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The Accreditation Council for Graduate Medical Education (ACGME) Milestone projects required each specialty to identify essential skills and develop means of assessment with supporting validity evidence for trainees. Several specialties rate trainees on a milestone subcompetency related to working in interprofessional teams. A tool to assess trainee competence in any role on an interprofessional team in a variety of scenarios would be valuable and suitable for simulation-based assessment. We developed a tool for simulation settings that assesses interprofessional teamwork in trainees. In 2015, existing tools that assess teamwork or interprofessionalism using direct observation were systematically reviewed for appropriateness, generalizability, adaptability, ease of use, and resources required. Items from these tools were included in a Delphi method with multidisciplinary pediatrics experts using an iterative process from June 2016 to January 2017 to develop an assessment tool. Thirty-one unique tools were identified. A 2-stage review narrowed this list to 5 tools, and 81 items were extracted. Twenty-two pediatrics experts participated in 4 rounds of Delphi surveys, with response rates ranging from 82% to 100%. Sixteen items reached consensus for inclusion in the final tool. A global 4-point rating scale from novice to proficient was developed. A novel tool to assess interprofessional teamwork for individual trainees in a simulated setting was developed using a systematic review and Delphi methodology. This is the first step to establish the validity evidence necessary to use this tool for competency-based assessment. [ABSTRACT FROM AUTHOR]

Background Transitions of care pose significant risks for patients with complex medical histories. There are few experiential medical education curricula targeting this important aspect of care. Objective We designed and tested an internal medicine transitions of care experience integrated into interns' ambulatory curriculum. Methods The program included 1-hour group didactics, a posthospitalization discharge visit in pairs with a home care nurse (cohort 1: 2011–2012; cohort 2: 2012–2013), and a half-day small-group visit to a skilled nursing facility led by a faculty member in geriatrics (cohort 2 only). Both visits had structured debriefings by faculty in geriatrics. For cohort 1, a quantitative follow-up survey was administered 18 to 20 months after the experience. For cohort 2, reflections were analyzed. Results Thirty-three of 42 second-year residents (79%) in cohort 1 who participated in didactics and a home visit completed the survey. Seventy-six percent (25 of 33) reported increased knowledge of interprofessional team members' roles and the discharge process for patients with complex medical histories. Seventy-nine percent (26 of 33) reported continued use of medication reconciliation at discharge, and 64% (21 of 33) reported the experience enhanced their ability to identify threats to transitions. Of cohort 2 interns, 88% (42 of 48) participated in the home visit and 69% (33 of 48) in the skilled nursing facility visit. Intern reflections revealed insights gained, incomprehensive discharge plans, posthospital health care teams, and patients' postdischarge experience. Conclusions An experiential transitions of care curriculum is feasible and acceptable. Residents reported using the curriculum 18 to 20 months after exposure. [ABSTRACT FROM AUTHOR]

Background Transitions of care pose significant risks for patients with complex medical histories. There are few experiential medical education curricula targeting this important aspect of care. Objective We designed and tested an internal medicine transitions of care experience integrated into interns' ambulatory curriculum. Methods The program included 1-hour group didactics, a posthospitalization discharge visit in pairs with a home care nurse (cohort 1: 2011-2012; cohort 2: 2012-2013), and a half-day small-group visit to a skilled nursing facility led by a faculty member in geriatrics (cohort 2 only). Both visits had structured debriefings by faculty in geriatrics. For cohort 1, a quantitative follow-up survey was administered 18 to 20 months after the experience. For cohort 2, reflections were analyzed. Results Thirty-three of 42 second-year residents (79%) in cohort 1 who participated in didactics and a home visit completed the survey. Seventy-six percent (25 of 33) reported increased knowledge of interprofessional team members' roles and the discharge process for patients with complex medical histories. Seventy-nine percent (26 of 33) reported continued use of medication reconciliation at discharge, and 64% (21 of 33) reported the experience enhanced their ability to identify threats to transitions. Of cohort 2 interns, 88% (42 of 48) participated in the home visit and 69% (33 of 48) in the skilled nursing facility visit. Intern reflections revealed insights gained, incomprehensive discharge plans, posthospital health care teams, and patients' postdischarge experience. Conclusions An experiential transitions of care curriculum is feasible and acceptable. Residents reported using the curriculum 18 to 20 months after exposure. [ABSTRACT FROM AUTHOR]

The article talks about transformations in medical education to make it competency-based by applying learning theory and talks of the model of a structured Education Scholarship Fellowship (ESF) a 2-year postgraduate training program for preparing future education leaders.

The article suggest how milestones can be used to guide resident remediation in interpersonal and communication skills and professionalism.

