Growth mindset in competency-based medical education.

The ongoing adoption of competency-based medical education (CBME) across health professions training draws focus to learner-centred educational design and the importance of fostering a growth mindset in learners, teachers, and educational programs. An emerging body of literature addresses the instructional practices and features of learning environments that foster the skills and strategies necessary for trainees to be partners in their own learning and progression to competence and to develop skills for lifelong learning. Aligned with this emerging area is an interest in Dweck's self theory and the concept of the growth mindset. The growth mindset is an implicit belief held by an individual that intelligence and abilities are changeable, rather than fixed and immutable. In this paper, we present an overview of the growth mindset and how it aligns with the goals of CBME. We describe the challenges associated with shifting away from the fixed mindset of most traditional medical education assumptions and practices and discuss potential solutions and strategies at the individual, relational, and systems levels. Finally, we present future directions for research to better understand the growth mindset in the context of CBME.

Twelve tips for organising speed mentoring events for healthcare professionals at small or large-scale venues.

Mentors play a critical role in the development of professionals, influencing their job satisfaction, career aspirations and evolving professional identity. A variety of mentoring models exist, each with distinct benefits and challenges. Speed mentoring, based on the concept of speed dating, provides mentees with opportunities to meet multiple mentors over a short time and pose focussed career development questions. At large-scale events such as the annual AMEE (Association for Medical Education in Europe) meeting, speed mentoring sessions can successfully connect aspiring, novice and mid-career educators with international educational leaders to facilitate transfer of valuable insights for professional growth. For some mentors and mentees, this might spur ongoing communications or even longitudinal relationships. In this paper, we aim to provide strategies for planning and implementing speed mentoring events, combining insights gained from the literature and our experience of organising speed mentoring at the 2019 AMEE meeting in Vienna. These tips will be useful to a variety of professionals planning to organise speed mentoring initiatives.

Reshaping the residency environment to enhance education and mitigate burnout.

Burnout remains a widespread issue in graduate medical education, with current trends to mitigate burnout shifting toward institutional systematic interventions as opposed to personal individual interventions. In this article, we propose utilizing Knowle's adult learning theory in conjunction with Maslach's organizational context for burnout to implement systemic changes within the postgraduate training environment that we posit would both optimize the learning experience and reduce the incidence of burnout.

Entrustable professional activities (EPAs) for teachers in medical education: Has the time come?

On a daily basis, patients put their trust in the healthcare system for safe and high-quality healthcare. However, what evidence do we have as an educational community that our supervising faculty members are competent to fulfill this responsibility? Few, if any, requirements exist for faculty members to have continuous professional development in the field of medical education. Many faculty "love to teach", however, this love of teaching does not make them competent to teach or assess the competence of trainees whom they supervise. Faculty members who have a significant role as a teacher in the clinical setting should be assessed with regards to their baseline competence in applicable teaching EPAs. When competence is reached, an entrustment decision can be made. Once proficient or expert, a statement of awarded responsibility (STAR) may be granted. The time has come to reach beyond the "standards" of the old adage "see one, do one, teach one" in medical education. In this personal view, the authors outline an argument for and list the potential benefits for teachers, learners, and patients when we assess clinical teachers using EPAs within a competency-based medical education framework.

Pediatric Emergency Medicine Online Curriculum Improves Resident Knowledge Scores, But Will They Use It?

