Shobhina G. Chheda

Succeeding as a Clinician Educator: Useful Tips and Resources

Clinician Educators (CEs) play an essential role in the education and patient care missions of academic medical centers. Despite their crucial role, academic advancement is slower for CEs than for other faculty. Increased clinical productivity demands and financial stressors at academic medical centers add to the existing challenges faced by CEs. This perspective seeks to provide a framework for junior CEs to consider with the goal of maximizing their chance of academic success. We discuss six action areas that we consider central to flourishing at academic medical centers: 1. Clarify what success means and define goals; 2. Seek mentorship and be a responsible mentee; 3. Develop a niche and engage in relevant professional development; 4. Network; 5. Transform educational activities into scholarship; and 6. Seek funding and other resources.

Reflective Writing in the Internal Medicine Clerkship: A National Survey of Clerkship Directors in Internal Medicine

Background and Purpose: Reflective writing programs have been implemented at many medical schools, but it is unclear to what extent and how they are structured. Methods: We surveyed the 107 Clerkship Directors of Internal Medicine member institutions on use of reflective writing assignments during the internal medicine clerkship. Results: Eighty-six of 107 (80%) institutional members completed the survey. Thirty-five percent reported having a reflective writing assignment, 48% did not, and 6% did not but were considering starting one within the next 2 years. Of the 30 assignments, most were partially structured (60%), involved small-group discussion (57%), and provided individual student feedback (73%). A minority (30%) contributed to the students’ grade. Respondents believed assignments contributed to students’ learning in multiple domains, most often Professionalism (97%) and Communication (77%). Conclusions: Although reflective writing programs were common, variability existed in their structure. Further research is needed to determine how best to implement them.

Complexity in Graduate Medical Education: A Collaborative Education Agenda for Internal Medicine and Geriatric Medicine

ABSTRACTInternal medicine residents today face significant challenges in caring for an increasingly complex patient population within ever-changing education and health care environments. As a result, medical educators, health care system leaders, payers, and patients are demanding change and accountability in graduate medical education (GME). A 2012 Society of General Internal Medicine (SGIM) retreat identified medical education as an area for collaboration between internal medicine and geriatric medicine. The authors first determined a short-term research agenda for resident education by mapping selected internal medicine reporting milestones to geriatrics competencies, and listing available sample learner assessment tools. Next, the authors proposed a strategy for long-term collaboration in three priority areas in clinical medicine that are challenging for residents today: (1) team-based care, (2) transitions and readmissions, and (3) multi-morbidity. The short-term agenda focuses on learner assessment, while the long-term agenda allows for program evaluation and improvement. This model of collaboration in medical education combines the resources and expertise of internal medicine and geriatric medicine educators with the goal of increasing innovation and improving outcomes in GME targeting the needs of our residents and their patients.

A Review of the Medical Education Literature for Graduate Medical Education Teachers

BACKGROUND A rapidly evolving body of literature in medical education can impact the practice of clinical educators in graduate medical education. OBJECTIVE To aggregate studies published in the medical education literature in 2011 to provide teachers in general internal medicine with an overview of the current, relevant medical education literature. REVIEW We systematically searched major medical education journals and the general clinical literature for medical education studies with sound design and relevance to the educational practice of graduate medical education teachers. We chose 12 studies, grouped into themes, using a consensus method, and critiqued these studies. RESULTS Four themes emerged. They encompass (1) learner assessment, (2) duty hour limits and teaching in the inpatient setting, (3) innovations in teaching, and (4) learner distress. With each article we also present recommendations for how readers may use them as resources to update their clinical teaching. While we sought to identify the studies with the highest quality and greatest relevance to educators, limitation of the studies selected include their single-site and small sample nature, and the frequent lack of objective measures of outcomes. These limitations are shared with the larger body of medical education literature. CONCLUSIONS The themes and the recommendations for how to incorporate this information into clinical teaching have the potential to inform the educational practice of general internist educators as well as that of teachers in other specialties.

