Only as Strong as the Weakest Link: Resident Perspectives on Entrustable Professional Activities and Their Impact on Learning.

Background Core to competency-based medical education (CBME) is the use of frequent low-stakes workplace-based assessments. In the Canadian context, these observations of performance are framed around entrustable professional activities (EPAs). Objective We aimed to explore residents' real-world perspectives of EPAs and their perceived impact on learning, because assessments perceived to be "inauthentic," or not truly reflective of their lived experiences, may interfere with learning. Methods Using constructivist grounded theory, we conducted 18 semistructured interviews in 2021 with residents from all programs that had implemented CBME at one tertiary care academic center in Canada. Participants were recruited via email through respective program administrators. Data collection and analysis occurred iteratively, and categories were identified using constant comparative analysis. Results Residents were strikingly polarized, perceiving EPAs as either a valuable opportunity for professional growth or as an onerous requirement that interfered with learning. Regardless of what view participants held, all perspectives were informed by: (1) the program administration and the perceived messaging from program to residents; (2) faculty assessors and their perceived degree of engagement, or "buy-in" with the EPA system; and ultimately (3) learner behavior. We theorized from these findings that all 3 aspects must be working in tandem for the assessment system to function as intended. Conclusions From the learners' perspective, there exists a dynamic, interdependent relationship between the 3 CBME stakeholders. As such, the perceived value of the EPA assessment system can only be as strong as the weakest link in the chain.

An Exploration of Discrepancies and Concordances Between Hospital Disaster Directors and General Health Care Providers in Gyeonggi Province, South Korea: Quantitative Analysis of a Multicenter Cross-Sectional Survey Study.

OBJECTIVE: The purpose of this study was to investigate differences in the perception of disaster issues between disaster directors and general health care providers in Gyeonggi Province, South Korea. METHODS: The Gyeonggi provincial committee distributed a survey to acute care facility personnel. Survey topics included awareness of general disaster issues, hospital preparedness, and training priorities. The questionnaire comprised multiple choices and items scored on a 10-point Likert scale. We analyzed the discrepancies and characteristics of the responses. RESULTS: Completed surveys were returned from 43 (67%) of 64 directors and 145 (55.6%) of 261 health care providers. In the field of general awareness, the topic of how to triage in disaster response showed the greatest discrepancies. In the domain of hospital level disaster preparedness, individual opinions varied most within the topics of incident command, manual preparation. The responses to "accept additional patients in disaster situation" showed the biggest differences (> 21 versus 6~10). CONCLUSIONS: In this study, there were disaster topics with discrepancies and concordances in perception between disaster directors and general health care providers. The analysis would present baseline information for the development of better training programs for region-specific core competencies, knowledge, and skills required for the effective response.

Effect of team-based cardiopulmonary resuscitation training for emergency medical service providers on pre-hospital return of spontaneous circulation in out-of-hospital cardiac arrest patients.

OBJECTIVE: This study aimed to assess whether team-based cardiopulmonary resuscitation (CPR) training for emergency medical service (EMS) providers improved the pre-hospital return of spontaneous circulation (ROSC) rates of non-traumatic adult out-of-hospital cardiac arrest (OHCA) patients. METHODS: This was a before-and-after study an evaluating educational intervention for community EMS providers, which was conducted in Gyeonggi province, South Korea. Team-based CPR training was conducted from January to March 2016 for every level 1 and level 2 EMS provider in the study area. Non-traumatic EMS treated OHCA patients from July to December 2015 and from July to December 2016 were enrolled and used for the analysis. The primary outcome was pre-hospital ROSC rates before and after the training period. A multivariable logistic regression model with an interaction term (period × dispatch type) was used to determine the adjusted odds ratios (aORs) according to the dispatch type (single vs. multi-tiered). RESULTS: Of the 2125 OHCA cases included, 1072 (50.4%) and 1053 (49.6%) were categorized in the before- and after-training groups, respectively, and the pre-hospital ROSC rates were 6.6% and 12.6%, respectively. In the multivariable logistic regression analysis, the aOR for pre-hospital ROSC was 2.07 (95% CI, 1.32-3.25) in the after-training period. In the interaction model (period × type of dispatch), the aORs for pre-hospital ROSC were 2.00 (95% CI, 1.01-3.98) and 2.13 (95% CI, 1.20-3.79) in the single- and multi-tiered dispatch groups, respectively, during the after-training period. CONCLUSION: Team-based CPR training for EMS providers in a large community EMS system improved the pre-hospital ROSC rates of OHCA patients.

