Development of Health Professions Education Competencies for a National Fellowship Program: A Group Consensus Process.

ABSTRACT: Health professions educators need knowledge, skills, and attitudes to provide high-quality education within dynamic clinical learning environments. Although postgraduate training opportunities in health professions education (HPE) have increased significantly, no shared competencies exist across the field. This article describes the systematic development of postgraduate HPE competencies for the Health Professions Education, Evaluation, and Research (HPEER) Advanced Fellowship, a 2-year, interprofessional, post-master's degree and postdoctoral HPE training program funded through the Department of Veterans Affairs' Office of Academic Affiliations. Using a modified RAND/University of California at Los Angeles Appropriateness Method, the authors developed competencies from March 2021 to August 2021 that were informed by current practices and standards in HPE. Literature reviews were conducted of published literature from November 2020 to February 2021 and gray literature from February to March 2021, identifying 78 and 274 HPE training competencies, respectively. These competencies were combined with 71 competencies submitted by program faculty from 6 HPEER fellowship sites, resulting in 423 initial competencies. Competencies were organized into 6 primary domains and condensed by deleting redundant items and combining overlapping concepts. Eight subject matter experts completed 3 Delphi surveys and met during 2 nominal group technique meetings. The final 25 competencies spanned 6 domains: teaching methods and learning theories; educational assessment and program evaluation; educational research methods; diversity, equity, and inclusion; interprofessional practice and team science; and leadership and management. In addition to informing the national HPEER curriculum, program evaluation, and learner assessment, these advanced competencies describe the knowledge, skills, and attitudes health professions educators need to provide high-quality education with an emphasis on the global and societal impact of HPE. These competencies represent a step toward leveraging HPE expertise to establish competencies to drive HPE program changes. Other programs should report their competencies and competency development processes to spur further dialog and progress.

When the Supervisor Needs a Supervisor: A Case-based Guide for Developing Psychotherapy Supervisors.

Supervision of psychotherapy is recognized as fundamental for attaining competency in psychotherapy. However, there is a lack of training in "best practices" of supervisory skills, and some supervisors may lack contemporary knowledge to support supervisees adequately. Training program leadership challenged by limited time and resources to provide supervisors with the necessary education and support can benefit from additional resources for developing psychotherapy supervisors. The authors present 3 core elements of navigating supervisory challenges: training, open dialogue in supervision, and a formal program-level process. Common issues in psychotherapy supervision are then presented in a case-based format. Reflection questions are included to provide an opportunity to consider a personal approach to the case, while specific guidance based on the literature addresses critical aspects of the case examples. Complex supervisory conflicts can challenge programs, but they are normative to the learning process and promote growth in our supervisors.

Development and Pilot of a Process for Regularly Sharing Summary Patient Safety Data.

OBJECTIVE: Dissemination of patient safety data is key to understanding safety events and improving the quality of patient care. However, there is limited guidance on how psychiatry residency programs can create a supportive environment in which to disclose and discuss such information. The authors developed and piloted a resident-led Patient Safety Presentation process at an Accreditation Council for Graduate Medical Education-accredited psychiatry residency program, sharing patient safety data while enhancing residents' education and engagement in patient safety. METHODS: From September 2020 through February 2021, the authors convened a workgroup of psychiatry residents and faculty members to devise and conduct the presentation process. The process consisted of an introductory hour-long training of residents in patient safety concepts, followed a week later by the presentation by two psychiatry residents. The authors evaluated the pilot presentation process using pre- and post-presentation resident surveys. RESULTS: The introductory training and the Patient Safety Presentation were included into the didactic schedules of all 32 program residents. Twenty (62.5%) and 17 (53.1%) residents completed the pre- and post-presentation surveys, respectively. Improvements were seen in residents' knowledge regarding the medical center's patient safety practices and perspectives on patient safety practices. On the post-presentation survey, all 17 residents reported overall satisfaction with the presentation. CONCLUSIONS: The piloted Patient Safety Presentation process increased psychiatry residents' knowledge of and engagement in patient safety. The development and pilot of the presentation process serve as an illustrative case study for other residency programs that are aspiring to grow this aspect of their curriculum.

Traumatic disclosures in the life stories of older Vietnam era veterans.

BACKGROUND: Eliciting life stories is an important component of person-centered care that may aid in understanding how an individual's unique background and narrative impacts their health. Such life stories, especially when gathered from older military Veterans, may include traumatic events, raising the urgency that clinicians be prepared to provide care that is trauma-informed and ensure Veteran's experiences are acknowledged and treated effectively. METHODS: We examined the prevalence and type of potentially traumatic and/or adverse life events spontaneously shared by 231 older Veterans participating in a life story intervention while receiving care within the U.S. Veterans Health Administration system. Veteran life stories were extracted from the electronic medical record and deductive qualitative content analysis was used to code potentially traumatic or adverse life experiences based on a codebook adapted from the Brief Trauma Questionnaire and Adverse Childhood Experience questionnaire. RESULTS: A majority (71.0%) of Veterans described at least one traumatic disclosure in their life story. Among narratives with a disclosure of any type, more than half (53.0%) included descriptions of combat trauma, 21.5% noted a history of life-threatening illness, and 9.5% reported having been in a serious accident. Fewer noted adverse childhood experiences (19.5%). CONCLUSIONS: Elicitation of life stories among older Veterans may advance person-centered care and life stories frequently include disclosure of potentially traumatic and/or adverse life events. These findings underscore the normative experience of traumatic events among older Veterans and highlight the importance of developing age-sensitive trauma-informed care competencies.

