Allison R. Ownby

A Review of Portfolio Use in Residency Programs and Considerations before Implementation

Background: Portfolios, often described as collections of evidence, are discussed as a means of teaching or assessing the Accreditation Council for Graduate Medical Education competencies. Yet, it is unclear how many residency programs utilize portfolios. The purpose of this article is to (a) review the literature on portfolio use in graduate medical education; (b) examine efficacy of portfolio use, based upon studies in the field; and (c) offer a discussion of considerations for implementing portfolios. Summary: Two searches of PubMed, OVID, JSTOR, SCOPUS, and FirstSearch Wilson Select were conducted between October 2006 and April 2007 to identify studies and articles related to portfolio usage. Thirty-nine articles met criteria and were reviewed. Conclusions: There is wide variation in how portfolios are utilized within U.S. residency programs. The challenge for graduate medical education is to create consensus on the definition and purpose of portfolios, such that best practices in portfolio implementation and assessment can be achieved.

Systems-Based Practice in Graduate Medical Education: Systems Thinking as the Missing Foundational Construct

Background: Since 2001, residencies have struggled with teaching and assessing systems-based practice (SBP). One major obstacle may be that the competency alone is not sufficient to support assessment. We believe the foundational construct underlying SBP is systems thinking, absent from the current Accreditation Council for Graduate Medical Education competency language. Summary: Systems thinking is defined as the ability to analyze systems as a whole. The purpose of this article is to describe psychometric issues that constrain assessment of SBP and elucidate the role of systems thinking in teaching and assessing SBP. Conclusion: Residency programs should incorporate systems thinking models into their curricula. Trainees should be taught to understand systems at an abstract level, in order to analyze their own healthcare systems, and participate in quality and patient safety activities. We suggest that a developmental trajectory for systems thinking be developed, similar to the model described by Dreyfus and Dreyfus.

The effect of monthly resident reflection on achieving rotation goals

Background: Reflection is a learning tool increasingly being used in medical education. It has not been well studied as a method of communicating resident rotation goals and objectives. Purpose: The purpose was to study the effect of monthly resident reflection on achieving curriculum goals. Methods: During the first half of the 2005–06 academic year, obstetrics/gynecology residents at a community hospital received curriculum goals in a traditional written manner. During the second 6 months, the same trainees underwent 1-hr monthly structured reflection sessions on the rotation goals and objectives. Results: Sixteen residents were studied. Compared to control, residents reported the rotation goals as better defined during reflection months. More trainees rated reflection as more valuable than the didactic time it replaced. All 16 residents documented more cumulative procedures in the Accreditation Council for Graduate Medical Education operative log Web site during reflection months for each of the three major categories; there was a mean increased number of procedures logged in Obstetrics (23.1 ± 14.0, p < .001), Gynecology (18.3 ± 10.9, p < .001), and Primary Care (21.1 ± 23.5, p = .003). Overall, there was a mean of 62.6 ± 32.1 (p < .001) more procedures entered during the reflection period, which translated to an 18% increase. Conclusions: Structured monthly reflection may lead to a higher success of achieving rotation goals.

Relieving the Bottleneck: An Investigation of Barriers to Expansion of Supervision Networks at Genetic Counseling Training Programs

Rapid growth in the demand for genetic counselors has led to a workforce shortage. There is a prevailing assumption that the number of training slots for genetic counseling students is linked to the availability of clinical supervisors. This study aimed to determine and compare barriers to expansion of supervision networks at genetic counseling training programs as perceived by supervisors, non-supervisors, and Program Directors. Genetic counselors were recruited via National Society of Genetic Counselors e-blast; Program Directors received personal emails. Online surveys were completed by 216 supervisors, 98 non-supervisors, and 23 Program Directors. Respondents rated impact of 35 barriers; comparisons were made using Kruskal-Wallis and Wilcoxon ranked sum tests. Half of supervisors (51%) indicated willingness to increase supervision. All non-supervisors were willing to supervise. However, all agreed that being too busy impacted ability to supervise, highlighted by supervisors’ most impactful barriers: lack of time, other responsibilities, intensive nature of supervision, desire for breaks, and unfilled positions. Non-supervisors noted unique barriers: distance, institutional barriers, and non-clinical roles. Program Directors’ perceptions were congruent with those of genetic counselors with three exceptions they rated as impactful: lack of money, prefer not to supervise, and never been asked. In order to expand supervision networks and provide comprehensive student experiences, the profession must examine service delivery models to increase workplace efficiency, reconsider the supervision paradigm, and redefine what constitutes a countable case or place value on non-direct patient care experiences.

Creating a Common Curriculum for the DSM-5: Lessons in Collaboration

In 2013, the introduction of the Fifth Edition of the Diagnostic and Statistical Manual ofMental Disorders (DSM-5) created a challenge and an opportunity for psychiatric educators. The challenge consisted of the necessity of revising a standing curriculum for educating medical students and other learners. The opportunity consisted of the stimulus for innovation and collaboration. We decided to take advantage of the challenge of the introduction of the DSM-5 to collaboratively create a new curriculum that could eventually be shared with others. Since some of us were experienced Team-Based Learning practitioners, and others were not, the innovation also created an opportunity to disseminate knowledge about the pedagogy. There are multiple reasons for organizations to work together around a shared goal [1]. When groups collaborate, they can improve decisionmaking, utilize multiple perspectives to solve complex problems, create synergies to enhance creativity and skill development, and pool resources to quicken responsiveness to evolving conditions. The success of a collaborative effort depends on a variety of factors described in published reports, including the environment, membership, process and structure, communication, purpose, and resources. We believed that the environment for our collaboration was ideal because of our shared need to revise our curricula in response to the introduction of the DSM-5. All members of our collaborative knew each other professionally, and several had previous experience working together. While all of the institutions involved in the collaborative had individual resources sufficient to complete a new curriculum, none were capable of autonomously developing the ambitious and high quality product we envisioned. The membership (e.g., collaborative faculty) included experienced clerkship directors and/or educational researchers and thus was capable of meaningfully contributing to the group effort. All members agreed to the process and structure developed by the primary investigator. We established regular communications to facilitate completion of our project via email, conference calls, and face-to-face visits. A clearly defined and shared purpose was developed based on the ensuing publication of the DSM-5. By pooling resources, the collaboration was able to result in a complete curriculum in a relatively short period of time. Following is a description of how we developed the collaboration and some of the lessons learned though our experiences. * Ruth E. Levine rlevine@utmb.edu

The University of Texas Medical School at Houston.

The Medical School Curriculum Committee is a standing committee of the Faculty Senate and is responsible for the management of the entire medical school educational program (Figure 1). The Curriculum Committee is composed of faculty members from medical school departments including course and clerkship directors, representatives from the Office of Educational Programs and the Office of Admissions and Student Affairs, and student representatives from each year. Faculty members are approved for three-year terms, renewable once. The Chair and Vice Chair are appointed for three-year terms. The Chair and Vice Chair of the Curriculum Committee are members of the general medical school faculty. The Curriculum Committee has six subcommittees: Educational Policy Subcommittee, MSI and MSII Evaluation Subcommittee, MSIII and MSIV Evaluation Subcommittee, Curriculum Integration Subcommittee, Technology in Education Advisory Committee, and Scholarly Concentrations Advisory Committee.