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IAMSE Winter 2018 WAS Session 3 Highlights

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In case you missed yesterday’s Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

Integration, Competence and Expertise: Preparing Learners for the Future
Presenter: Nicole N. Woods PhD
January 25, 12 PM ET

Discuss the current and future state of Competency Based Medical Education (CBME).

The Expert: The planned model of CBME and most educational programs is that at some point the individuals that enter and complete our programs will in fact end up as experts.

Medical education can be seen as the pathway that allows our learners to become experts.

What are a few of the assumptions we make as educators along this pathway prior to CBME?

Required Skill: assume students will have a set of required skills at the end of the journey or pathway.

Time: assume a certain amount of time that this journey to expertise is to take.

Single summit: everyone reaches the same place and there is only one-way to get there.

Inevitable: expertise is an inevitable outcome of the journey.

Some of these assumptions can be problematic. CBME has been proposed at many schools as an opportunity to address these assumptions/challenges head on.

1.Competencies are clearly articulated

2.Competencies are arranged progressively

3.Learning experiences facilitate the progressive development of competencies

4.Teaching practices promote the progressive development of competencies

5.Assessment practices support and document the progressive development of competencies

Core components of CBME are underlined above.

Keep in mind that CBME, like any approach to education will succeed or fail based on how it is implemented.

If we have not put into place the learning experiences, the teaching practices and the assessment practices to support the skills that our students need, all of this work will be for not.

Expertise Development: What does it mean to be an expert in a given field and what is the pathway to get there?

Most of the models agree that at the very least an expert must be able to efficiently and effectively perform all of the general, everyday tasks that make up their daily work.

Routine Work—Something you’ve seen before or know how to deal with.

According to Dreyfus and Dreyfus “when things are proceeding normally experts do what normally works”.

Here’s the challenge.  Medical practice is not just about routine work.

Non-Routine Work – Something you’ve never seen before or don’t know how to deal with.

Useful models of expertise development tells us the expert must be prepared to deal with:

Complexity: problem that looks similar to other problems but now has an added level of complexity.

Ambiguity: problems and solutions are not always obvious.

Novelty: encounter something that they have never seen before. Expert is not able to just walk away.

Adaptive experts use existing knowledge to solve routine problems and are able to create new solutions to non-routine problems. Can deal with both routine and non-routine problems.

Adaptive expertise is not the sole trajectory of education.

We have a Goal.

We want to use CBME to create educational experiences that prepares students to become competent.

Competence is the ability to handle routine and non-routine aspects of clinical work.

Therefore, teaching strategies, learning experiences and assessment practices must prepare learner to handle routine and non-routine clinical problems in the future.

Adaptive experts use existing knowledge to problem solve.

Knowledge is memory and memory is knowledge.

Information enters the brain and is processed and is stored in short-term memory. With rehearsal or practice that information would eventually move out of short-term memory in to long-term memory where it can be retrieved when needed. If there is no practice or rehearsal, the information is forgotten.

In order to keep this information in long-term memory, it seems that repetition becomes really important.

Here’s the problem. Repetition encourages shallow processing. Basically repetition is not as useful as we think in transferring information from short-term to move to long-term storage.

Repetition does not necessarily enhance memory and can actually harm later performance.

Learning experiences that emphasize repetition are insufficient for the development of knowledge.

Therefore in the implementation of CBME we need to be mindful that we don’t inadvertently emphasize repetition of performance as demonstration of competence.

There are different types of knowledge and CBME has to be constructed to support the development of all of them.

Procedural knowledge: knowing what to do.

Conceptual knowledge: knowing WHY you’re doing it.

All knowledge is contained what is known as a semantic network, which is a set of abstract concepts and specific experiences.

Basis of semantic network is Connections are based on meaning and based on why.

Semantic networks are comprised of boxes and lines. The boxes are the nodes and the lines are the connections between the nodes.

Nodes are clinical concepts and connections are basic science concepts.

Any educational models need to emphasize integration of procedural and conceptual knowledge.

Need to teach and assess in an integrated fashion.

The depth of the memory trace depends on the meaning you extract from the stimulus not the number of times it is encountered.

Why does any of this matter?

Need to adapt/create solutions to address new problems.

New solutions to new problems require deep conceptual knowledge

CME teaching and assessment must be carefully constructed to foster the development of conceptual knowledge through instruction and assessment that capitalizes on Variation.