OBJECTIVE: Shift work on a pediatric emergency medicine (PEM) rotation makes didactic scheduling difficult, thereby limiting teaching opportunities. These constraints make this rotation an ideal setting to supplement resident education with an online curriculum. We aimed to determine if implementation of an online curriculum during a resident PEM rotation improves posttest performance and increases satisfaction with resident educational experience. METHODS: This was a prospective before/after study of pediatric and emergency medicine residents on a 1-month rotation in a tertiary care pediatric emergency department. A curriculum was developed consisting of 17 online modules. In the first 5 months of the study, 42 control residents received traditional bedside teaching. In the last 12 months, 80 intervention residents completed at least 8 modules during their rotation. Both groups completed a pretest at rotation start and a posttest and end-of-rotation survey at rotation end. RESULTS: Control group pretest and posttest scores were not significantly different. In the intervention group, posttest scores were significantly increased compared with pretest scores (68 vs 59, P < 0.01). A low percentage of residents completed the study. Only 42% of the 189 residents enrolled in the intervention group completed the posttest and 28% completed the survey. CONCLUSIONS: Implementing an online PEM curriculum significantly improved knowledge. As residency programs face new duty hour requirements, online curricula may provide an effective way to supplement teaching. However, to capitalize on this self-directed curriculum, the low participation rates in this study suggest we must first determine and establish ways to overcome barriers to online learning.

Twelve tips for developing, implementing, and sustaining medical education fellowship programs: Building on new trends and solid foundations.

Medical education fellowship programs (MEFPs) are a form of faculty development contributing to an organization's educational mission and participants' career development. Building an MEFP requires a systematic design, implementation, and evaluation approach which aligns institutional and individual faculty goals. Implementing an MEFP requires a team of committed individuals who provide expertise, guidance, and mentoring. Qualified MEFP directors should utilize instructional methods that promote individual and institutional short and long term growth. Directors must balance the use of traditional design, implementation, and evaluation methodologies with advancing trends that may support or threaten the acceptability and sustainability of the program. Drawing on the expertise of 28 MEFP directors, we provide twelve tips as a guide to those implementing, sustaining, and/or growing a successful MEFP whose value is demonstrated by its impacts on participants, learners, patients, teaching faculty, institutions, the greater medical education community, and the population's health.

Pediatric trainees' engagement in the online nutrition curriculum: preliminary results.

BACKGROUND: The Pediatric Nutrition Series (PNS) consists of ten online, interactive modules and supplementary educational materials that have utilized web-based multimedia technologies to offer nutrition education for pediatric trainees and practicing physicians. The purpose of the study was to evaluate pediatric trainees' engagement, knowledge acquisition, and satisfaction with nutrition modules delivered online in interactive and non-interactive formats. METHODS: From December 2010 through August 2011, pediatric trainees from seventy-three (73) different U.S. programs completed online nutrition modules designed to develop residents' knowledge of counseling around and management of nutritional issues in children. Data were analyzed using SPSS version 19. Both descriptive and inferential statistics were used in comparing interactive versus non-interactive modules. Pretest/posttest and module evaluations measured knowledge acquisition and satisfaction. RESULTS: Three hundred and twenty-two (322) pediatric trainees completed one or more of six modules for a total of four hundred and forty-two (442) accessions. All trainees who completed at least one module were included in the study. Two-way analyses of variance (ANOVA) with repeated measures (pre/posttest by interactive/non-interactive format) indicated significant knowledge gains from pretest to posttest (p < 0.002 for all six modules). Comparisons between interactive and non-interactive formats for Module 1 (N = 85 interactive, N = 95 non-interactive) and Module 5 (N = 5 interactive, N = 16 non-interactive) indicated a parallel improvement from the pretest to posttest, with the interactive format significantly higher than the non-interactive modules (p < .05). Both qualitative and quantitative data from module evaluations demonstrated that satisfaction with modules was high. However, there were lower ratings for whether learning objectives were met with Module 6 (p < 0.03) and lecturer rating (p < 0.004) compared to Module 1. Qualitative data also showed that completion of the interactive modules resulted in higher resident satisfaction. CONCLUSIONS: This initial assessment of the PNS modules shows that technology-mediated delivery of a nutrition curriculum in residency programs has great potential for providing rich learning environments for trainees while maintaining a high level of participant satisfaction.

Resident-as-Teacher: Can It Be Done With an E-Learning Module?

