2016 Fall: Times are Changing: Evolution and Revolution in Medical Education: Strategies for Assessment of Skills, Attitudes, and Behaviors across the Health Sciences

Contemporary health science curricula have increasingly expanded beyond teaching knowledge and skills to fostering attitudes, behaviors and elements of professionalism. The fall seminar series addresses approaches by which these qualities and activities can be assessed in learners when they are not easily quantified by standard methods. The presentations will address contemporary approaches to assessing entrustable professional activities, clinical skills, and non-cognitive components critical to careers in health professions such as life-long learning and professional behaviors. Sessions will focus on using simulation to teach and assess basic science knowledge and skills, assessment of “self-directed, life-long learning”, utilization of standardized patient educators in clinical skills assessment, and effective strategies for assessing professionalism. In addition, there will be a session on “defining competency, milestones and EPAs”, further developing their relationship, and addressing the challenge associated with their assessment. Throughout the series the audience will be invited to contribute to the discussion by sharing their experiences via telephone or our newly implemented back-channel communication leading to a stimulating and thought provoking experience that will inform current thinking on the issues.

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September 8, 2016 at 12:00 pm

Use of preclinical High Fidelity Medical Simulations (HFMS) to promote the integration of basic and clinical sciences in undergraduate medical education

Presenter: Laurel Gorman, PhD

Dr. Gorman completed a Ph.D. in pharmacology and therapeutics with a primary focus in neuropharmacology from Louisiana State University School of Medicine, and went on to complete post-doctoral fellowships at the Weill Cornell College of Medicine and the University of Miami School of Medicine in the Miami Project for Spinal Cord Research before transitioning to a focus on medical education and pharmacology curriculum development in 2000. An experienced and passionate medical educator, Dr. Gorman also served as founding faculty developing an innovative integrated curriculum for new medical school. Currently an Associate Professor of Pharmacology and Director of preclinical pharmacology curricula for the University Of Central Florida College Of Medicine, Dr. Gorman has distinguished herself by receiving numerous national and institutional awards for excellence in both teaching and educational scholarship. She was recently inducted into the national American Society for Pharmacology and Experimental Therapeutics Academy of Pharmacology Educators in recognition for her contributions to the innovation of pharmacology education and educational scholarship. Dr. Gorman has been an active member of IAMSE for several years presenting at several meetings and contributing to programing and reviewing for both the annual meeting and Medical Science Educator. Additionally, she has presented the results of her research on the value of using medical simulations and game-based teaching approaches at several national and international meetings, and has published her results in several peer-reviewed medical education journals.

This session will discuss how to implement and effectively integrate pharmacology and physiology with other essential foundational and clinical sciences using preclinical high fidelity medical simulations carefully scaffolded to keep cognitive domain levels appropriate to the novice medical student’s abilities. While the medical educational literature is replete with proposed curricular models designed to integrate critical foundational sciences like physiology and pharmacology with clinical sciences, gaps exist on the best pedagogy and procedures to maximize conceptual integration and learner encapsulation at the instructor and sessional level. We will review our research evaluating the effectiveness of various techniques used to teach pharmacology within preclinical simulations, and share models and implemental procedures that best support active learning and reflection on error to maximize the impact to learners. Further, we hope to promote a dialogue with other medical educators on how to utilize medical simulation pedagogy to support horizontal and vertical integration of the foundational basic and clinical sciences.

Seminar Archive
September 15, 2016 at 12:00 pm

Self-directed learning in your curriculum—getting from theory to practice.