Teaching About Racial/Ethnic Health Disparities: A National Survey of Clerkship Directors in Internal Medicine

Background: The Institute of Medicine and the Liaison Committee on Medical Education (LCME) have both identified the importance of integrating teaching regarding health disparities into medical education. Thus far most of the limited teaching in this area occurs in the first two years of medical school. Purpose: The purpose of this study is to evaluate education in internal medicine clerkships about health disparities and understand barriers to including this content. Method: In 2005, the Clerkship Directors in Internal Medicine (CDIM) conducted their annual, confidential survey. The authors asked about clerkship content addressing ethnic/racial health disparities, means for implementing curricula, and barriers to covering disparities content. For each, there were yes/no statements, multiple-choice questions, and free text responses. Results: The survey response rate was 81% (88/109). Forty-one percent indicated that they cover ethnic/racial health disparities in their clerkship. Of these 36 respondents, 50% covered prevalence of disease. Fewer clerkships addressed differences in presentation of disease (33%), health outcomes (24%), and quality of care (19%). Barriers to including health disparities content: limited time in the curriculum (34%), clerkship director lack of expertise (12%), concerns regarding sensitive material (11%), and the opinion that evidence remains controversial (7%). Sixty-one percent of all respondents did feel that the “internal medicine clerkship should explicitly address ethnic/racial differences in common medical illnesses”; there was no correlation between clerkship director gender or age and response to this question (chi-square and Mann–Whitney U, respectively; p >.05). Conclusions: Although most internal medicine clerkships do not currently have explicit content about racial/ethnic health disparities, many regard this as essential content. National organizations, such as CDIM, can take leadership through modification of published guides on curriculum objectives and creating opportunities for dissemination of appropriate curriculum.

Update in medical education.

Academic general internists are integral medical educators across the entire continuum of learners. Medical education research allows us to incorporate best practices in curriculum development and assessment and to promote effective teaching behaviors. In this paper, we summarize selected articles chosen for presentation at the Update in Medical Education session at the 30th annual meeting of the Society of General Internal Medicine.

Re-demonstration without remediation – a missed opportunity? A national survey of internal medicine clerkship directors

Background Many different components factor into the final grade assigned for the internal medicine clerkship. Failure of one or more of these requires consideration of remedial measures. Purpose To determine which assessment components are used to assign students a passing grade for the clerkship and what remediation measures are required when students do not pass a component. Methods A national cross-sectional survey of Clerkship Directors in Internal Medicine (CDIM) institutional members was conducted in April 2011. The survey included sections on remediation, grading practices, and demographics. The authors analyzed responses using descriptive and comparative statistics. Results Response rate was 73% (86/113). Medicine clerkships required students to pass the following components: clinical evaluations 83 (97%), NBME subject exam 76 (88%), written assignments 40 (46%), OSCE 35 (41%), in-house written exam 23 (27%), and mini-CEX 19 (22%). When students failed a component of the clerkship for the first time, 55 schools (64%) simply allowed students to make up the component, while only 16 (18%) allowed a simple make-up for a second failure. Additional ward time was required by 24 schools (28%) for a first-time failure of one component of the clerkship and by 49 (57%) for a second failure. The presence or absence of true remedial measures in a school was not associated with clerkship director academic rank, grading scheme, or percent of students who failed the clerkship in the previous year. Conclusions Most schools required passing clinical evaluations and NBME subject exam components to pass the medicine clerkship, but there was variability in other requirements. Most schools allowed students to simply re-take the component for a first-time failure. This study raises the question of whether true remediation is being undertaken before students are asked to re-demonstrate competence in a failed area of the clerkship to be ready for the subinternship level.Background Many different components factor into the final grade assigned for the internal medicine clerkship. Failure of one or more of these requires consideration of remedial measures. Purpose To determine which assessment components are used to assign students a passing grade for the clerkship and what remediation measures are required when students do not pass a component. Methods A national cross-sectional survey of Clerkship Directors in Internal Medicine (CDIM) institutional members was conducted in April 2011. The survey included sections on remediation, grading practices, and demographics. The authors analyzed responses using descriptive and comparative statistics. Results Response rate was 73% (86/113). Medicine clerkships required students to pass the following components: clinical evaluations 83 (97%), NBME subject exam 76 (88%), written assignments 40 (46%), OSCE 35 (41%), in-house written exam 23 (27%), and mini-CEX 19 (22%). When students failed a component of the clerkship for the first time, 55 schools (64%) simply allowed students to make up the component, while only 16 (18%) allowed a simple make-up for a second failure. Additional ward time was required by 24 schools (28%) for a first-time failure of one component of the clerkship and by 49 (57%) for a second failure. The presence or absence of true remedial measures in a school was not associated with clerkship director academic rank, grading scheme, or percent of students who failed the clerkship in the previous year. Conclusions Most schools required passing clinical evaluations and NBME subject exam components to pass the medicine clerkship, but there was variability in other requirements. Most schools allowed students to simply re-take the component for a first-time failure. This study raises the question of whether true remediation is being undertaken before students are asked to re-demonstrate competence in a failed area of the clerkship to be ready for the subinternship level.