Variation allows learners to purposely learn through problem solving.

Assessment is a good way to do this.

Static assessment is to teach and then test. Does not provide crucial information about learning processes deficient cognitive functions.

Better way to assess is through dynamic assessment. Assesses the level of internalization and transfer value to other problems of increased level of complexity, novelty and abstraction.

CBME can support training for routine and non-routine problems.

Adaptive experts use existing knowledge to solve routine problems where conceptual knowledge is needed to adapt new solutions for non-routine problems.

Can support development of conceptual knowledge through integration, contextual variation and dynamic assessment.

For more information on the next session or to register, please click here.

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IAMSE – Featured Member: Rick Vari, IAMSE President

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I am honored to serve as the next President of IAMSE, my medical educational family! I would like to personally thank Veronica Michaelsen for her leadership as president for the past two years and recognize three mentors in IAMSE who have provided me with their wisdom, support and encouragement: Adi Haramati, Giulia Bonaminio, and Amy Wilson-Delfosse. Thank You.

I am excited to help facilitate and lead the Board of Directors and the many committee chairs and membership into an exciting future as we expand our connectivity to other health sciences educators from around the globe. We will work diligently together to not only provide outstanding programming, innovative educational opportunities and exciting and interesting meeting venues; but to explore new ways to expand the impact of IAMSE on health sciences education. The membership of our association, growing across multiple professions, is full of excitement and loaded with new ideas. We have a lot of momentum. We need to seize this opportunity to reach new heights. That will take teamwork and leadership, enthusiasm and hard work. Let’s get to it!

IAMSE – Publications Committee MSE Article Review

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The Publications Committee wants to call your attention to interesting articles in Medical Science Educator, our society’s journal. I have briefly reviewed “How Do Medical Students Prepare for Flipped Classrooms?” Bouwmeester et al (Medical Science Educator 26:297-305:2016). The flipped classroom concept has students study the lecture and some supplementary material online before class. In class students discuss and ask questions on the study topics.  In education circles, the flipped classroom has had success in pre-college education. One of the major requirements of the flipped classroom is that the students are required to study topics to be discussed in class before coming to class. This paper asked the question how medical students prepare for flipped courses in medical school for both basic and clinical science courses. This paper identifies the student’s study choices for their preparation for flipped classroom medical school courses.

The paper describes student preparation at Utrecht University for a 4-week basic science Anatomy class and a 5-week clinical Rheumatology and Orthopedics course. For both courses learning instructions stressed pre-class preparation was critical for in-class discussions and activities to be successful. For the Anatomy course all pre-class study material were prepared in an iBook format including text selections on the topics, web lectures, informative test questions, links to scientific papers, and links to additional e-books. For the flipped clinical Rheumatology and Orthopedics similar course materials were provided for students on Blackboard.

For both courses web lectures and text study were rated most highly by the students followed closely by formative questions which students used to evaluate their progress in learning. Additional books and scientific papers were rated about half as high as the lecture and text materials. The authors noted that in both courses a subset of students used formative questions, scientific papers and additional texts to a greater extent. Interestingly the subgroups of students were not the same for the two courses.  This observation suggested that limiting materials to only web lectures and texts might not be beneficial to all students.

Other questions asked students to correlate self-reported use of study materials and their perceived learning strategies. In this study watching web lectures helped students discern important topics for study and how they will need to tailor their study habits for each class. Students reported that reading text materials helped motivate students to prepare for the upcoming classes and also helped students to identify material that may need to be memorized or rehearsed prior to class for better understanding.

For educators that anticipate switching teaching methods to utilize the flipped classroom this paper could be quite helpful and provide important insight for materials provided for the medical student’s education. You can access this article and many others like this at www.iamse.org by following the link to Medical Science Educator.

IAMSE – Call for Teaching Excellence Award Nominations – Due April 1

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DEADLINE EXTENDED

Since 2007, IAMSE has honored member medical educators with two prestigious awards to recognize and promote teaching excellence and educational scholarship in the medical sciences. We now open the nominations for the 2018 Excellence in Teaching awards, which will be presented at the annual meeting in Las Vegas, Nevada in June.

