NcXHF

MODERN DAY MEDICAL EDUCATION
TABLE 1. Potential Outcomes of a Successful Medical Education Program
Outputs Activities to Support Outputs Resources Required for Outputs
Educationally sound curriculum
or curricular intervention to
meet the needs of changing
health care landscape
Scholarship in medical education
Leaders trained specifically to address,
effectively navigate, and develop
programing in an increasingly complex
medical education and health care
landscape
Curricular development training including
project-based experiential learning in
curriculum development and
implementation, and skills
development in curricular evaluation
Training in research design and
methodology, data analysis,
manuscript writing, grant writing,
and statistics
Training in leadership skills development,
maintaining and developing
organizational efficiency, development
of personal leadership style, and how
to develop people
Faculty experts in curricular
development
Funding to support program
Faculty time
Funding for research
Faculty trained in medical
education research
methodology
Possible medical education
cooperative groups
Faculty time
Mentorship
Faculty time
Networking community
Educators in leadership
development
Funding
Potential Outcomes Related to
Successful Outputs
Compassionate and knowledgeable
providers who deliver efficient and cost
effective care
Innovative educational practices
Dissemination of new knowledge
Changes in organizational contexts and
leadership roles
Institutional and professional society
support and promotion of faculty as
medical educator
tural/ethnic background, trainee discussing informed consent
with a patient with low literacy level, etc. The trainee is
then judged based on an entrustment scale that describes the
level of trust that the trainee can carry out the given activity
competently and independently. For example, the trainee
can perform the skill with distant supervision, the trainee can
perform the skill with direct supervision, the trainee is aspirational
and can teach this skill to others. This gives the faculty
a more grounded view of how to evaluate trainees to
ascertain clinical competence in an area of emphasis in
modern-day medicine/health care. However, activities need
to be prescribed that allow observable behaviors to ensue.
Trainees will be evaluated on a trajectory of competence
and should demonstrate progress, not perfection, as they
advance toward independent practice. However, the question
remains how is the behavior measured or observed to
accurately place the trainee on a milestone trajectory? Additionally,
what activities meet the millennial learner
“right where they are” and, thus, provide a meaningful educational
experience? To meet these challenges, educators
need to cultivate and employ new assessment strategies.
Some of these new processes are described below and
placed in context of the aforementioned milestone.
In order to ground milestones in observable behavior, programs
are encouraged to develop entrustable professional activities
(EPAs) for each rotation. EPAs are units of
professional practice that can be performed (and observed by
faculty) with increasing autonomy and decreasing supervision
over time. 26,27 Think of EPAs as essential goals to achieve
over training. For instance, on the ward service, a trainee
should know how to manage febrile neutropenia and conduct
a family meeting; on the hematology consult rotation, a
trainee should accurately interpret a peripheral blood smear;
in their continuity clinic, a trainee should recognize and
manage the toxicities associated with chemotherapy. EPAs
can inform multiple competencies as noted in Table 2. The
training programs, under NAS, have the independence to
create the types and numbers of EPAs for each rotation.
ASSESSMENT STRATEGIES
Direct Observation
Direct observation provides the most accurate assessment of
a learner and provides the opportunity for immediate feedback.
Direct observation removes the biases of hearsay, selective
recall, or forgetting details that are common in global
end-of-rotation ratings. One of the limitations of direct observation
is that the rater may observe the learner in only a
fraction of their working hours. Direct observation should be
made by multiple observers on many occasions, and these
should be reviewed by the training program’s competency
committee.
The 360-Degree Evaluation
Multisource or 360-degree evaluations are another assessment
strategy that is valuable in providing evaluation of a
learner from multiple raters or sources. Such evaluations are
common in industry and gaining acceptance in the assess-
TABLE 2. Linking EPAs to ACGME Competencies
EPA Examples
ACGME Competencies
PC MK PBL SBP ICS P
Manage neutropenic fevers X
Conduct a family meeting X X X
Interpret a peripheral blood smear X X
Manage chemotherapy toxicities X X X
Abbreviations: EPA, entrustable professional activities; ACGME, Accreditation Council for
Graduate Medical Education; PC, patient care; MK, medical knowledge; PBL, practice-based
learning and improvement; SBP, systems-based practice; ICS, interpersonal and
communication skills; P, professionalism.
asco.org/edbook | 2015 ASCO EDUCATIONAL BOOK 35