Interprofessional education faculty development survey: Perspectives on IPE and collaborative practice and COVID-19.

The cancellation of in-person classes in March 2020 due to COVID-19 caused a sudden shift in the educational experiences of health profession students enrolled at the University of Michigan (U-M). With the move to remote learning, educators engaging in interprofessional education (IPE) were faced with the challenge of preparing students for interprofessional collaboration from a distance. A survey was designed to investigate the impact of the pandemic on IPE practices and discover educator development needs. Faculty and staff from 10 health sciences schools within the U-M and Michigan Medicine were invited to complete a survey investigating their use of IPE competencies prior to, during, and after the pandemic; their development needs; and their ideas for future implementation of IPE and collaborative practice. Fifty-six percent of respondents reported their ability to teach IPE competencies was impacted by changes related to COVID. There was a significant (p ≤ 0.001) difference between self-report of incorporating IPE competencies prior to and during pandemic and during and into the future across all five competencies. Technology was reported as a challenge when teaching IPE, and a need for future faculty development. Leveraging virtual and case-based learning and increasing collaboration between schools were identified as ideas for future implementation.

Bridging the Expertise of Advocates and Academics to Identify Reproductive Justice Learning Outcomes.

Phenomenon: Reproductive justice (RJ) is defined by women of color advocates as the right to have children, not have children and parent children while maintaining reproductive autonomy. In the United States, physicians have been complicit in multiple historical reproductive injustices, involving coercive sterilization of thousands of people of color, low income, and disabilities. Currently, reproductive injustices continue to occur; however, physicians have no formal RJ medical education to address injustices. The objective of this study was to engage leading advocates within the movement using a Delphi method to identify critical components for such a curriculum. Approach: In 2016, we invited 65 RJ advocates and leaders to participate in an expert panel to design RJ medical education. A 3-round Delphi survey was distributed electronically to identify content for inclusion in an RJ curriculum. In the next 2 survey rounds, experts offered feedback and revisions and rated agreement with including content recommendations in the final curriculum. We calculated descriptive statistics to analyze quantitative data. A team with educational expertise wrote learning outcomes based on expert content recommendations. Findings: Of the 65 RJ advocates and leaders invited, 41 participated on the expert panel of the Delphi survey. In the first survey, the expert panel recommended 58 RJ content areas through open-ended response. Over the next 2 rounds, there was consensus among the panel to include 52 of 58 of these areas in the curriculum. Recommended content fell into 11 broad domains: access, disparities, and structural competency; advocacy; approaches to reproductive healthcare; contemporary law and policy; cultural safety; historical injustices; lesbian, gay, bisexual, transgender, queer/questioning, and intersex health; oppression, power, and bias training; patient care; reproductive health; and RJ definitions. The 97 learning outcomes created from this process represented both unique and existing educational elements. Insights: A collaborative methodology infused with RJ values can bridge experts in advocacy and academics. New learning outcomes identified through this process can enhance medical education; however, it is just as important to consider education in RJ approaches to care as it is knowledge about that care. We must explore the pedagogic process of RJ medical education while considering that expertise in this area may exist outside of the medical community and thus there is a need to partner with RJ advocates. Finally, we expect to use innovative teaching methods to transform medical education and achieve an RJ focus.

Employing a Root Cause Analysis Process to Improve Examination Quality.

PROBLEM: Multiple-choice question (MCQ) examinations represent a primary mode of assessment used by medical schools. It can be challenging for faculty to produce content-aligned, comprehensive, and psychometrically sound MCQs. Despite best efforts, sometimes there are unexpected issues with examinations. Assessment best practices lack a systematic way to address gaps when actual and expected outcomes do not align. APPROACH: The authors propose using root cause analysis (RCA) to systematically review unexpected educational outcomes. Using a real-life example of a class's unexpectedly low reproduction examination scores (University of Michigan Medical School, 2015), the authors describe their RCA process, which included a system flow diagram, a fishbone diagram, and an application of the 5 Whys to understand the contributors and reasons for the lower-than-expected performance. Using this RCA approach, the authors identified multiple contributing factors that potentially led to the low examination scores. These included lack of examination quality improvement (QI) for poorly constructed items, content-question and pedagogy-assessment misalignment, and other issues related to environment and people. OUTCOMES: As a result of the RCA, the authors worked with stakeholders to address these issues and develop strategies to prevent similar systematic issues from reoccurring. For example, a more robust examination QI process was developed. NEXT STEPS: Using an RCA approach in health care is grounded in practice and can be easily adapted for assessment. Because this is a novel use of RCA, there are opportunities to expand beyond the authors' initial approach for using RCA in assessment.

Competency-based education: programme design and challenges to implementation.

CONTEXT: Competency-based education (CBE) has been widely cited as an educational framework for medical students and residents, and provides a framework for designing educational programmes that reflect four critical features: a focus on outcomes, an emphasis on abilities, a reduction of emphasis on time-based training, and promotion of learner centredness. Each of these features has implications and potential challenges for implementing CBE. METHODS: As an experiment in CBE programme design and implementation, the University of Michigan Master of Health Professions Education (UM-MHPE) degree programme was examined for lessons to be learned when putting CBE into practice. The UM-MHPE identifies 12 educational competencies and 20 educational entrustable professional activities (EPAs) that serve as the vehicle for both learning and assessment. The programme also defines distinct roles of faculty members as assessors, mentors and subject-matter experts focused on highly individualised learning plans adapted to each learner. CONCLUSIONS: Early experience with implementing the UM-MHPE indicates that EPAs and competencies can provide a viable alternative to traditional courses and a vehicle for rigorous assessment. A high level of individualisation is feasible but carries with it significant costs and makes intentional community building essential. Most significantly, abandoning a time-based framework is a difficult innovation to implement in a university structure that is predicated on time-based education.