Learners' perspective: where and when pre-residency trainees learn more to achieve their core clinical competencies.

PURPOSE: While it is known that effective clinical education requires active involvement of its participants, regular feedback, communication skills and interprofessional training, limited studies have been conducted in Korea that demonstrate how pre-residency trainees acquire their core clinical skills. This is a cross-sectional study of interns and students across a third-tier university hospital in Korea to examine where and when they acquire core clinical skills. METHODS: A total of 74 students and 91 interns were asked to participate in a closed-ended questionnaire, and 50 participants (20 students and 30 interns) were involved in semistructured individual interviews. The questionnaire was based on the Accreditation Council for Graduate Medical Education core competencies. RESULTS: The majority of core clinical skills were acquired during their rotations in emergency medicine, general surgery, and cardiothoracic surgery. The semistructured interviews revealed that these departments required their trainees to be highly involved and analytical, and participate in clinical discourse. CONCLUSION: The common factor among the three departments is an environment in which trainees are highly involved in clinical duties, and are expected to make first-contact patient encounters, participate in clinical discourse, interpret investigative results and arrive at their own conclusions. Work-based learning appear to be key to the trends observed, and further study is warranted to determine whether these findings are indicative of true acquisition of clinical competence.

Beyond accreditation: excellence in medical education.

Medical school accreditation is a relatively new phenomenon in Korea. The development of an accreditation body and standards for a two-tiered "Must" and "Should" system in 1997 eventually led to the implementation of a third "Excellence" level of attainment. These standards were conceived out of a desire to be able to first recognize and promote outstanding performance of medical schools, second to provide role models in medical education, and furthermore to preview the third level as potential components of the pre-existing second level for the next accreditation cycle. It is a quality-assurance mechanism that, while not required for accreditation itself, pushes medical schools to go beyond the traditional requirements of mere pass-or-fail accreditation adequacy, and encourages schools to deliver an unprecedented level of medical education. The Association for Medical Education in Europe developed its own third-tier system of evaluation under the ASPIRE project, with many similar goals. Due to its advanced nature and global scope, the Korean accreditation body has decided to implement the ASPIRE system in Korea as well.

A 2-year follow-up of irradiated homologous costal cartilage used as a septal extension graft for the correction of contracted nose in Asians.

BACKGROUND: Septal extension graft is a useful method for the correction of contracted nose. When septal or costal cartilage is not available, irradiated homologous costal cartilage (IHCC) may be an alternative choice. This preliminary study is focused on noninfective absorption and other complications and postoperative changes of nasal length after septal extension graft using IHCC. METHODS: Thirty patients who could be observed for more than 2 years postoperatively were assessed. All patients had contracted nose deformities with a history of an inflammatory contracture after previous aesthetic surgical procedures. The IHCC was used only as a septal extension graft in each patient. Nasal length was analyzed by comparing preoperative and 2-year postoperative photographs. RESULTS: There was no noticeable graft warping or infective IHCC absorption. However, 3 patients underwent revision: 2 cases of graft avulsion fracture and 1 case of minimal nasal obstruction. Nasal length, which had increased an average of 8.5% after the procedure, was maintained at follow-up 2 years postoperatively. CONCLUSIONS: The IHCC has the advantages of avoiding donor-site scars, and also provides the same benefits as autogenous costal cartilage. It can therefore be a reliable alternative material for rhinoplasty. A longer follow-up may be necessary to confirm the structural stability of the IHCC graft in the lengthened caudal septum.