This column aims to provide a list of insightful publications on topics of interest to teaching faculty and professionals in CME/CPD.
By William Rayburn, MD, MBA
Tuesdays are great for teaching tips: A spaced education strategy for faculty development. DOI: 10.4300/JGME-D-20-01249.1
Difficulty in meeting faculty development requirements is consistently reported in the literature due to competing workload requirements. This report from the Case Western Reserve University describes their Tuesday’s Teaching Tips (TTT) program developed as a 14-week encapsulated course via email utilizing spaced education as a strategy to reimagine delivering course content with evaluation and feedback. Course evaluations revealed that 98% of 84 faculty across 15 specialties felt that the information gained would enhance patient care or medical education. Faculty were very receptive to this teaching strategy as it was designed to be easily accessible, eliminated the need to “go to a training,” was time efficient, and used simple strategies to practice. Kalynych C, Edwards L, West D, Snodgrass C, Zenni E. J Grad Med Ed 2021; 13: 434-5.
Psychological safety in feedback: What does it look like and how can educators work with learners to foster it. DOI: 10.1111/medu.14154
Feedback pays a central role in health professional workplace learning. This can risk exposing their limitations or offending the educator, however. The authors attempted to answer what does psychological safety look like in a workplace feedback and how can educators work with learners to foster it. An analysis of 36 videos of routine formal feedback episodes led to identification of four themes: 1) setting the scene for dialogue and candor, 2) educator as ally, 3) a continuing improvement orientation, and 4) encouraging interactive dialogue. This study builds on the importance of psychological safety in feedback by clarifying what psychological safety in workplace feedback conversations might look like and identifying associated educator approaches. Johnson C, Keating J, Molloy E. Med Educ 2020; 54: 557-70
Continuing board certification: Seeing our way forward. DOI: 10.3122/jabfm.2020.S1.190439
The breadth and dept of new information, combined with the pressures of system barriers and administrative burdens, can make it challenging for clinicians to stay current and maintain their own competency. Certification boards have a critical role to set and evolve standards for competence and to conduct rigorous assessments of physicians. The authors present four key areas to address to move forward with a board certification system that is effective, relevant, and respected. These that boards should: set and communicate the specific expectations of specialists, use technology to create practice-relevant assessments, collaborate with educators, and establish and meet standards for professionalism and ethics that reflect their position as regulatory bodies. McMahon G, Newton W. JABFM 2020; 33: S10-S14.
Exploring the factors that influence ethical Spanish use among medical students and solutions for improvement. DOI: 10.1080/10401334.2021.1949996
Physicians and physicians-in-training are in vulnerable positions to use second language skills in situations that step beyond their abilities. This article explores how hierarchy intensifies previously established factors, including a lack of adequate training or evaluation and other structural barriers, in contributing to learners' inappropriate use of Spanish with limited-English proficiency patients. An approach is proposed that includes student education, standardization of clinic rules regarding interpretation, and comprehensive faculty development to address this important patient care issue. Meacham J, Salazar M, Perez R, et al. Teach Learn Med 2021; 27:1-8.
Measuring impacts of continuing professional development (CPD): The development of the CPD impacts survey (CPDIS). DOI: 10.1080/0142159X.2021.1887834
Evaluating CPD programs is essential. This study developed a CPD impacts survey (CPDIS) by conducting a systematic scoping review, qualitative interviewing, using existing survey instruments to develop the initial survey items, and completing the survey by past participants from two international health professions education institutes. A three-component solution from the survey involved learnings and self-efficacy, networking and building community, and achievement and validation. The CPDIS will allow more efficient and accurate evaluation of the utility and value of CPD programs and to inform about their improvement and quality. Allen L, Palermo C, Armstrong E, Hay M. Med Teach 2021; 43: 677-85.
Twelve tips for facilitating and implementing clinical debriefing (CD) programs. DOI: 10.1080/0142159X.2020.1817349
High demand clinical practice would benefit from workplace practices such as clinical debriefing (CD) to support everyday learning and patient care. Debriefing, defined as a 'guided reflective learning conversation', is most often undertaken in small workplace settings. Emerging evidence suggests that debriefing may enhance learning while simultaneously balancing psychological safety, learning goals, and emotional well-being. The twelve tips in this article resulted from a recent Association for Medical Education in Europe (AMEE) debriefing symposium. These tips encompass the benefits of CD: team focus, interdisciplinary, implementation in stages, and use of a clear structure. Coggins A, Zaklama R, Szabo R, et al. Med Teach 2021; 43: 509-17
Examining associations between physician data utilization for practice improvement and lifelong learning. DOI: 10.1097/CEH.0000000000000268
Health care is becoming increasingly data-driven, and greater data accessibility has created more opportunity to use data to improve quality of care. This pan-Canadian survey was administered to psychiatrists, radiation oncologists, and general surgeons to assess factors that influence the use of data for practice improvement and orientation to lifelong learning. Significant predictors of data use in practice included frequency of assessing learning needs, helpfulness of data to improve practice, and frequency to develop learning plans. Associations between practice data use and perceived data utility, reflections on learning needs, and learning plan development were demonstrated. Sockalingam S, Tavares W, Charow R, et al. JCEHP 2019; 39: 236-42.