The Distinguished Career Award for Excellence in Teaching and Educational Scholarship (formerly called the Master Scholar Award) recognizes an IAMSE member who has a distinguished record of educational scholarship, including educational research and dissemination of scholarly approaches to teaching and education. Candidates should be Professor, Associate Professor, or equivalent rank, or have demonstrated greater than 10 years of educational scholarship. Additionally, candidates must have a significant record of engagement within IAMSE.

The Early Career Award for Excellence in Teaching and Innovation honors an IAMSE member who has made significant contributions to the field in the short time they have focused their careers toward enhancing teaching, learning and assessment. Candidates for this award will be Assistant Professor or equivalent rank, or have demonstrated less than 10 years of educational scholarship.

Qualified candidates may self-nominate, or be nominated by an IAMSE colleague.

Details regarding each award, required application materials, and deadlines are found in the document linked here. All nomination/application packets must be received by Cassie Chinn (cassie@iamse.org) no later than April 1, 2018.

IAMSE Winter 2018 WAS Session 2 Highlights

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In case you missed yesterday’s Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

Generating Trust in Entrustment: an update from the AAMC Core EPA Pilot Group
Presenter: Kimberly D. Lomis MD
January 11, 12 PM EST

Goals of Webinar

  • Review the background of the AAMC Core EPAs for Entering Residency initiative
  • Summarize recent activities of the national pilot group
  • Review guiding principles for implementation
  • Introduce the EPA toolkits
  • Discuss areas of ongoing development & study
  • Can see the Core EPA Pilot Project at AAMC website

Core EPA Pilot Project Motivated by patient safety

Desired Outcomes

  • Competencies, which are trainable attributes of an individual
  • Milestones, which are the developmental trajectory of the individual
  • EPAs describes units of work
  • Entrustments for a task requires the synthetic application of multiple competencies at a specified level of performance (milestone)

13 EPAs that can be found at the AAMC website

  • History and examination
  • Differential diagnosis
  • Common tests
  • Enter orders
  • Document encounter
  • Oral presentation
  • Clinical questions
  • Patient handover
  • Interprofessional team
  • Emergent care
  • Obtain consent
  • Perform procedures
  • Safety and improvement

Targeting summative entrustments decisions for that class at graduation in 2019.

10 Medical Schools participated in the Pilot

Four Key Concepts in Implementation of EPAs

  • Entrustment

Dimensions of Trustworthiness

  • Knowledge and Skill
  • Discernment
  • Conscientiousness
  • Truthfulness
  • Assessment
    • Need to be able to assess the Resident in the “ clinical work place”
    • Digital Portfolios are necessary to assess
  • Curriculum
    • Organized and systems-based approach
  • Faculty Development needs include:
    • Various faculty roles will require differing levels of training regarding the EPA framework

Nine Guiding Principles are available on the AAMC Initiative Website

  • EPA Toolkits and “One-Pagers” are available at the website as well.
  • Toolkit Structure includes
  • FAQs
  • “One-Pager” Schematic for the specific EPA
  • Resources from AAMC’s DREAM repository
  • Bulleted list of Behaviors and Vignettes
  • Complete Physician Competency Reference Set (PCRS)

Resources

  • Faculty and Learners’ Guide
    Curriculum Developers’ Guide
    AAMC Core EPA Guides
  • AAMC Pilot Group recommendations: Guiding Principles

To subscribe to the AAMC Core EPA list serve, send a blank email to subscribe-coreepas@lists.aamc.org

For more information on the next session or to register, please click here.

IAMSE Winter Web Audio Seminar “Competency based education across the UME-GME continuum: the EPAC program”

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Competency based education across the UME-GME continuum: the EPAC program
Presenter: Deborah Powell
February 8, 12 PM ET

This session will describe the Education in Pediatrics Across the Continuum project (EPAC) which is sponsored by the AAMC and initially funded by the Josiah Macy Jr. Foundation. In addition to describing the goals and structure of this educational initiative, the project’s assessment strategies and criteria for advancement to GME will be outlined. Project outcomes to date and ongoing work will be discussed as well.

For more information and to register for the Winter 2018 Audio Seminar Series, please click here.

#IAMSE18 – Registration Now Open!

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We are pleased to announce that registration for the 22nd Annual Meeting of IAMSE to be held June 9-12, 2018 at the Green Valley Ranch and Resort, just outside of Las Vegas, NV, USA is now open!