Background A core objective of residency education is to facilitate learning, and programs need more curricula and assessment tools with demonstrated validity evidence. Objective We sought to demonstrate concurrent validity between performance on a widely shared, ambulatory curriculum (the Johns Hopkins Internal Medicine Curriculum), the Internal Medicine In-Training Examination (IM-ITE), and the American Board of Internal Medicine Certifying Examination (ABIM-CE). Methods A cohort study of 443 postgraduate year (PGY)- 3 residents at 22 academic and community hospital internal medicine residency programs using the curriculum through the Johns Hopkins Internet Learning Center (ILC). Total and percentile rank scores on ILC didactic modules were compared with total and percentile rank scores on the IM-ITE and total scores on the ABIM-CE. Results The average score on didacticmodules was 80.1%; the percentile rank was 53.8. The average IM-ITE score was 64.1% with a percentile rank of 54.8. The average score on the ABIM-CE was 464. Scores on the didactic modules, IMITE, and ABIM-CE correlated with each other (P < .05). Residents completing greater numbers of didactic modules, regardless of scores, had higher IM-ITE total and percentile rank scores (P < .05). Resident performance on modules covering back pain, hypertension, preoperative evaluation, and upper respiratory tract infection was associated with IM-ITE percentile rank. Conclusions Performance on a widely shared ambulatory curriculum is associated with performance on the IM-ITE and the ABIM-CE. [ABSTRACT FROM AUTHOR]

Background To further evolve in an evidence-based fashion, medical education needs to develop and evaluate new practices for teaching, learning, and assessment. However, educators face barriers in designing, conducting, and publishing education research. Objective To explore the barriers medical educators face in formulating, conducting, and publishing high-quality medical education research, and to identify strategies for overcoming them. Methods A consensus workshop was held November 5, 2013, at the Association of American Medical Colleges annual meeting. A working group of education research experts and educators completed a preconference literature review focusing on barriers to education research. During the workshop, consensusbased and small group techniques were used to refine the broad themes into content categories. Attendees then ranked the most important barriers and strategies for overcoming them with the highest potential impact. Results Barriers participants faced in conducting quality education research included lack of (1) expertise, (2) time, (3) funding, (4) mentorship, and (5) reward. The strategy considered most effective in overcoming these barriers involved building communities of education researchers for collaboration and networking, and advocating for education researchers' interests. Other suggestions included trying to secure increased funding opportunities, developing mentoring programs, and encouraging mechanisms to ensure protected time. Conclusions Barriers to education research productivity clearly exist. Many appear to result from feelings of isolation that may be overcome with systemic efforts to develop and enable communities of practice across institutions. Finally, the theme of ''reward'' is novel and complex and may have implications for education research productivity. [ABSTRACT FROM AUTHOR]

Background Despite an explosion of medical education research and publications, it is not known how medical educator consumers decide what to read or apply in their practice. Objective To determine how consumers of medical education research define quality and value. Methods Journal of Graduate Medical Education editors performed a literature search to identify articles on medical education research quality published between 2000 and 2013, surveyed medical educators for their criteria for judging quality, and led a consensus-building workshop at a 2013 Association of American Medical Colleges meeting to further explore how users defined quality in education research. The workshop used standard consensus-building techniques to reach concept saturation. Attendees then voted for the 3 concepts they valued most in medical education research. Results The 110 survey responses generated a list of 37 overlapping features in 10 categories considered important aspects of quality. The literature search yielded 27 articles, including quality indexes, systematic and narrative reviews, and commentaries. Thirty-two participants, 12 facilitators, and 1 expert observer attended the workshop. Participants endorsed the following features of education research as being most valuable: (1) provocative, novel, or challenged established thinking; (2) adhered to sound research principles; (3) relevant to practice, role, or needs; (4) feasible, practical application in real-world settings; and (5) connection to a conceptual framework. Conclusions Medical educators placed high value on rigorous methods and conceptual frameworks, consistent with published quality indexes. They also valued innovative or provocative work, feasibility, and applicability to their setting. End-user opinions of quality may illuminate how educators translate knowledge into practice. [ABSTRACT FROM AUTHOR]

Background Teaching practice-based learning and improvement and systems-based practice are challenging. Cardiology fellows at St John Hospital & Medical Center participate in a national registry of outpatient cardiology care. Objective We assessed the use of the registry, hypothesizing that it could serve as an effective foundation for studying ambulatory care, identifying gaps in care, and planning interventions to advance competence in practice-based learning and improvement and systems-based practice. Methods Starting in 2009, trainees prospectively entered data for ambulatory cardiac patients into the PINNACLE Registry database where compliance with 28 performance measures was calculated and reported quarterly. Fellows met with the program director individually and in groups to identify performance gaps and to develop and implement plans for quality improvement. Cardiology fellows were surveyed annually to assess this process. Results Through March 2012, the fellows had completed 2400 patient visits. Participation was feasible because it was cost neutral, with data form completion averaging 5 minutes. It was acceptable, with most fellows describing positive effects on practice-based learning and improvement without significant detriment to work flow. Performance achievement for drug therapies ranged from 69% (77 of 111) of the patients with atrial fibrillation receiving anticoagulation to 99% (486 of 489) of patients with coronary disease receiving lipidlowering therapy. Gaps in system performance included low levels for diabetes screening (5%; 20 of 422) and lipid monitoring (10%; 58 of 573). Initial quality improvement projects addressed practice gaps with straightforward solutions. Improving system performance was more challenging. Conclusions Using a registry in cardiology trainees' outpatient practice is feasible, acceptable, and valuable. It allows for planning and studying the effects of quality improvement projects. [ABSTRACT FROM AUTHOR]