Presenter: Sandrijn Vanschaik, MD, PhD, Douglas Larsen, MD, William Cutrer, MD

Dr. van Schaik is Associate Professor of Pediatrics at the University of California San Francisco (UCSF) where she serves as Education Director of the UCSF Kanbar Center for Simulation, Fellowship Director for Pediatric Critical Care Medicine and Director of Faculty Development for the new UCSF School of Medicine Bridges Curriculum. She completed her medical school training at the University of Amsterdam, the Netherlands, followed by a PhD from the University of Utrecht, the Netherlands and residency training in pediatrics at the New England Medical Center/Tufts University in Boston, MA. She came to UCSF for pediatric critical care fellowship and has been on faculty since 2006. Her academic career focus is on health professions education with a research focus on self-directed learning as well as interprofessional teamwork, communication and feedback. She has completed a medical education research fellowship at UCSF and was part of the Josiah Macy Faculty Scholars Program from 2012 to 2014.

Dr. Douglas Larsen is a medical education researcher, teacher, and practicing pediatric neurologist. His research interests include self-regulated and socially-regulated learning as well as the role of memory in education. His work focuses on developing theory-based, practical interventions that improve day-to-day educational practice. He has developed collaborations across various disciplines and institutions. Dr. Larsen completed his medical degree at the University of Utah School of Medicine in 2003. He pursued residency training in pediatrics at Cincinnati Children’s Hospital, and then trained in pediatric neurology at St. Louis Children’s Hospital and Washington University. He has been on the faculty at the Washington University in St. Louis School of Medicine since 2008. He received a master’s degree in education from the University of Cincinnati in 2010. Dr. Larsen was a Macy Faculty Scholar of the Josiah Macy Jr. Foundation from 2014-2016. He is the Director of Medical Student Education for the Division of Pediatric Neurology.

Dr. Cutrer received his M.D. with high distinction from the University of Kentucky College of Medicine and completed his Pediatrics residency, chief residency and Pediatric Critical Care fellowship at Baylor College of Medicine and Texas Children’s Hospital. He also has a Master of Education from the University of Cincinnati. Dr. Cutrer is an Assistant Professor of Pediatrics in the Division of Pediatric Critical Care Medicine at Vanderbilt University School of Medicine (VUSM). He is actively involved in medical student education and curriculum development. Dr. Cutrer is very interested in understanding how students learn in the workplace and how to help them more effectively. He has published and presented widely on these topics. He co-leads the AMA’s Accelerating Change in Medical Education initiative Master Adaptive Learner Working Group and is a member of the Vanderbilt core team participating in the AAMC pilot project Core Entrustable Professional Activities for Entering Residency (CEPAER).

In today’s health care arena with rapidly expanding knowledge, yesterday’s best practice may be obsolete tomorrow. This creates an imperative for physicians to be life-long learners. As students progress through medical education their learning will need to be increasingly self-directed and develop the necessary skills to diagnose and address their own learning gaps. Despite the growing recognition that such skills can and should be taught, this is not yet a consistently integrated component of medical school curriculum. In this webinar, we will first define terminology and explain theoretical frameworks that guide our understanding of self-directed, life-long learning; including metacognition, self-regulation, informed self-assessment and the newer framework of master adaptive learning. We will then provide a brief literature review of strategies employed to help students develop the relevant skills, including the use of reflection, learning plans, portfolios and coaches. We will discuss challenges encountered when applying theoretical frameworks to practical strategies and areas of ambiguity in which more research is needed. We will end with some practical suggestions based on the literature and our own experiences.

Seminar Archive
September 22, 2016 at 12:00 pm

Entrustment decision making in EPA-based curricula

Presenter: Olle ten Cate, PhD

Olle ten Cate attended medical school at the University of Amsterdam, the Netherlands and has spent his professional life from 1980 serving medical education. In 1986 he completed a PhD dissertation on peer teaching in medical education. Until 1999 he was closely involved with all of the University of Amsterdam’s major preclinical and clinical curriculum reforms, education research, program evaluation and educational development. In 1999 he was appointed full professor of Medical Education at Utrecht University, the Netherlands, and program director of undergraduate medical education at University Medical Center Utrecht. Since 2005 he leads the Center for Research and Development of Education at UMCU. His research interests include curriculum development, peer teaching, competency-based medical education, and many other topics. From 2006 until 2012 he served as president of the Netherlands Association for Medical Education. In 2012 was appointed adjunct professor of medicine at the University of California, San Francisco, next to his work in Utrecht. He has published extensively in the medical education literature (250+) and supervised and supervises many doctoral students (25+) in medical education research.

