By William Rayburn, MD

This column aims to provide a list of insightful publications on topics of interest to teaching faculty and professionals in CME/CPD. 

Hanging up the surgical cap: Assessing the competence of aging surgeons

Determining when a surgeon should retire includes continuing education and public safety considerations. This search of websites describing non-medical professions where cognitive and physical competency are necessary include airline pilots, air traffic controllers, firefighters, and state judges. Six objective testing methods for evaluation of surgeon technical skills were identified and validated for surgical trainees. Only Objective Structured Assessment of Technical Skills (OSATS) was capable of distinguishing between surgeons of different skill levels and showing a relation between skill level and postoperative outcomes.  (Frazer A, Tanzer M. World J Orthop 2021; 12: 234-45 doi:10.5312/wjo. v12.i4.234. PMID: 33959487)

Australian endocrinologists need more training in transgender health: A national survey

This anonymous 14-item survey was a national medical society to assess the level of training and confidence of Australian endocrinologists and trainees in the endocrine management of trans and gender diverse (TGD) individuals in a representative sample.  The 54.9% response rate of the 545 members highlighted the shortfall in training and showed that prior clinical experience is associated with higher levels of confidence.  This targeted area will require more focused continuing education to adapt to meet the increasing demand for quality TGD health services (Bretherton I, Grossmann M, Leemaqz S, Zajac J, Cheung A. Clin Endocrinol 2020; 92: 247-57. Doi: 10.1111/cen.14143. PMID: 31845345)

Measuring impacts of continuing professional development (CPD): The development of the CPD Impacts Survey (CPDIS)

Evaluating CPD programs is essential to demonstrate their value to participants and their institutions. This study developed a survey that can measure a broad range of impacts of CPD programs, not just those that are easily measured such as knowledge, skills, attitudes, and confidence.  The development of the CPDIS survey was using best practice guidelines. A systematic scoping review, qualitative interviews, and existing survey instruments were used to develop the initial survey items. Professionals in international health professions education completed the survey. A principal component analysis provided refinements into three components: 1) learnings and self-efficacy, 2) networking and building community, and 3) achievement and validation assessed this broader range for more efficiently and accurately evaluating value of CPD programs. (Allen L, Palermo C, Armstrong E, Hay M. Med Teach 2021 Feb 26: 1-23 doi: 10.1080/0142159X.2021.1887834 PMID: 33635733)

Videoconferencing: A Steep Learning Curve for Medical Educators

The COVID-19 pandemic led to medical educators watching their health care systems morph and their ability to deliver in-person curricula disappear due to limitations on group sizes. This tutorial to make the “virtual education jump” serves as a starting point for transitioning curriculum from face-to-face to a virtual platform.  Three curricular design principles to optimize teaching via webinar include: making it active, making it accessible, making it appealing. Hosting a webinar successfully involves knowing your platform, practicing, having a partner, establishing ground rules, creating a learning environment, and avoiding pitfalls. Best practices in videoconferencing (lights, camera, action) are described. (Smeraglio A, DiVeronica M, Terndrup C, McGhee B, Hunsaker S. J Grad Med Ed 2020; October: 553-6. Doi: 10.4300/JGME-D-20-00514.1)

Perception among ophthalmologists about webinars as a method of continued medical education during COVID-19 pandemic

More medical specialty societies are conducting virtual multi-day annual meetings. A 21-question survey that focused on the quality and usefulness of webinars based on the Bloom’s taxonomy was circulated using digital media to approximately 1,400 ophthalmologists in India.   Of the 28% who responded, the quality of the webinars was good or excellent, knowledge was gained, and webinars were important in clinical practice and to be continued. However, there are needs for improvising the volume of webinars, target-audience-based delivery, and participant interaction to add value to this new dimension of teaching-learning that will likely continue either alone or as a hybrid with in-person learning. (Rana R, Kumawat D, Sahay P, et al. Indian J Ophthalmol 2021; 69: 951-7. Doi: 10.4103/ijo.IJO_3136_20  PMID: 33727465