Background Resident-as-teacher initiatives are traditionally specialty-specific and performed in-person, limiting ability to disseminate essential teaching skills to all residents. Objective The aim of this study was to develop, implement, and evaluate a resident-as-teacher interactive e-learning module on growth mindset and coaching. Methods The module was designed and implemented between August 2022 and March 2023. It was distributed to postgraduate year (PGY) 1 residents in all specialties at a large academic institution. Completion rates, Likert ratings, and answers to 2 open-ended questions were used for assessment. Descriptive statistics and 1-way analysis of variance with Sîdák correction for multiple comparisons were performed on Likert ratings. Responses to open-ended questions were evaluated using content analysis. Results The module was completed by all 277 PGY-1 residents (100%), with the evaluation completed by 276 of 277 (99.6%) residents. Mean rating of the module's relevance to the role of resident teacher was 4.06±0.90 (5-point Likert scale), with general surgery residents rating the module less favorably compared to all specialties (3.28±1.06; P<.01; 95% CI 0.26-1.30). Open-ended comments revealed that residents most liked the delivery of relevant teaching strategies and the interactive design of the module. The most common area for suggested improvement was the addition of content such as teaching in challenging situations. Time needed for design, implementation, and evaluation was 80 hours total. Conclusions An e-learning module offers an interactive platform for teaching skills and was found to be an acceptable method of instruction for residents.

Methodologies and study designs relevant to medical education research.

Research is an important part of educational scholarship. Knowledge of research methodologies is essential for both conducting research as well as determining the soundness of the findings from published studies. Our goals for this paper therefore are to inform medical education researchers of the range and key components of educational research designs. We will discuss both qualitative and quantitative approaches to educational research. Qualitative methods will be presented according to traditions that have a distinguished history in particular disciplines. Quantitative methods will be presented according to an evidence-based hierarchy akin to that of evidence-based medicine with the stronger designs (systematic reviews and well conducted educational randomized controlled trials) at the top, and weaker designs (descriptive studies without comparison groups, or single case studies) at the bottom. It should be appreciated, however, that the research question determines the study design. Therefore, the onus is on the researcher to choose a design that is appropriate to answering the question. We conclude with an overview of how educational researchers should describe the study design and methods in order to provide transparency and clarity.

Understanding burnout in Pediatric residency through the lens of the 'Areas of worklife'.

BACKGROUND AND OBJECTIVES: Burnout is a widespread problem in medicine, especially among trainees. Despite this, data on effective interventions are limited. An organizational context for burnout entitled Areas of Worklife identified six areas of the work environment that can affect burnout through mismatches between individuals expectations of that area and the reality of the work environment. This study aimed to gain a deeper understanding of pediatric residents' perspectives of the Areas of Worklife to allow programs to utilize this framework in the development of future interventions. METHODS: Using qualitative methodology founded in grounded theory, we employed an iterative data collection by conducting semi-structured interviews, until data saturation was achieved, with 15 pediatric residents in 2018. We recorded interviews and transcribed them verbatim. Content analysis was conducted concurrently with data collection using constant comparison methods; the principal investigator and co-investigators worked jointly to generate codes and identify themes. RESULTS: Themes were identified for the individual Areas of Worklife that represented resident perspectives and mismatches with the work environment. Overall, patient care was a central focus connecting the areas of control, reward, values, and workload; themes in these areas concentrated on resident's ability to interact with and learn from patients. CONCLUSIONS: Residents' definitions of the Areas of Worklife can be used to identify mismatches between residents' expectations and their work environment, which can inform organizational interventions. These findings highlight the importance of a patient-focused approach to residency training, which is consistent with literature that shows patient care is a means to find meaning in their work. Resident definitions of the Areas of Worklife offer residency programs a practical approach in their battle against burnout by providing focused direction to respond to resident needs and identify tangible targets for intervention.

The APPD Longitudinal Educational Assessment Research Network's First Decade.