Assessment of clinical competence is an ongoing topic of debate among medical educators. Competency-based medical education intends to train and assess residents and students who meet predefined standards. The quest for psychometrically valid assessments, i.e. sound measurement of trainee competencies, to provide sufficient certainty to the public that all those who complete undergraduate medical education are ready for residency, and all those who complete graduate medical education are ready for unsupervised practice, has not yet yielded a gold standard for evaluation. A new concept in workplace training and assessment is Entrustable Professional Activities (EPAs), units of professional practice that learners may execute without supervision once they have satisfactorily demonstrated to possess the relevant competence in postgraduate specialty training, or indirect supervision in undergraduate medical education. EPA-based curricula with entrustment decisions provide a conceptual change in perspective on both the standards for competence and their evaluation among trainees. This presentation will focus on entrustable professional activities for curriculum development and assessment, the concept of entrustment as part of assessment and entrustability scales that use levels of supervision as anchor points. The connection with milestones will be highlighted. While EPA-based assessment is new and there is yet limited experience with EPA-based curricula, there are a number of arguments to guide a development in that direction.

Seminar Archive
September 29, 2016 at 12:00 pm

T​he Breadth and Depth of Standardized Patients in the Teaching and Assessment of Clinical Skills

Presenter: Gayle Gliva, PhD, Carrie Bohnert, MPA, Heidi Lane, PhD

Gayle Gliva-McConvey has been the Director of Professional Skills teaching and Assessment at Eastern Virginia Medical School (EVMS) since its inception in 1993. For over 43 years she has developed and integrated the Standardized Patient (SP) methodology in clinical skills assessment and training. In 1973, as the first non-physician SP Educator, she managed the first Standardized Patient Program at McMaster University Faculty of Health Sciences in Hamilton, Ontario Canada.

She has over 20 publications on Standardized Patients and has presented at over 160 conferences, lectures or workshops internationally. She served as consultant to the China Medical Board, the three medical schools in Puerto Rico and the National University of Singapore and Yong Loo Lin School of Medicine and Uzhgorod University Clinic in Moldova, as part of post-soviet medical education restructuring.

In 1998 she received the first annual award from the American Association of Medical Colleges recognizing her contributions in the field of Standardized Patient Educators. She is a founding board member of the Association of Standardized Patient Educators (ASPE) and the first Chair of the Committee for developing Standards of Practice. She represented ASPE on the Simulation Inventory Advisory Committee with AAMC and the Society of Simulation in Healthcare (SSH). She was on the SSH certification committee’s executive committee and on the test development sub-committee developing certification for Simulation Specialists. She served on the SSH Terminology committee which developed the Healthcare Simulation Dictionary. She is a reviewer for SSiH Journal.

In 2012 – 2014 she served as ASPE President-Elect, President and Past President and Membership Committee Chair 2014 to 2015.

Carrie Bohnert, MPA, serves as director of the Standardized Patient Program at the University of Louisville. For U of L, Ms. Bohnert has implemented rigorous quality control measures, expanded use of the program, presented at international conferences, and published in Academic Medicine.

Ms. Bohnert serves as the Vice President for Operations for the Association of Standardized Patient Educators. In 2013, she was invited to serve on the organization’s President’s Task Force for Standards of Practice, and in 2014, she received ASPE’s Outstanding Emerging Leader Award.

Highlights of Ms. Bohnert’s previous work assignments include training high school students to produce a radio show, shepherding two hundred high school students through a three-week intensive arts program, and coaching teachers to engage their students in science learning. She is a classically trained singer who loves Mozart and Handel.

