. Improved resources and accountability may position our DME to better handle the increasing complexity of graduate medical education

Organizing graduate medical education programs into communities of practice.

Background A new organizational model of educational administrative support was instituted in the Department of Medical Education (DME) to better meet increasing national accreditation demands. Residency and fellowship programs were organized into four \u27Communities of Practice\u27 (CoOPs) based on discipline similarity, number of learners, and geographic location. Program coordinator reporting lines were shifted from individual departments to a centralized reporting structure within the DME. The goal of this project was to assess the impact on those most affected by the change. Methods This was a mixed methods study that utilized structured interviews and the Organizational Culture Assessment Instrument (OCAI). Eleven members of the newly formed CoOPs participated in the study. Results Three major themes emerged after review and coding of the interview transcripts: improved group identity, improved availability of resources, and increased opportunity for professional growth. OCAI results indicated that respondents are committed to the DME and perceived the culture to be empowering. The \u27preferred culture\u27 was very similar to the culture at the time of the study, with some indication that DME employees are ready for more creativity and innovation in the future. Conclusion Reorganization within the DME of residency programs into CoOPs was overwhelmingly perceived as a positive change. Improved resources and accountability may position our DME to better handle the increasing complexity of graduate medical education

Is it time for entrustable professional activities for residency program directors?

Residency program directors (PDs) play an important role in establishing and leading high-quality graduate medical education programs. However, medical educators have failed to codify the position on a national level, and PDs are often not recognized for the significant role they play. The authors of this Commentary argue that the core entrustable professional activities (EPAs) framework may be a mechanism to further this work and define the roles and responsibilities of the PD position. Based on personal observations as PDs and communications with others in the academic medicine community, the authors used work in competency-based medical education to define a list of potential EPAs for PDs. The benefits of developing these EPAs include being able to define competencies for PDs using a deconstructive process, highlighting the increasingly important role PDs play in leading high-quality graduate medical education programs, using EPAs as a framework to assess PD performance and provide feedback, allowing PDs to focus their professional development efforts on the most important areas for their work, and helping guide the PD recruitment and selection processes

The feedback tango: an integrative review and analysis of the content of the teacher-learner feedback exchange.

PURPOSE: To conduct an integrative review and analysis of the literature on the content of feedback to learners in medical education. METHOD: Following completion of a scoping review in 2016, the authors analyzed a subset of articles published through 2015 describing the analysis of feedback exchange content in various contexts: audiotapes, clinical examination, feedback cards, multisource feedback, videotapes, and written feedback. Two reviewers extracted data from these articles and identified common themes. RESULTS: Of the 51 included articles, about half (49%) were published since 2011. Most involved medical students (43%) or residents (43%). A leniency bias was noted in many (37%), as there was frequently reluctance to provide constructive feedback. More than one-quarter (29%) indicated the feedback was low in quality (e.g., too general, limited amount, no action plans). Some (16%) indicated faculty dominated conversations, did not use feedback forms appropriately, or provided inadequate feedback, even after training. Multiple feedback tools were used, with some articles (14%) describing varying degrees of use, completion, or legibility. Some articles (14%) noted the impact of the gender of the feedback provider or learner. CONCLUSIONS: The findings reveal that the exchange of feedback is troubled by low-quality feedback, leniency bias, faculty deficient in feedback competencies, challenges with multiple feedback tools, and gender impacts. Using the tango dance form as a metaphor for this dynamic partnership, the authors recommend ways to improve feedback for teachers and learners willing to partner with each other and engage in the complexities of the feedback exchange

Aligning Strategic Interests in an Academic Medical Center: A Framework for Evaluating GME Expansion Requests

Background  In 2017, the Maine Medical Center Graduate Medical Education Committee received an unprecedented number of requests (n = 18) to start new graduate medical education (GME) programs or expand existing programs. There was no process by which multiple programs could be prioritized to compete for scarce GME resources. Objective  We developed a framework to strategically assess and prioritize GME program expansion requests to yield the greatest benefits for patients, learners, and the institution as well as to meet regional and societal priorities. Methods  A systems engineering methodology called tradespace exploration was applied to a 6-step process to identify relevant categories and metrics. Programs\u27 final scores were peer evaluated, and prioritization recommendations were made. Correlation analysis was used to evaluate the relevance of each category to final scores. Stakeholder feedback was solicited for process refinement. Results  Five categories relevant to GME expansion were identified: institutional priorities, health care system priorities, regional and societal needs, program quality, and financial considerations. All categories, except program quality, correlated well with final scores (R2 range 0.413–0.662). Three of 18 requested programs were recommended for funding. A stakeholder survey revealed that almost half of respondents (48%, 14 of 29) agreed that the process was unbiased and inclusive. Focus group feedback noted that the process had been rigorous and deliberate, although communication could have been improved. Conclusions  Applying a systems engineering approach to develop institution-specific metrics for assessing GME expansion requests provided a reproducible framework, allowing consideration of institutional, health care system, and regional societal needs, as well as program quality and funding considerations

Feedback for learners in medical education: What is known? A scoping review.

PURPOSE: To conduct a scoping review of the literature on feedback for learners in medical education. METHOD: In 2015-2016, the authors searched the Ovid MEDLINE, ERIC, CINAHL, ProQuest Dissertations and Theses Global, Web of Science, and Scopus databases and seven medical education journals (via OvidSP) for articles published January 1980-December 2015. Two reviewers screened articles for eligibility with inclusion criteria. All authors extracted key data and analyzed data descriptively. RESULTS: The authors included 650 articles in the review. More than half (n = 341) were published during 2010-2015. Many centered on medical students (n = 274) or residents (n = 192); some included learners from other disciplines (n = 57). Most (n = 633) described methods used for giving feedback; some (n = 95) described opinions and recommendations regarding feedback. Few studies assessed approaches to feedback with randomized, educational trials (n = 49) or described changes in learner behavior after feedback (n = 49). Even fewer assessed the impact of feedback on patient outcomes (n = 28). CONCLUSIONS: Feedback is considered an important means of improving learner performance, as evidenced by the number of articles outlining recommendations for feedback approaches. The literature on feedback for learners in medical education is broad, fairly recent, and generally describes new or altered curricular approaches that involve feedback for learners. High-quality, evidence-based recommendations for feedback are lacking. In addition to highlighting calls to reassess the concepts and complex nature of feedback interactions, the authors identify several areas that require further investigation