Reliability of simulation-based assessment for practicing physicians: Performance is context-specific

I often wonder whether all practicing physicians will be required to undertake some simulation-based assessments to assess their competencies.  Anesthesiologists likely undergo the best simulation training using standardized complex simulation scenarios developed and administration for their maintenance of certification.  In this study, a subset agreed to be assessed by trained raters on both teamwork/behavioral and technical performance measures.   Findings showed that realistic simulation-based assessment is resource-intensive and may be best-suited for individualized formative feedback. Skill and knowledge gaps can be used in training programs and continuing education programs. (Sinz E, Banerjee A, Steadman R, et al. BMC Med Educ 2021; 21:207. Doi: 10:1186/s12909-021-02617-8  PMID: 3385837)

Faculty development for milestones and Clinical Competency Committees (CCC)

The goal of postgraduate training is the development of competency necessary for independent practice. This perspective article provides guidance for specific areas of faculty development for CCC members, including strategies for novel approaches to professional development for the committee. This includes the purpose and structure of the CCCs strategies, strength, and weaknesses of the assessments employed by the program, development of a shared mental model of the milestones of the relevant specialty, and the best practices of an effective group discussion. Optimal functioning of a CCC requires dedicated faculty time, education, and investment in faculty development across levels of experience and unique training needs of interprofessional members.  (Heath J, Davis J, Dine C, Padmore J. J Grad Med Ed 2012; 13 (April 2021 supplement): 127-31. Doi: 10.4300/JGME-D-20-00851.1)

Developing leaders and scholars in health care improvement: The VA Quality Scholars (VAQS) program competencies

Health care improvement leaders fill multiple roles within organizations and promote interprofessional improvement practice. The authors describe the VAQS program, an interprofessional postdoctoral training program whose mission is to develop leaders and scholars to improve health care. The final version included 22 competencies spanning 5 domains: interprofessional collaboration and teamwork, improvement and implementation science, organization and system leadership, methodological skills and analytic techniques for improvement and research, and teaching and coaching. Once attained, the VAQS competencies will guide the skill development that interprofessional health care improvement leaders need to participate in and lead health care improvement. (Horstman M, Miltner R, Wallhagen M, et al. Acad Med 2021; 96: 68-74. Doi: 10.1097/ACM.0000000000003658   PMID: 32769476)

Developing Physican gender as a source of implicit bias affecting clinical decision-making process: A scoping review

While medical education may not differ by gender, studies have shown that physician practice outcomes vary by provider gender.  This scoping review of 177 records found that gender-based implicit bias may be inadvertently acquired from culture and education. Although implicit bias is highly researched, much of the current literature focuses on the gender of the patient. This study found important gaps in the available literature regarding race and gender of the physician. Further studies could explore outcome differences between recent graduates and those in practice, for both female and male physicians. (Champagne-Langabeer T, Hedges A. BMC Med Educ 2021; 21: 171. Doi: 10.1186/s12909-021-02601-2. PMID: 33740973)

Developing Leadership Cirricula and Assessment in Australian and New Zealand Medical Schools

There is a significant research gap and no national consensus in these two countries on how to educate, assess, and evaluate leadership skills in medical professional entry degree/programs. A self-administered cross-sectional survey was distributed to senior academics and/or head of Australasian medical schools.  There is a variety of leadership competencies taught, with strength being communication, evidence-based practice, critical reflective practice, self-management, ethical decision-making, critical thinking and decisions making. Major gaps in teaching were financial management, strategic planning, and workforce planning. There appears to be no continuous quality improvement process for leadership education, and there is much more to do to shape professional development of academics to teach medial leadership and the required leadership skills for learners. (Jacquelyn Ross S, Sen Gupta T, Johnson P. BMC Med Educ 2021; 21: 28. Doi: 10.1186/s12909-020-02456-z    PMID: 33413349)

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.