Assessment of multiple physician competencies in postgraduate training: utility of the structured oral examination.

Competency based medical education involves assessing physicians-in-training in multiple roles. Training programs are challenged by the need to introduce appropriate yet feasible assessment methods. We therefore examined the utility of a structured oral examination (SOE) in the assessment of the 7 CanMEDS roles (Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional) in a Neonatal-Perinatal Medicine subspecialty training program. Between 2004 and 2008, 68 trainees participated in an annual SOE. Each SOE consisted of 4 1st year and 4 2nd year clinical scenarios with standardized questions written by neonatologists that addressed all 7 CanMEDS roles. Examiners assigned a checklist score and global rating scores for knowledge and organization. A satisfaction survey was completed at the end of 3 examinations. Across the 5 SOEs, questions related to each competency were tabulated and an overall checklist score for each competency calculated. Inter-station reliability was determined for each CanMEDS role. Values for Cronbach's alpha were 0.62 ± 0.2 (Medical Expert), 0.43 (Communicator), 0.40 ± 0.34 (Collaborator), 0.19 ± 0.17 (Manager), 0.46 ± 0.32 (Advocate), 0.67 ± 0.18 (Scholar) and 0.79 (Professional). Inter-rater reliability, determined for the first examination when there were 2 examiners per case, was moderate to substantial for 67% of cases. Participant satisfaction was high. Electronic communication facilitated exam development and costs were minimal. The SOE demonstrates psychometric properties suitable for a formative, in-training assessment as well as low cost, ease of administration and acceptability. It may be a useful way to assess physician competencies in training programs.

Evaluation of a collaborative mentorship program in a multi-site postgraduate training program.

BACKGROUND: Traditional one-on-one mentorship of trainees is challenging for multi-site training programs. Our three-site Neonatal - Perinatal Medicine Training Program therefore implemented collaborative mentorship. AIM: To describe and evaluate the effectiveness of collaborative mentorship. METHOD: Faculty Advisory Committee Triads (FACTs), comprising one staff neonatologist from each site, were created for each trainee. Guidelines for meeting frequency and process were developed. After 3 years, participants were invited to complete a questionnaire exploring three domains - helpfulness, participant opinion, and process. RESULTS: Twenty-four staff participated in 32 FACTs that mentored 32 trainees; 19 staff (79%) and 19 trainees (60%) completed the survey. All but one respondent preferred FACTs to individual mentors. Trainees were comfortable discussing both training program issues (90%) and social or personal issues (47%) with their FACT. Despite various ethno-cultural backgrounds, only 26% thought these should be similar for FACTs and trainees. More than 80% found FACTs supportive and beneficial for providing staff contacts at each site. Trainees found FACTs helpful for career planning, resource identification, clinical performance advice, and research motivation. More staff (79%) than trainees (33%) felt FACTs helped trainees get started in the program (p = 0.01), perhaps because not all trainees (47%) met with their FACT at the start of training. FACTs met one to four times annually; staff availability made scheduling difficult. CONCLUSION: In a multi-site training program, collaborative mentorship was effective in overcoming many barriers encountered with one-on-one mentorship.

Using an objective structured clinical examination (OSCE) to assess multiple physician competencies in postgraduate training.

BACKGROUND: Competency-based models of medical education require reliable and valid assessment of multiple physician roles. AIMS: To develop and evaluate an objective structured clinical examination (OSCE) designed to assess 7 physician competencies (CanMEDS Roles). METHODS: Twenty four candidates from 4 neonatal-perinatal medicine training programs participated in a 10-station OSCE. Ten 5-point rating scales were developed and used to assess the CanMEDS Roles of Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional. Three descriptors of performance anchored the ratings. For each station, examiners completed appropriate CanMEDS ratings, a station-specific binary checklist and an overall process-related global rating. Trained standardized patients (SP) and standardized health professionals (SHP) completed rating scales that assessed verbal and non-verbal expression, empathy and coherence as well as the overall global rating. RESULTS: Each station incorporated 3-5 physician Roles. Interstation alpha was 0.80 for checklist scores and 0.88 for examiners' overall global rating. Median interstation alpha for individual CanMEDS ratings was 0.72 (range 0.08-0.91). There were significant correlations between examiner Medical Expert scores and SP/SHP overall global scores and between examiner Communicator scores and 4 SP/SHP assessments of communication skills. Second year trainees' CanMEDS scores for each competency were significantly higher than those of first year trainees (p < 0.05). CONCLUSIONS: The OSCE may be useful as a reliable and valid method of simultaneously assessing multiple physician competencies.

Molar tooth sign in fetal brain magnetic resonance imaging leading to the prenatal diagnosis of Joubert syndrome and related disorders.

Joubert syndrome is a rare autosomal recessive disorder characterized by ataxia, developmental delay, and oculomotor and respiratory abnormalities in relation to cerebellar vermian and midbrain dysgenesis. The midbrain dysgenesis is responsible for the molar tooth sign on axial magnetic resonance imaging (MRI). This classic hallmark of Joubert syndrome has been identified in other disorders sharing overlapping clinical and radiologic features with Joubert syndrome. Recent identification of two different genes points to genetic heterogeneity in this group of disorders, now entitled Joubert syndrome and related disorders, making a genetic prenatal diagnosis not readily available. In addition, fetal ultrasonography lacks sensitivity in regard to posterior fossa malformation. Fetal MRI is now acknowledged as the method of choice to delineate posterior fossa malformation in a fetus. The identification of a molar tooth sign has, however, rarely been documented by a fetal brain MRI. We report a case of Joubert syndrome diagnosed prenatally using fetal MRI. We also discuss the etiology of Joubert syndrome in view of the recent genetic advances and murine models of cerebellar dysgenesis.