Using the Modified Delphi Method to Develop a Tool to Assess Pediatric Residents Supervising on Inpatient Rounds.

BACKGROUND: Consensus about behaviors that define effective supervision by residents of more junior trainees on pediatric inpatient rounds is lacking. OBJECTIVE: Use modified Delphi method to develop a checklist of essential supervisory behaviors pediatric residents demonstrate while leading inpatient, non-ICU, nonspecialty teaching rounds and pilot the checklist. DESIGN/METHODS: One hundred and forty-one initial candidate behaviors were identified through literature review and narrowed by local stakeholders. Forty-one behaviors were submitted to national experts identified through purposive sampling to be refined using the modified Delphi method. Participants indicated agreement with behaviors' inclusion in the checklist and whether any were nonobservable. Measures of central tendency and dispersion were used to identify consensus with a behavior's inclusion in the next cycle. A criterion was eliminated if >25% of experts felt it was not observable. Cycles continued until consensus was reached on ≤20 behaviors. The resulting checklist was piloted at 2 hospitals. RESULTS: After 2 modified Delphi cycles, consensus was obtained on 18 behaviors for inclusion in the final checklist. These were spread across 3 subcategories: teaching, leadership, and patient safety. In the pilot, the checklist of behaviors discriminated between residents with differing levels of competency in supervising trainees on inpatient rounds. For residents who had the checklist completed by 2 faculties, there was 75% agreement in behaviors observed. CONCLUSION(S): Based on literature review, local stakeholder input, and consensus of national experts through the modified Delphi method, we created and piloted a checklist of observable behaviors characteristic of effective clinical supervision by pediatric residents leading trainee teams on inpatient, non-ICU, nonspecialty rounds.

TEACH and repeat: Deliberate practice for teaching.

BACKGROUND: Deliberate practice facilitates skill mastery. We aimed to create a novel resident-as-teacher rotation, leveraging a deliberate practice framework with repeated practice in real-life teaching settings, with feedback from dedicated faculty member coaches. METHODS: A resident-as-teacher rotation was designed for 35 Postgraduate Year-2 (PGY2) paediatric residents. To facilitate deliberate practice, teaching experiences were observed by faculty member coaches and were repeated with different audiences. Participating residents received pre-rotation, post-rotation and follow-up surveys on their confidence and comfort with teaching, supervision and feedback skills. All residents were also surveyed the year before and the year after implementation on their perceptions of their teaching, supervision and feedback skills, and whether the residency provided adequate training on these topics. RESULTS: Survey response rates varied from 40 to 71%. The rotation was highly valued, and deliberate practice was a most valued aspect. Mean scores in comfort and confidence significantly increased from pre- to post-rotation, with these increases sustained months later. Prior to implementation, residents' perceptions of their teaching skills and the adequacy of their training increased incrementally with each postgraduate year. After the inaugural year of the rotation, the PGY2 class rated their teaching skills and training as higher than more experienced residents. DISCUSSION: A novel resident-as-teacher rotation successfully incorporated deliberate practice in real-life settings by repeating teaching activities with feedback from dedicated coaches. The rotation led to sustained increases in residents' confidence in their teaching, supervising and feedback skills, and improved perceptions of their teaching training during residency.

The Columbia-Bronx VA amalgamative clerkship: an effective, 12-week, integrated, longitudinal clinical experience.

BACKGROUND: Many medical schools have adopted the longitudinal integrated clerkship (LIC) model in response to calls for increased continuity in clinical learning environments. However, because of implementation challenges, such programs are not feasible at some institutions or are limited to a small number of students. OBJECTIVE: In January 2014, Columbia University College of Physicians and Surgeons (P&S) recognized the need to explore different LIC formats and began offering four, 12-week amalgamative clerkships (AC). Students within this curricular track experienced primary care, internal medicine 'away', orthopedic surgery, urology, and an elective in an integrated format. DESIGN: P&S developed the AC in partnership with the James J. Peters VA Medical Center in Bronx, NY (BVA). All patient care and educational conferences took place at the BVA during the 12-week experience. The learning objectives of the AC were aligned to the learning objectives of a 52-week20 LIC also offered at Columbia. An evaluation process was developed to determine studentlearning experiences and preliminary outcomes, including how well the LIC-related objectivescould be achieved in a shorter period of time. RESULTS: In 2015, P&S collected AC evaluation data through three student feedback sessions. Students reported that the AC provided opportunity for patient continuity, patient-centered care approaches, meaningful roles for students, career development opportunities, and health systems awareness. CONCLUSIONS: Early outcomes indicate that the BVA AC provides a degree of longitudinality that can influence student perceptions of patient care, career development, and health systems, consistent with the larger LIC. The team continues to gather additional data on students' experiences and investigate additional sites that have potential to serve as future AC learning environments.