Curricular needs for training telemedicine physicians: A scoping review. DOI: 10.1080/0142159X.2020.1799959
An ideal curriculum for educating physicians to practice in the emerging use of telemedicine has not been established. This review of peer-reviewed articles identified 43 curricula from 11 countries. Instructional methods included mostly hands-on experiences and lectures, along with directed reading online modules, reflection, simulations, and group discussions. The authors suggest centering curricula on a competency-based, outcomes-oriented framework using multiple teaching modalities complementing hands-on experiences. Stovel R, Gabarin N, Cavalcanti R, Abrams H. Med Teach 2020; 42
Using quality improvement tools to enhance workplace learning in an anesthesia unit. DOI: 10.1080/0142159X.2020.1799960
Quality improvement (QI) tools can be used in medical education to facilitate improvement in learning outcomes and competencies of junior doctors. This report from the National University Hospital in Singapore presents a stepwise competency checklist devised to guide and monitor the learning of junior faculty. QI tools, namely the Fishbone diagram and Pareto chart, were used to identify modifiable root causes and prioritize interventions. Monthly competency scores from test results ranged 30-50% at baseline and improved to 60-75% after 6 months. Focused improvement cycles that are aligned to learning outcomes were key to the success of using QI tools in medical education. Wai Foong T, Tiong H-F, Yang Ong S, Gee Chen F. Med Teach 2020; 42:1228-33.
Exploiting the power of information in medical education. DOI: 10.1080/0142159X.2021.1925234
The explosion of medical information demands a thorough reconsideration of medical education, including what we teach and assess, how we educate, and whom we educate. Physicians of the future will need to be self-aware, self-directed, resource-effective team players who can synthesize and apply summarized information and communicate clearly. Training in metacognition, data science, informatics, and artificial intelligence is needed. Education programs must shift focus from content delivery to providing students explicit scaffolding for future learning, such as the Master Adaptive Learner model. Additionally, educators should leverage informatics to improve the process of education and foster individualized, precision education. Finally, attributes of the successful physician of the future should inform adjustments in recruitment and admissions processes. This paper explores how member schools of the American Medical Association Accelerating Change in Medical Education Consortium adjusted all aspects of educational programming in acknowledgment of the rapid expansion of information. William B. Cutrer, W. Anderson Spickard III, Marc M. Triola, Bradley L. Allen, Nathan Spell III, Steven K. Herrine, John L. Dalrymple, Paul N. Gorman & Kimberly D. Lomis (2021) Exploiting the power of information in medical education, Medical Teacher, 43:sup2, S17-S24.
Health systems science education: The new post-Flexner professionalism for the 21st century. DOI: 10.1080/0142159X.2021.1924366
The foundations of medical education have drawn from the Flexner Report to prepare students for practice for over a century. These recommendations relied, however, upon a limited set of competencies and a relatively narrow view of the physician’s role. There have been increasing calls and recommendations to expand those competencies and the professional identity of the physician to better meet the current and future needs of patients, health systems, and society. We propose a framework for the twenty-first century physician that includes an expectation of new competency in health systems science (HSS), creating ‘system citizens’ who are effective stewards of the health care system. Experiential educational strategies, in addition to knowledge-centered learning, are critically important for students to develop their professional identity as system citizens working alongside interprofessional colleagues. Challenges to HSS adoption range from competing priorities for learners, to the need for faculty development, to the necessity for buy-in by medical schools and their associated health care systems. Ultimately, success will depend on our ability to articulate, encourage, support, and evaluate system citizenship and its impact on health care and health care systems. Jeffrey M. Borkan, Maya M. Hammoud, Elizabeth Nelson, Julie Oyler, Luan Lawson, Stephanie R. Starr & Jed D. Gonzalo (2021) Health systems science education: The new post-Flexner professionalism for the 21st century, Medical Teacher, 43:sup2, S25-S31.
Perspectives: Teaching the Teachers With Milestones: Using the ACGME Milestones Model for Professional Development. doi.org/10.4300/JGME-D-20-00891.1
Janae K. Heath, C. Jessica Dine, Ann E. Burke, Kathryn M. Andolsek. J Grad Med Educ (2021) 13 (2s): 124–126. Full text only.
William Rayburn, MD, MBA is an emeritus distinguished professor, chair of obstetrics and gynecology, and associate dean at the University of New Mexico School of Medicine, Albuquerque, NM and a clinical professor of obstetrics and gynecology and graduate studies at the Medical University of South Carolina, Charleston, SC. wrayburnmd@gmail.com