Update in medical education 2010-2011.

This review brings important medical education articles of 2010 to the attention of academic general internists. These studies offer methods to improve trainee supervision, continuity of care and the physical examination. The summaries also serve as a reminder of the environmental challenges facing faculty and learners, including burnout and a sense of entitlement among learners, and offer some insight in addressing both issues.

An Entrustable Professional Activity (EPA)-Based Framework to Prepare Fourth-Year Medical Students for Internal Medicine Careers

The purpose of the fourth year of medical school remains controversial. Competing demands during this transitional phase cause confusion for students and educators. In 2014, the Association of American Medical Colleges (AAMC) released 13 Core Entrustable Professional Activities for Entering Residency (CEPAERs). A committee comprising members of the Clerkship Directors in Internal Medicine and the Association of Program Directors in Internal Medicine applied these principles to preparing students for internal medicine residencies. The authors propose a curricular framework based on five CEPAERs that were felt to be most relevant to residency preparation, informed by prior stakeholder surveys. The critical areas outlined include entering orders, forming and answering clinical questions, conducting patient care handovers, collaborating interprofessionally, and recognizing patients requiring urgent care and initiating that care. For each CEPAER, the authors offer suggestions about instruction and assessment of competency. The fourth year of medical school can be rewarding for students, while adequately preparing them to begin residency, by addressing important elements defined in the core entrustable activities. Thus prepared, new residents can function safely and competently in supervised postgraduate settings.

For the General Internist: A Review of Relevant 2013 Innovations in Medical Education

We conducted a review of articles published in 2013 to identify high-quality research in medical education that was relevant to general medicine education practice. Our review team consisted of six general internists with expertise in medical education of varying ranks, as well as a professional medical librarian. We manually searched 15 journals in pairs, and performed an online search using the PubMed search engine for all original research articles in medical education published in 2013. From the total 4,181 citations identified, we selected 65 articles considered most relevant to general medicine educational practice. Each team member then independently reviewed and rated the quality of each selected article using the modified Medical Education Research Study Quality Instrument. We then reviewed the quality and relevance of each selected study and grouped them into categories of propensity for inclusion. Nineteen studies were felt to be of adequate quality and were of moderate to high propensity for inclusion. Team members then independently voted for studies they felt to be of the highest relevance and quality within the 19 selected studies. The ten articles with the greatest number of votes were included in the review. We categorized the studies into five general themes: Improving Clinical Skills in UME, Inpatient Clinical Teaching Methods, Advancements in Continuity Clinic, Handoffs/Transitions in Care, and Trainee Assessment. Most studies in our review of the 2013 literature in general medical education were limited to single institutions and non-randomized study designs; we identified significant limitations of each study. Selected articles may inform future research and practice of medical educators.