At the annual meeting of the International Association of Medical Science Educators (IAMSE) faculty, staff and students from around the world who are interested in medical science education join together in faculty development and networking opportunities. Sessions on curriculum development, assessment and simulation are among the common topics available at the annual meetings.

Additional meeting details and registration can be found online at www.iamseconference.org.

We look forward to seeing you in Las Vegas!

IAMSE Winter 2018 WAS Session 1 Highlights

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In case you missed yesterday’s Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

Competency-Based Medical Education: Understanding the Principles
Presenter: Linda Snell, MD, MHPE, FRCPC, MACP
January 11, 12 PM EST

Goals of Webinar

  • To lay the foundation for future sessions in this series;
  • To outline reasons why we need to change our current education system, and how competency-based medical education (CBME) may address these
  • To define CBME and common terms that are used when discussing it;
  • To enumerate the 5 components of CBME
  • To describe models for implementing CBME across the continuum of medical education

Key terms:

  • Competency – the thing(s) they need to do.
  • Competent – can do all of the things.
  • Competence – does all of the things consistently, adapting to contextual and situational needs.

Why change our current education system?

  • Today’s medicine is changing in terms of the Profession, Patient and Public safety and access to care.
  • How can we as medical educators prepare physicians to be effective in this environment?
  • Competence drops over time and there are competency gaps.

Challenges of current education system

  • Modern Medical Education is based on time (fixed length of time) and not ability.
  • Trainees unprepared to move on
  • Tend to assess trainees outside of clinical setting.
  • Fail to fail
  • Overloaded or burden of faculty
  • Education not based on patient or society’s needs

Highlights of the Flexner Report

  • Need for fundamental redesign
  • Facts and concepts need to be taught, practiced and assessed in the context
  • Evaluation of learners must reach beyond knowledge to rigorously assess procedural skills, judgment
  • practice until an acceptable level of proficiency is attained
  • develop approaches to skills training that do not put our patients at risk in service to education

We need doctors who …

  • Are optimally prepared for practice
  • Can safely provide complex care
  • Can work and lead health care teams
  • Maintain / improve their competence in changing contexts
  • Possess skills and abilities beyond knowledge
  • Knowing > doing > being

We need medical education that …

  • Is based on explicit outcomes needed by graduates
  • Transparent to learners, teachers, assessors
  • Focuses on individual learner needs
  • Ensures physician competence increases over time
  • Teaches for competence, aims for excellence
  • Promotes life-long learning
  • Provides ‘right’ amount of time
  • Provides public accountability

“We believe that in the future, expertise rather than experience will underlie competency-based practice and…certification.”

Fundamental concepts of CBME

  • Education must be based on the health needs of the populations served
  • Primary focus of education & training should be desired outcomes for learners rather than structure and process of the system
  • The formation of a physician should be integrated across the continuum – UGME > PGME > practice

CBME principles

  1. Focus on outcomes: graduate abilities
  2. Ensure progression of competence
  3. Time is a resource, not framework
  4. Promote learner centeredness
  5. Greater transparency & utility

Milestones and EPAs

Milestone: 

A defined, observable marker of an individual’s ability along a developmental continuum that expresses the stepwise progression of expertise; ‘significant point in development’

e.g. Respond to patients’ non-verbal communication; use appropriate non-verbal behaviors to enhance communication with patients

Milestones tend to be:

  • Applied to a person
  • More detailed than competencies
  • Clear descriptions, explicit statements
  • Expected level of ability
  • Observable – link to feedback

Issues Milestones Address

  1. Progression of Competence
  2. Authentic Assessment
  3. Comprehensive Curriculum
  4. Faculty guidance
  5. Learner transparency
  6. Failure to fail

Entrustable Professional Activity (EPA): 

A key task of a discipline (profession, specialty, or sub-specialty) that an individual can be trusted to perform without direct supervision in a given health care context, once sufficient competence has been demonstrated.

EPAs Describes a task

  • Links competency to clinical context
  • Reflects a collection of different competencies as applied to the work of the discipline

Linking EPAs and milestones

  • Assessing unstable patients, providing targeted treatment and consulting as needed
  • Recognize medical instability
  • Address primary priorities of resuscitation (ABCs)
  • Perform a focused clinical assessment
  • Develop a specific differential diagnosis
  • Develop and implement preliminary treatment strategies
  • Identify the necessity and urgency of consultation for advanced care
  • Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions
  • Communicate with the receiving physicians or health care professionals during transitions in care

Core Components of CBME

  1. Competencies required for practice are clearly articulated.
  2. Competencies are arranged progressively.
  3. Learning experiences facilitate the progressive development of competencies.
  4. Teaching practices promote the progressive development of competencies.
  5. Assessment practices support and document the progressive development of competencies.

