Proactive Coaching in General Surgery Internship: Incorporating Well-being Practices into Resident Professional Life.

OBJECTIVE: Coaching can provide learners with space to reflect on their performance while ensuring well-being and encouraging professional achievement and personal satisfaction outside of traditional mentorship and teaching models. We hypothesized that a proactive coaching program for general surgery interns coupled with individualized learning plans would help build foundational skills necessary for residency success and facilitate the incorporation of well-being practices into resident professional life. Here, we present the development, implementation, and outcomes of a novel well-being coaching program for surgical interns. DESIGN AND SETTING: A well-being coaching program was developed and implemented from July 2020 through June 2021 at a single university-based surgical residency program. To assess impact of the coaching program, we designed a mixed-methods study incorporating end-of-program survey results as well as participant narratives from commitment-to-act statements for thematic content. PARTICIPANTS: All 32 general surgery interns participated in aspects of the coaching program. RESULTS: The end-of-program survey was completed by 19/32 (59%) interns and commitment-to-act statements were completed by 22/32 (69%). The majority (89%) of survey respondents "agreed" or "strongly agreed" that the longitudinal intern coaching program helped them reach goals they had set for themselves this academic year; 15/19 (79%) noted that the coaching experience was effective in promoting well-being practices in their life. Well-being and professional goals were identified as major themes in the end-of-the-year commitment-to-act statements. Statements specifically mentioned resources highlighted and skills taught in our coaching program such as mindfulness techniques, gratitude journals, and self-compassion strategies. CONCLUSIONS: Our study illustrates the effectiveness of a coaching pilot program on promoting well-being practices in a university-based general surgery internship and can be a roadmap with proven efficacy and measurable outcomes.

Integrating addiction medicine into graduate medical education in primary care: the time has come.

Substance use disorders create an enormous burden of medical, behavioral, and social problems and pose a major and costly public health challenge. Despite the high prevalence of substance use and its consequences, physicians often do not recognize these conditions and, as a result, provide inadequate patient care. At the center of this failure is insufficient training for physicians about substance use disorders. To address this deficit, the Betty Ford Institute convened a meeting of experts who developed the following 5 recommendations focused on improving training in substance abuse in primary care residency programs in internal medicine and family medicine: 1) integrating substance abuse competencies into training, 2) assigning substance abuse teaching the same priority as teaching about other chronic diseases, 3) enhancing faculty development, 4) creating addiction medicine divisions or programs in academic medical centers, and 5) making substance abuse screening and management routine care in new models of primary care practice. This enhanced primary care residency training should represent a major step forward in improving patient care.

Jumpstarting Academic Careers: A Workshop and Tools for Career Development in Anesthesiology.

CONTEXT: Career development is essential and has the potential to assist in building a sustained faculty within academic departments of Anesthesiology. Career development is essential for growth in academic medicine. Close attention to the details involved in career management, goal setting as part of career planning, and professional networking are key elements. METHODS: This article examines the specific educational strategies involved in a 120 minute workshop divided into four 25 minute segments with 20 minutes at the end for discussion for training junior faculty in career development. The teaching methods include 1) brief didactic presentations, 2) pre-workshop completion of two professional development tools, 3) facilitated small group discussion using trained facilitators and 4) use of a commitment to change format. Three major learning tools were utilized in conjunction with the above methods: a professional network survey, a career planning and development form and a commitment to change form. RESULTS: Forty one participants from 2009 reported 80 projected changes in their practice behaviors in relation to career management: Build or enhance professional network and professional mentoring (36.3%); Set career goals, make a plan, follow though, collaborate, publish (35.1%); Increase visibility locally or nationally (10.0%); Building core skills, such as clinical, teaching, leading (36.3%); Identify the criteria for promotion in own institution (5.0%); Improved methods of documentation (2.5%). Over the past two years, the workshop has been very well received by junior faculty, with over 95% marking each of the following items as excellent or good (presentation, content, audiovisuals and objectives met). CONCLUSIONS: The challenge for continuing development and promotion of academic anesthesiologists lies in the explicit training of faculty for career advancement. Designing workshops using educational tools to promote a reflective process of the faculty member is the one method to meet this challenge. We believe that this national workshop has initiated an increasing awareness of a core of junior faculty nationally having now delivered the material to almost 200 junior faculty and having trained seven facilitators in the usage of these materials.

The development of a comprehensive school-wide simulation-based procedural skills curriculum for medical students.

OBJECTIVE: The purpose of this project was to assess the effectiveness of using the Delphi process to create a structured simulation-based procedural skills curriculum for all students at the Keck School of Medicine of the University of Southern California (KSOM). METHODS: The Delphi process was used to develop a list of procedural skills that students are expected to perform competently prior to graduation. Once consensus of faculty was reached, a needs assessment was performed to poll graduating seniors' experience performing each skill. A comprehensive simulation-based curriculum was developed and implemented for all Year II students at KSOM. Student satisfaction with the curriculum was collected using a standardized end-of-session evaluation form and student self confidence was assessed using a retrospective pre- and post-self-efficacy rating for each skill. RESULTS: The needs assessment clearly established the need for a more organized approach to teaching procedural skills at KSOM. Quantitative and qualitative data revealed that students responded favorably to the curriculum and appreciated the efforts put forth by KSOM. Student self-efficacy increased significantly for each skill. CONCLUSIONS: The Delphi process was effective in reaching consensus among educational leaders at KSOM regarding which skills to include in the curriculum. Although there were a few minor challenges, we determined that it is feasible to develop and implement an explicit school-wide simulated-based procedural skills curriculum.