Background: Evidence-based medicine (EBM) has become an important part of residency education, yet many EBM curricula lack a valid and standardized tool to identify learners' prior knowledge and assess progress. Objective: We developed an EBM examination in psychiatry to measure our effectiveness in teaching comprehensive EBM to residents. Methods: We developed a psychiatry EBM test using the validated EBM Fresno Test of Competence for family medicine. The test consists of case scenarios with openended questions. We also developed a scoring rubric and obtained reliability with multiple raters. Fifty-seven residents provided test data after completing 3, 6, 25, or 31 EBM sessions. The number of sessions for each resident was based on their length of training in our program. Results: The examination had strong interrater reliability, internal reliability, and item discrimination. Many residents showed significant improvement on their examination scores when data were compared from tests taken before and after a sequence of teaching sessions. Also, a threshold for the level of expert on the examination was established using test data from 5 EBM teacher-experts. Conclusions: We successfully developed a valid and reliable EBMexamination for use with psychiatry residents tomeasure essential EBMskills as part of a larger project to encourage EBM practice for residents in routine patient care. The test provides information on residents' knowledge in EBM from entry level concepts through expert performance. It can be used to place incoming residents in appropriate levels of an EBMcurriculumand to monitor the effectiveness of EBM instruction. [ABSTRACT FROM AUTHOR]

Background: Evidence-based practice in education requires high-quality evidence, and many in the medical education community have called for an improvement in the methodological quality of education research. Objective: Our aim was to use a valid measure of medical education research quality to highlight the methodological quality of research publications and provide an overview of the recent internal medicine (IM) residency literature. Methods: We searched MEDLINE and PreMEDLINE to identify English-language articles published in the United States and Canada between January 1, 2010, and December 31, 2011, focusing on IM residency education. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI), which has demonstrated reliability and validity. Qualitative articles were excluded. Articles were ranked by quality score, and the top 25% were examined for common themes, and 2 articles within each theme were selected for in-depth presentation. Results: The search identified 731 abstracts of which 223 articles met our inclusion criteria. The mean (±SD) MERSQI score of the 223 studies included in the review was 11.07 (±2.48). Quality scores were highest for data analysis (2.70) and lowest for study design (1.41) and validity (1.29). The themes identified included resident well-being, duty hours and resident workload, career decisions and gender, simulation medicine, and patient-centered outcomes. Conclusions: Our review provides an overview of the IM medical education literature for 2010-2011, highlighting 5 themes of interest to the medical education community. Study design and validity are 2 areas where improvements in methodological quality are needed, and authors should consider these when designing research protocols. [ABSTRACT FROM AUTHOR]

An introduction to the supplement for the "Journal of Graduate Medical Education" is presented.

The article presents a study which assessed competency-based assessment in medical training of residents based on entrustable professional activities (EPA) for the Internal Medicine (IM) Educational Milestones.

The article presents a study which examined the facets of competence (FOC) that are utilized by physician educators in entrusting responsibilities to medical trainees the Netherlands,

Background Despite the movement toward competency-based assessment by accrediting bodies in recent years, there is no consensus on how to best assess medical competence. Direct observation is a useful tool. At the same time, a comprehensive assessment system based on direct observation has been difficult to develop. Intervention We developed a system that translates data obtained from checklists of observed behaviors completed during educational activities, including direct observation of clinical care, into a graphic tool (the "radar graph") usable for both formative and summative assessment. Using unique, observable behaviors to evaluate levels of competency on the Dreyfus scale, we assessed resident performance in 6 learning sites within our residency. Data are represented on a radar graph, which residents and faculty used to recognize both strengths and areas for growth to guide educational planning for the individual learner. Results Initial data show that the radar graphs have construct validity because the development process accurately reflects the desired construct, assessors were adequately trained, and the radar graphs demonstrated resident growth over time. A form completion rate of 90% for .1500 disseminated assessments suggests the feasibility of our process. Conclusions The radar graph is a promising tool for use in resident feedback and competency assessment. Further research is needed to determine the full utility of the radar graphs, including a better understanding of the tool's reliability and construct validity. [ABSTRACT FROM AUTHOR]

The article discusses various papers published in this issue including one by Hauer et al. on the application of entrustable professional activity (EPA), one by Cianciolo and Kegg on the decision of clinical supervisors, and one by Wijnen-Meijer et al. on the qualities of medical educators.