ABSTRACT: In 2009, the Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN), a national educational research network, was formed. We report on evaluation of the network after 10 years of operation by reviewing program context, input, processes, and products to measure its progress in performing educational research that advances training of future pediatricians. Historical changes in medical education shaped the initial development of the network. APPD LEARN now includes 74% (148 of 201) of US Pediatric residency programs and has recently incorporated a network of Pediatric subspecialty fellowship programs. At the time of this evaluation, APPD LEARN had approved 19 member-initiated studies and 14 interorganizational studies, resulting in 23 peer-reviewed publications, numerous presentations, and 7 archived sharable data sets. Most publications focused on how and when interventions work rather than whether they work, had high scores for reporting rigor, and included organizational and objective performance outcomes. Member program representatives had positive perceptions of APPD LEARN's success, with most highly valuing participation in research that impacts training, access to expertise, and the ability to make authorship contributions for presentations and publication. Areas for development and improvement identified in the evaluation include adopting a formal research prioritization process, infrastructure changes to support educational research that includes patient data, and expanding educational outreach within and outside the network. APPD LEARN and similar networks contribute to high-rigor research in pediatric education that can lead to improvements in training and thereby the health care of children.

A step-by-step guide for mentors to facilitate team building and communication in virtual teams.

As collaborative work in medical education has increasingly moved online, team mentors have had to adapt their practices into the virtual environment. Fostering connection, communication and productivity on virtual teams requires specific skills and deliberate practice that differ from in-person teamwork. Drawing from best practices in business, education and medicine and also from our own experience as a virtual team, we present a guide for mentors to create and sustain successful virtual teams. Grounded in Tuckman's Five Stage Model of Team Development, we offer specific strategies for virtual team mentors to promote team cohesion, mitigate conflict, maintain productivity and leverage the benefits of the virtual environment.

Creation of the Association of Pediatric Program Directors Faculty Development for Educators "Nuts and Bolts" Teaching Aids.

Faculty development (FD) continues to be a great need and challenge for faculty engaged in graduate medical education (GME) and such educator development should ultimately benefit learners in GME programs. As a Task Force within the Association of Pediatric Program Directors (APPD) FD Learning Community, our Educator subcommittee utilized multiple needs assessments to develop a novel educator development program called the APPD FD for Educators Nuts and Bolts (Nuts & Bolts) consisting of 1 to 2 page FD teaching aids. This paper outlines the development of these teaching aids and can be used as a reference for developing future Nuts & Bolts teaching aids. The development was based on 1) a defining framework (Glassick's criteria), 2) a clear model for evaluation of the program (Logic model), and 3) development of an assessment tool to demonstrate effectiveness of the teaching aids in FD at the local level. These 3 components help establish the scholarly nature of the FD Nuts & Bolts program. Multiple lessons learned from development of this program are presented to inform others engaged in educator program development. Detailed proposals for use of FD Nuts & Bolts for faculty improvement and plans for generating additional teaching aids are presented.

Integrating Graduates of a National Faculty Development Program Into a Community of Practice.

PURPOSE: The Educational Scholars Program (ESP) started as a national 3-year faculty development (FD) program for pediatric educators. Fourteen years later, the ESP has grown into a larger community of practice (CoP). The purpose of this study was to identify programmatic processes that serve as bridges or barriers to integrating ESP graduates into the CoP. METHODS: A cross-sectional survey was sent to 126 ESP graduates. Based on their self-reported level of engagement, graduates were categorized into 4 groups: Core, Active, Peripheral, and Outsider groups. Factors contributing to engagement with the ESP community, and the impact of varying levels of engagement on outcomes related to the organization and the graduate were ascertained. RESULTS: Half of the ESP graduates completed the survey. Thirty-five percent of the respondents were in the Core or Active groups. Almost all ESP graduates in the Core and Active groups felt a sense of belonging to the ESP community. Opportunities provided to network, collaborate, and receive mentorship were reported as highly significant influences on their decision to remain engaged. CONCLUSION: Purposeful integration of graduates of an FD program within a CoP, by allowing varying levels of involvement, enhances engagement within the CoP.