Teaching and learning in medicine
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Construct: The McMaster Modular Assessment Program (McMAP) is a programmatic workplace-based assessment (WBA) system that provides emergency medicine trainees with competency judgments through frequent task-specific and global daily assessments. Background: The longevity of McMAP relative to other programmatic WBA systems affords a unique view that precedes large-scale transitions to competency-based medical education (CBME), particularly in North America. Although prior work has described the perspective of residents using this system, the in-depth experiences of assessors using the system have yet to be explored. ⋯ However, attendings also perceived a number of challenges of McMAP and programmatic WBA more broadly. These included a reluctance to give and to document negative feedback, "gaming" of the system by both attendings and residents, and a variety of logistic and technology-related concerns. Conclusions: Based on our findings, we offer several key recommendations that can help programs maximize the benefits of programmatic WBA as they transition to CBME.
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Phenomenon: The oral case presentation represents a unique method of communication and forms the foundation for trainee-supervisor interactions in the clinical setting. Recently, entrustment has been highlighted as an essential element of trainee-supervisor interactions. Despite the growing body of knowledge concerning entrustment in medical education, how supervisors conceptualize the oral case presentation as a contributor to entrustment decision making during clinical supervision remains unknown. ⋯ Insights: The oral case presentation represents a core activity within the trainee-supervisor relationship in which entrustment plays a central role. Given the numerous factors influencing oral case presentation content, we caution supervisors against relying solely on the oral case presentation as an entrustment check point, as this may lead to inaccurate judgments of trainee competence. We recommend that the oral case presentation be used in conjunction with other means of direct and indirect observation to assist with entrustment decisions relating to trainee supervision.
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Phenomenon: Academic health centers face significant challenges trying to improve medical education while meeting patient care needs. In response to problems with traditional forms of didactic education, many residency programs have transitioned to Academic Half Day (AHD), a curricular model in which learning is condensed into half-day blocks. In this model, trainees have protected educational time free from clinical responsibilities. ⋯ Insights: We found that attending physicians experienced significant emotional strain, faced technological challenges, and were concerned about impeded workflow and patient safety when residents departed clinical sites for AHD. This is likely to be true whenever residents are pulled out of the clinical setting for any reason. Educators need to partner with hospital administrators to provide appropriate support for attending physicians when residents leave clinical sites, evaluate the effectiveness of different educational models, and determine how structured learning activities fit into the overall curriculum.
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Issue: The practice of medicine is intrinsically unpredictable. Clinicians must respond skillfully to this uncertainty; therefore, medical educators are using improvisational theater training methods to teach improvisational ability in areas such as communication and professionalism. This teaching approach is called "medical improv." Although early reports of medical improv suggest promise, the collective descriptions of curricular content lack consistency. ⋯ In addition, improv-based exercises represent an experiential learning modality that is underutilized in communication skills training; therefore, exercises could be integrated into existing coursework to bridge the learning pathway between texts and simulation. Furthermore, the deliberate cultivation of affirmation skills could enhance resilience and wellness in clinical and learning environments. In summary, through their conceptual simplicity, these curricular frameworks for medical improv can help educators understand, study, and optimize teaching of improvisation in medical education.
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Burnout in graduate medical education is pervasive and has a deleterious impact on career satisfaction, personal well-being, and patient outcomes. Interventions in residency programs have often addressed isolated contributors to burnout; however, a more comprehensive framework for conceptualizing wellness is needed. ⋯ This work surveys current interventions to mitigate burnout and organizes them into a scaffold that can be used by residency programs interested in a complete framework to supporting wellness.