Tai M. Lockspeiser

Students’ Perspectives on the Fourth Year of Medical School: A Mixed-Methods Analysis

Purpose Little is known about the purpose and value of the fourth year of medical school from the perspective of medical students. In this study, the authors systematically explored the year’s purpose and value as determined by students. Method In April 2011, the authors conducted semistructured focus groups with graduating fourth-year students at the University of Colorado School of Medicine to understand their perspectives on the purpose of the fourth year. Using results of a thematic analysis of the focus group data, the authors developed and administered a 10-item questionnaire to all graduating fourth-year medical students in May 2011. Questionnaire data were analyzed using descriptive statistics and exploratory factor analysis. Results A total of 17 students participated in two focus groups. Six themes related to the purpose of the fourth year emerged from the focus group data: career development and preparation, pursuing personal interests, career identification, exploration of diverse practice settings, influence of emotion, and flexibility and individualization. The questionnaire was completed by 134 of 148 students (91% response rate). Factor analysis of the questionnaire data identified five factors: strengthening one’s residency application, developing skills, pursuing personal interests, exploring diverse practice settings, and identifying a career. Conclusions Medical students uniformly identified the fourth year of medical school as having purpose and value, but their views on the fourth year’s purpose differed. This finding underscores the importance of the individualization of the fourth year. Students’ perspectives should inform any decisions made about modifying fourth-year curricula and structure.

Assessing residents' written learning goals and goal writing skill: Validity evidence for the learning goal scoring rubric

Purpose To provide validity evidence for use of the Learning Goal Scoring Rubric to assess the quality of written learning goals and residents’ goal writing skills. Method This two-part study used the rubric to assess University of Colorado third-year pediatric residents’ written learning goals to obtain validity evidence. In study 1, five raters independently scored 48 goals written in 2010–2011 and 2011–2012 by 48 residents, who also responded to the Jefferson Scale of Physician Lifelong Learning (JeffSPLL). In study 2, two raters independently scored 48 goals written in 2011–2012 by 12 residents. Intraclass correlation coefficients (ICCs) assessed rater agreement to provide evidence for response process. Generalizability theory assessed internal structure. Independent-samples Mann–Whitney U tests and correlations assessed relationship to other variables. Content was matched to published literature and instructional methods. Results The ICC was 0.71 for the overall rubric. In study 1, where the generalizability study’s (G study’s) object of measurement was learning goals, the phi coefficient was 0.867. In study 2, where the G study’s object of measurement was the resident (goal writing skill), the phi coefficient was 0.751. The total mean score of residents with goal writing training was significantly higher than that of those without (7.54 versus 4.98, P < .001). Correlation between goal quality and JeffSPLL score was not significant. Investigators agreed that the content matched the published literature and instructional methods. Conclusions Preliminary validity evidence indicates that this scoring rubric can assess learning goal quality and goal writing skill.

Practical Suggestions for the Creation and Use of Meaningful Learning Goals in Graduate Medical Education.

From the Department of Pediatrics, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus, Ohio (Drs Reed and Mahan); Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo (Drs Lockspeiser, Hanson, and Rosenberg); Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children’s Hospital, Dayton, Ohio (Dr Burke); Department of Pediatrics, Children’s Hospital at Dartmouth, Geisel School of Medicine at Dartmouth, Hanover, NH (Dr Gifford); Department of Pediatrics, Riley Hospital for Children and IU School of Medicine, Indianapolis, Ind (Dr McKenna); and Department of Pediatrics, University of California Davis School of Medicine, Sacramento, Calif (Dr Li) The authors declare that they have no conflict of interest. Address correspondence to Suzanne Reed, MD, Division of Hematology/Oncology/BMT, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205 (e-mail: suzanne.reed@nationwidechildrens.org).

Applying the One Minute Preceptor Model to Pediatric and Adolescent Gynecology Education

There are multiple challenges to teaching in the clinical setting. The One Minute Preceptor is a learner-centered model for effective and efficient teaching in a clinical setting that can help to overcome these challenges. It consists of 5 microskills: get a commitment; probe for supporting evidence; teach general rules; reinforce what was right; correct mistakes. This article illustrates with case vignettes the use of these microskills for the busy Pediatric and Adolescent Gynecology clinician.

A longitudinal career-focused block for third-year pediatrics residents.

BACKGROUNDnThe traditional 1-month training blocks in pediatrics may fail to provide sufficient exposure to develop the knowledge, skills, and attitudes residents need for practice and may not be conducive to mentoring relationships with faculty and continuity with patients.nnnINTERVENTIONnWe created a 4-month career-focused experience (CFE) for third-year residents. The CFE included block time and longitudinal experiences in different content areas related to residents choice of urban and rural primary care, hospitalist medicine, or subspecialty care (prefellowship). Content was informed by graduate surveys, focus groups with primary care pediatricians and hospitalists, and interviews with fellowship directors. Outcomes were assessed via before and after surveys of residents attitudes and skills, assessment of skills with an objective structured clinical examination (OSCE), and interviews with residents and mentors.nnnRESULTSnTwenty-three of 49 third-year residents took part in the first 2xa0years of CFE. Two residents dropped out, leaving 21 who completed the 4-month experience (9 in primary care, 2 in hospitalist medicine, and 10 in a subspecialty). Residents reported improvement in their clinical skills, increased satisfaction with faculty mentoring and evaluation, and the ability to focus on what was important to their careers. OSCE performance did not differ between residents who completed the CFE and those who did not. Administrative burden was high.nnnCONCLUSIONSnFour-month career-focused training for pediatrics residents is feasible and may be effective in meeting part of the new requirement for 6xa0months of career-focused training during pediatrics residency.