Do breaks in gastroenterology fellow endoscopy training result in a decrement in competency in colonoscopy?

BACKGROUND: Skills decay without practice, but the degree is task specific. Some experts believe that it is essential to teach endoscopy longitudinally to build and maintain endoscopic skills. OBJECTIVE: To determine whether breaks in gastroenterology fellow endoscopy training are associated with a decrement in competency in independent intubation of the cecum. DESIGN: Observational cohort of colonoscopies performed by gastroenterology fellows. SETTING: Academic fellowship program from July 2010 to March 2012. SUBJECTS: Twenty-four fellows. MAIN OUTCOME MEASUREMENTS: The adjusted change in the slope of cumulative summation learning curves for cecal intubation after breaks in training and the slope at the end of the subsequent endoscopy rotation. RESULTS: A total of 6485 colonoscopies were performed by 24 fellows with 87 breaks in training. The average break was 6 weeks (range 2-36 weeks). Seventy-five percent of the breaks were 8 weeks or less. For every additional 4 weeks, the slope after the break worsened by 0.022 (P = .06, maximum possible change = -1.0 to +1.0). By the end of the subsequent rotation, there was no association between the slope of the learning curve and the length of the break (P = .68). LIMITATIONS: This was an observational study of only 24 fellows with relatively few long breaks. Cecal intubation is only 1 component of overall competency in colonoscopy. CONCLUSIONS: There may be a very small decrement in fellows' abilities to intubate the cecum after a break in endoscopy training. Because these changes are so small, teaching endoscopy in blocks is probably adequate, if necessary to balance other clinical and research experience. However, further research is needed to determine whether a longitudinal endoscopy experience is superior for attaining and maintaining competency, to evaluate the effects of breaks longer than 8 weeks, and to determine whether the effects of breaks depend on the previous volume of experience with colonoscopy.

Effect of resident evaluations of obstetrics and gynecology faculty on promotion.

BACKGROUND: Promotion for academic faculty depends on a variety of factors, including their research, publications, national leadership, and quality of their teaching. OBJECTIVE: We sought to determine the importance of resident evaluations of faculty for promotion in obstetrics-gynecology programs. METHODS: A 28-item questionnaire was developed and distributed to 185 department chairs of US obstetrics-gynecology residency programs. RESULTS: Fifty percent (93 of 185) responded, with 40% (37 of 93) stating that teaching has become more important for promotion in the past 10 years. When faculty are being considered for promotion, teaching evaluations were deemed "very important" 60% of the time for clinician track faculty but were rated as mainly "not important" or "not applicable" for research faculty. Sixteen respondents (17%) stated a faculty member had failed to achieve promotion in the past 5 years because of poor teaching evaluations. Positive teaching evaluations outweighed low publication numbers for clinical faculty 24% of the time, compared with 5% for research faculty and 8% for tenured faculty being considered for promotion. The most common reason for rejection for promotion in all tracks was the number of publications. Awards for excellence in teaching improved chances of promotion. CONCLUSIONS: Teaching quality is becoming more important in academic obstetrics-gynecology departments, especially for clinical faculty. Although in most institutions promotion is not achieved without adequate research and publications, the importance of teaching excellence is obvious, with 1 of 6 (17%) departments reporting a promotion had been denied due to poor teaching evaluations.

Medication safety in obstetrics and gynecology.

The safe prescribing, use, administration, and monitoring of medications are an important component of patient safety efforts and are of particular importance to the obstetrician/gynecologist. Safe use of medications requires a team-based approach focused on medication safety with effective 2-way communication, use of technology to prevent and identify errors, diligent monitoring of the medication's effects on the patient, and use of standardized protocols to decrease the likelihood of a medication error.

An interdisciplinary course in women's health integrating basic and clinical sciences: clinical anatomy and women's health.

Traditionally, undergraduate medical education is divided into preclinical and clinical years, with basic sciences taught during the first years and clinical sciences taught during the latter years. In an effort to better integrate the basic and clinical sciences in undergraduate medical education, and focus on women's health, we have developed a new interdisciplinary fourth-year elective at the University of Michigan Medical School. The elective, titled "Clinical Anatomy and Women's Health," is a joint effort between the Division of Anatomical Sciences and the Department of Obstetrics and Gynecology at the University of Michigan Health System. During the course students participate in didactic, laboratory, cadaveric dissection, and clinical-correlate sessions that focus on gynecologic anatomy and clinical issues in women's health. Educational goals and learning objectives were used to assess the effectiveness of the curriculum; revisions, based on outcomes of the educational assessment, will be implemented in the next offering of the course. Preliminary data from the first offering of the course in February 2002 are provided. The goals of this course include integrating basic science and clinical concepts while reducing the division between preclinical and clinical medical education, addressing issues of women's health, and encouraging lifelong learning by using basic science concepts and techniques of discovery in clinical practice.