Common competencies within the frameworks

  • (Clinical) expertise
  • Problem solving
  • Health advocacy / prevention
  • Communication skills
  • Teamwork / collaboration
  • Leadership and management
  • Teaching skills
  • Life-long learning
  • Critical appraisal
  • Professionalism

For more information on the next session or to register, please click here.

IAMSE Winter Web Audio Seminar “Continuity, LICs and Competency-based Education – 2018”

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Continuity, LICs and Competency-based Education – 2018
Presenter: Molly Cooke
February 1, 12 PM ET

This session will describe the current state of Longitudinal Integrated Clerkships (LICs) in medical education in the US, including the variety of formats that incorporate longitudinally and integration in some degree. It will describe what we know about the outcome of clinical education in this format for medical students and emerging trends in LICs. Because of the audience, special attention will be paid to how issues and concepts in fundamental science can be addressed in the LIC format.

For more information and to register for the Winter 2018 Audio Seminar Series, please click here.

IAMSE Winter Web Audio Seminar “Integration, competence and expertise: Preparing learners for the future”

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Integration, competence and expertise: Preparing learners for the future
Presenter: Nikki Woods
January 25, 12 PM ET

As medical education prepares for the shift to competency-based education, there is increasing emphasis on identifying and assessing the specific knowledge and skills needed for safe medical practice. However, putting this new understanding into practice is made complicated by perceptual/knowledge limitations of students and fundamentally flawed models of information processing and memory implicitly held by many teachers. This session will provide participants with basic understanding of core principles of memory, attention, categorization and expertise development drawn from the cognitive psychology literature. Participants will learn new ways to conceptualize their own expertise and better prepare their learners for the complexities of future practice.

For more information and to register for the Winter 2018 Audio Seminar Series, please click here.

IAMSE – Spring 2018 Webcast Audio Seminar Series Save the Date!

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IAMSE is pleased to announce the Spring 2018 Web Seminar Series!

Integrating Nutrition and Wellness Instruction: Practical Applications for Health Science Educators

As a follow-up to our successful series on faculty and student wellness and resiliency and as a prelude to our annual meeting integrating nutrition and wellness education in teaching the health sciences, the 2018 Spring IAMSE Web Seminar Series focuses on specific examples of how schools have implemented programs to address these issues. The first session will feature presentations by Angela Cheung from the University of Toronto and Maryam Hamidi from Stanford who will describe the current status of physician nutrition, barriers to healthy eating by physician training and practice, and suggestions for awareness recognition of the importance of proper nutrition in the wellness of physicians. The second session will be presented by Nicholas Pennings from Campbell University who will highlight, from a practical standpoint, how a new osteopathic medical school implemented a longitudinal nutrition theme focused on obesity. The next session will be presented by Sian Cotton who will provide a detailed description of a highly successful center for the promotion of integrative health and wellness at the University of Cincinnati. The fourth session will be another paired presentation by John Yoon from the University of Chicago and Tania Jenkins from Temple who will highlight research focused on the moral and spiritual development of students over-time, conducted as part of the of the “Good Physician Project”. The series concludes with a presentation by Joe Shapiro from Beth Israel on promotion of student wellness using peer-support groups. This series will set the stage for our upcoming meeting and provide insight into implementation of these important curricular initiatives.

Sessions will be every Thursday at 12 PM Eastern Time from March 8 to April 5, 2018.

Registration is set to open in January. Please visit www.iamse.org for more information.

IAMSE Winter Web Audio Seminar “Generating Trust in Entrustment: an update from the AAMC Core EPA Pilot Group”

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Generating Trust in Entrustment: an update from the AAMC Core EPA Pilot Group
Presenter: Kim Lomis
January 18, 12 PM ET

Dr. Lomis, on behalf of the national pilot group, will briefly review the background of the AAMC Core EPAs for Entering Residency initiative and will summarize recent activities of the national pilot group. Guiding principles for implementation will be elucidated, and areas of ongoing development and study will be discussed.

For more information and to register for the Winter 2018 Audio Seminar Series, please click here.