Dr. Lane is the Senior Director of Clinical Skills Assessment & Education at Virginia Tech Carilion School of Medicine (VTCSOM) with over 20 years of experience in SP methodology. She earned her doctorate in Leadership in Higher Education at East Carolina University (ECU). Dr. Lane was a member of the task force on standardized patients and case development with the National Board of Medical Examiners, collaborating on research and development of the USMLE Step 2 C S. She is past Chair of the Standards of Practice Committee in the Association of Standardized Patient Educators (ASPE). In 2007 she received the ASPE coveted Outstanding Educator Award.

While at ECU, she began collaboration with Kazan State Medical University in Kazan Russia, to open the first clinical skills laboratory in the Russian Federation. This 17 year collaboration continues with Dr. Lane in her role at VTCSOM. In 2013, Dr. Lane was awarded the title of Privat Docent from Kazan State Medical University (KSMU) for her role introducing SP methodology to medical education in Russia. Russia has now initiated plans for using standardized patients in assessing medical, dental and pharmacy students for certification.

Over the past five decades Standardized Patient methodology has evolved from its roots in teaching and assessing proficiency in communicating with patients. Standardized Patients (SPS) now perform a variety of roles in medical and non-medical education from undergraduate learning to licensure examinations to continuing education. In this presentation, we will use a non-traditional definition of Standardized Patients (SPs): “individuals who are trained to perform in a role in a standardized and repeatable way where presentation varies based only on learner performance. SPs are used for teaching and assessment of learners in a broad range of skills in simulated environments. SPs are trained to facilitate learning, provide feedback and evaluate learner performance.” Three institutions (Eastern Virginia Medical School, Virginia Tech Carilion School of Medicine and the University of Louisville) are represented in this presentation. Discussions will encompass the traditional and evidence-based ways SPs are integrated into medical curriculums for teaching and assessing clinical skills, and widening the lens to include teaching and assessment of skills that are historically taught by clinicians, as a solution for clinical teaching when clinician time is challenging. We will also present innovative uses of the SP methodology to challenge our audience’s imagination.

Seminar Archive
October 6, 2016 at 12:00 pm

New Tools and Paradigms for Assessing Professionalism in the Health Sciences

Presenter: John Mahan, MD

For the past 32 years I have had the privilege of working in multiple areas of pediatrics and pediatric nephrology. After my clinical and research training at the University of Minnesota, I began in the tenure track in basic science at the Ohio State University (OSU) and Nationwide Children’s Hospital (NCH) in 1984. In 1990 I was appointed and still serve as Program Director of the NCH General Pediatric Residency Program and in 2003 I started and still direct the NCH Pediatric Nephrology Fellowship Program. I served as Director of the OSU College of Medicine (COM) Center for Education and Scholarship from 2009-2012 and now serve as Assistant Director of Faculty Development in the COM (since 2010). I have led the OSU Professionalism Council Educators Working Group since 2009 and am responsible for the evaluation and ongoing improvement of professionalism education as Director of Competence for Professionalism in the COM. We have recently developed the OSU Professionalism Climate Questionnaire to define the environment so critical for developing professionalism skills in medical education learners and promoting resilience in physicians.

As an OSU Professor I continue to develop and lead medical education programs, and focus on developing and mentoring junior investigators interested in medical education careers. I am fortunate to work in collaborative teams on local and national medical education research projects and recently have begun to extend our efforts to better understand burnout and resilience in pediatric residents as co-founder and director of the Pediatric Resident Burnout Resilience Research Study Consortium

Professionalism is a critical component of both undergraduate and graduate medical education. Continual assessment of professionalism is necessary for mastery of this competency and to help learners understand and ultimately develop skills to avoid professionalism lapses. Individual behavior and attitudes are often affected by the overall work and learning environments and role modeling by attending physicians and peer pressure from colleagues can contribute to both positive and unprofessional behaviors. This engaging webinar will provide grounding in the current state of professionalism assessment, insights on the obstacles and strategies for assessing professionalism.

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