Using Individualized Learning Plans to Facilitate Learner-Centered Teaching

Individualized learning plans (ILPs) are helpful tools that can facilitate learner-centered education and can be used with all levels of learners. We introduce the concept of ILPs, the rationale for their use in pediatric and adolescent gynecology education, and review the challenges that learners might face in creating ILPs, and describes how educators can support learners during this process.

Conducting Quantitative Medical Education Research: From Design to Dissemination

Rigorous medical education research is critical to effectively develop and evaluate the training we provide our learners. Yet many clinical medical educators lack the training and skills needed to conduct high-quality medical education research. We offer guidance on conducting sound quantitative medical education research. Our aim is to equip readers with the key skills and strategies necessary to conduct successful research projects, highlighting new concepts and controversies in the field. We utilize Glassicks criteria for scholarship as a framework to discuss strategies to ensure that the research question of interest is worthy of further study and how to use existing literature and conceptual frameworks to strengthen a research study. Through discussions of the strengths and limitations of commonly used study designs, we expose the reader to particular nuances of these decisions in medical education research and discuss outcomes generally focused on, as well as strategies for determining the significance of consequent findings. We conclude with information on critiquing research findings and preparing results for dissemination to a broad audience. Practical planning worksheets and comprehensive tables illustrating key concepts are provided in order to guide researchers through each step of the process. Medical education research provides wonderful opportunities to improve how we teach our learners, to satisfy our own intellectual curiosity, and ultimately to enhance the care provided to patients.

Leadership Observation and Feedback Tool: A Novel Instrument for Assessment of Clinical Leadership Skills

BackgroundnWhile leadership training is increasingly incorporated into residency education, existing assessment tools to provide feedback on leadership skills are only applicable in limited contexts.nnnObjectivenWe developed an instrument, the Leadership Observation and Feedback Tool (LOFT), for assessing clinical leadership.nnnMethodsnWe used an iterative process to develop the tool, beginning with adapting the Leadership Practices Inventory to create an open-ended survey for identification of clinical leadership behaviors. We presented these to leadership experts who defined essential behaviors through a modified Delphi approach. In May 2014 we tested the resulting 29-item tool among residents in the internal medicine and pediatrics departments at 2 academic medical centers. We analyzed instrument performance using Cronbachs alpha, interrater reliability using intraclass correlation coefficients (ICCs), and item performance using linear-by-linear test comparisons of responses by postgraduate year, site, and specialty.nnnResultsnA total of 377 (of 526, 72%) team members completed the LOFT for 95 (of 519, 18%) residents. Overall ratings were high-only 14% scored at the novice level. Cronbachs alpha was 0.79, and the ICC ranged from 0.20 to 0.79. Linear-by-linear test comparisons revealed significant differences between postgraduate year groups for some items, but no significant differences by site or specialty. Acceptability and usefulness ratings by respondents were high.nnnConclusionsnDespite a rigorous approach to instrument design, we were unable to collect convincing validity evidence for our instrument. The tool may still have some usefulness for providing formative feedback to residents on their clinical leadership skills.

Identification of foundational non-clinical attributes necessary for successful transition to residency: a modified Delphi study with experienced medical educators

BackgroundWe aimed to identify foundational non-clinical attributes expected of medical school graduates to be successful in residency.MethodsWe conducted a three-round modified Delphi study with snowball sampling of experienced medical educators. In Round 1, respondents rated 28 attributes identified from a literature search. Additional attributes were proposed through invited comments. In Round 2, respondents expressed their agreement with advanced attribute definitions and examples. Consensus on final definitions and examples was obtained in Round 3.ResultsSixty-four percent (105/163) of invited educators participated in Round 1. There was broad representation of educational focus (undergraduate, graduate, and continuing medical education) and field of practice (primary care, sub-specialty, medical, and surgical). Thirteen attributes were advanced to Round 2. Ninety-seven of 105 (92%) respondents participated in Round 2, with greater than 92% agreement for all attributes. Three pairs were consolidated. In Round 3, 88% (85/97) of educators expressed greater than 92% agreement about definitions and representative examples. The final 10 foundational attributes are: communication skills, critical thinking, emotional intelligence, ethical behavior, intellectual curiosity, organizational skills, resilience, self-improvement, teamwork, and vocational commitment.ConclusionThrough a consensus-building process of medical educators, we identified and defined 10 foundational non-clinical attributes for a medical student’s successful transition to residency.