A "medical student practice profile" as the foundation for a case-based curriculum revision.

BACKGROUND: In 2001, the Keck School of Medicine of the University of Southern California initiated a major curriculum reform with fully integrated teaching of the basic sciences. DESCRIPTION: The new curriculum integrated a set of selected clinical cases called the student practice profile (SPP). The SPP cases were designed to (a) define the core target knowledge base and essential clinical experience of all graduating students, (b) to improve the relevance of basic science teaching, and (c) to serve as the overarching organizational structure for the 4-year curriculum. EVALUATION: Evaluation data demonstrated that implementation of the SPP project has been moderately successful and students have reported high exposure to the SPP cases and confidence in their ability to diagnose and manage problems. Improvement in teaching the basic sciences in a clinically relevant manner is suggested by a small continued improvement in USMLE scores since the SPP project was fully implemented. CONCLUSIONS: The SPP design represents a uniquely successful pathway to curriculum redesign.

How to write a scholarly book review for publication in a peer-reviewed journal: a review of the literature.

PURPOSE: To describe and discuss the processes used to write scholarly book reviews for publication in peer-reviewed journals and to provide a recommended strategy and book appraisal worksheet to use when conducting book reviews. METHODS: A literature search of MEDLINE, EMBASE, CINAHL, and the Index to Chiropractic Literature was conducted in June 2009 using a combination of controlled vocabulary and truncated text words to capture articles relevant to writing scholarly book reviews for publication in peer-reviewed journals. RESULTS: The initial search identified 839 citations. Following the removal of duplicates and the application of selection criteria, a total of 78 articles were included in this review including narrative commentaries (n = 26), editorials or journal announcements (n = 25), original research (n = 18), and journal correspondence pieces (n = 9). DISCUSSION: Recommendations for planning and writing an objective and quality book review are presented based on the evidence gleaned from the articles reviewed and from the authors' experiences. A worksheet for conducting a book review is provided. CONCLUSIONS: The scholarly book review serves many purposes and has the potential to be an influential literary form. The process of publishing a successful scholarly book review requires the reviewer to appreciate the book review publication process and to be aware of the skills and strategies involved in writing a successful review.

Using the Affective Domain to Enhance Teaching of the ACGME Competencies in Anesthesiology Training.

Teaching and assessing the advanced competencies will continue to be a challenge. Incorporating new and nontraditional skills into an already complex and challenging clinical curriculum and practice is not easy. This makes development of methods for curricular design, teaching and assessment of anesthesiology resident and fellow performance essential. The Domains of learning, particularly the Affective Domain can serve as an organizing structure for developing objectives and selecting teaching and assessment techniques. Using the Affective Domain to select targeted teaching techniques might help foster development of key beliefs and values that underlie the advanced competencies (and sub-competencies). Targeted teaching, outside of the patient care arena, when combined with traditional clinical teaching practices, may help to ensure continued performance of desired behaviors. These include acting in a consultative role for other health professionals (ICS), providing culturally responsive care (Professionalism), using evidence to enhance the care of patients (PBLI), and advocating for quality of care and working to enhance patient safety (SBP). As educators, our aim is not only to impact knowledge, attitudes and skills, but to impact the daily behavior of our graduates.

Shaping professionalism in pre-clinical medical students: Professionalism and the practice of medicine.

BACKGROUND: Increasing emphasis is placed on teaching and assessment of professionalism in the continuum of medical education. Consistent and longitudinal instruction and assessment are crucial factors that learners need in order to internalize the tenets of professionalism. AIM: We aimed to develop a novel longitudinal course in professionalism spanning the first 2 years in a medical curriculum. METHODS: This is a description of the process undertaken over the past 7 years to develop and implement a professionalism curriculum. We used the conceptual framework of constructivism, principles of adult learning, experiential learning and reflective practice to integrate learning with experience. We included student input in session development. Faculty mentors serve as role models to guide, assist and counsel students. Assessment of learners is accomplished using self, peer and mentor evaluation, and a student portfolio. Program evaluation is by course and faculty evaluation. RESULTS: Students are given a final grade of pass or fail, together with a brief narrative. Course evaluations were positive. A survey questionnaire showed that more than 60% of the students reported gaining skills related to course goals. CONCLUSIONS: A longitudinal curriculum for the pre-clinical years was successfully launched. Plans are under way to expand this into the clinical years.

Assessing the teaching of procedural skills: can cognitive task analysis add to our traditional teaching methods?

BACKGROUND: The purpose of this study was to determine if a cognitive task analysis (CTA) could capture steps and decision points that were not articulated during traditional teaching of a colonoscopy. METHODS: Three expert colorectal surgeons were videotaped performing a colonoscopy. After the videotapes were transcribed, the experts participated in a CTA. A 26-step procedural checklist and a 16-step cognitive demands table was created by using information obtained in the CTA. The videotape transcriptions were transposed onto the procedural checklist and cognitive demands table to identify steps and decision points that were omitted during traditional teaching. RESULTS: Surgeon A described 50% of "how-to" steps and 43% of decision points. Surgeon B described 30% of steps and 25% of decisions. Surgeon C described 26% of steps and 38% of cognitive decisions. CONCLUSIONS: By using CTA, we were able to identify relevant steps and decision points that were omitted during traditional teaching by all 3 experts.