Training Interprofessional Staff in Whole Health Clinical Care at the Veterans Health Administration.

Introduction: The Veterans Health Administration (VHA) initiated a system-wide redesign in 2011 toward a patient-centered approach called the Whole Health System (WHS) of care. Education of VHA clinical staff in WHS-informed care, Whole Health Clinical Care (WHCC), is one critical element of this redesign effort. At a minimum, WHCC education should address core competencies for clinicians and be considered satisfactory for learners. This is the first study to evaluate learner satisfaction and perceived achievement of course objectives in WHCC that incorporated active learning strategies. Method: A large VA Healthcare System developed an in-person workshop focused on WHCC that used multiple active learning activities. These activities included case presentations, role playing, experiential learning, and group discussion. Results: Sixty-two interprofessional staff attended the workshop in November 2019. Forty (64.50%) participants completed post-workshop surveys within 30 days. Data suggest participants were highly satisfied with the workshop and that they successfully met stated learning objectives. Conclusions: We call on VHA and private-sector hospitals to train clinical staff in WHCC that incorporates use of active learning strategies.

Sharing perspectives on feedback: a combined resident-faculty workshop.

BACKGROUND: Feedback is essential to medical education. Although the need for effective feedback delivery is well known, more recent focus is on understanding and strengthening the faculty-trainee relationship within which the feedback process is carried out. The authors developed and implemented a combined resident-faculty feedback workshop within a psychiatry residency training program to enhance participants' understanding of challenges residents and faculty experience with the feedback process. METHODS: The one-hour workshop consisted of small group activities and large group discussions, focused on (i) feedback challenges for both residents and faculty and (ii) potential ways to address identified challenges. Participants completed pre-and post-workshop questionnaires to rate their level of understanding of, and answer open-ended questions regarding, feedback challenges. Mixed-methods assessment of questionnaire responses examined quantitative rating changes from pre- to post-workshop, as well as emergent qualitative themes from the open-ended responses. RESULTS: From a pool of 30 workshop participants, 26 completed each of the pre- and post-workshop questionnaires. Overall, participants were satisfied with the programming. Important considerations for the feedback process were (i) specific/constructive/timely feedback, (ii) meeting logistical/administrative feedback requirements, (iii) setting norms/expectations of effective/routine feedback, and (iv) relational/emotional considerations surrounding feedback. It appeared both faculty and residents were able to increase perspective taking about how the other group perceived the feedback process. CONCLUSIONS: This pilot project is one of the first to examine a joint resident-faculty workshop focused on understanding how faculty and residents can interact to better understand each other's perspective on the feedback process. Further work in this area is needed to identify common misperceptions and design programming to help correct them. Further research is also needed to examine the impact of such programming on the feedback process.

Evaluation of a Whole Health-Lifestyle Medicine Curriculum for Physician Assistant Students: a Mixed Methods Analysis.

There is increased urgency to train healthcare professionals in lifestyle medicine (LM) to mitigate the impact of lifestyle factors on chronic disease (Trilk et al. in Am J Prevent Medic. 2019:e169-e75, 2019; Polak et al. in Am J Lifestyle Med. 2015;9:361-7, 2015). This training addresses physical activity, nutrition, stress management, sleep hygiene, relationships, tobacco cessation (Lifestyle medicine in ACLM Home, 2020), and self-care. Several studies have evaluated the impact of this training on physician assistant (PA) students (Keyes and Gardner in Clin Teach. 2020, 2020; Phillips et al. Med Sci Educ. 1-5). The current paper extends previous quantitative findings from Phillips et al., 2021, revealing positive qualitative changes in PA student language and approach to clinical vignettes after completion of a novel Whole Health/lifestyle medicine (WH-LM) curriculum.

Development and Preliminary Evaluation of an Implementation Facilitation Training Program.

Background: Implementation scientists are identifying evidence-based implementation strategies that support the uptake of evidence-based practices and other clinical innovations. However, there is limited information regarding the development of training methods to educate implementation practitioners on the use of implementation strategies and help them sustain these competencies. Methods: To address this need, we developed, implemented, and evaluated a training program for one strategy, implementation facilitation (IF), that was designed to maximize applicability in diverse clinical settings. Trainees included implementation practitioners, clinical managers, and researchers. From May 2017 to July 2019, we sent trainees an electronic survey via email and asked them to complete the survey at three-time points: approximately 2 weeks before and 2 weeks and 6 months after each training. Participants ranked their knowledge of and confidence in applying IF skills using a 4-point Likert scale. We compared scores at baseline to post-training and at 6 months, as well as post-training to 6 months post-training (nonparametric Wilcoxon signed-rank tests). Results: Of the 102 participants (76 in-person, 26 virtual), there was an increase in perceived knowledge and confidence in applying IF skills across all learning objectives from pre- to post-training (95% response rate) and pre- to 6-month (35% response rate) follow-up. There was no significant difference in results between virtual and in-person trainees. When comparing post-training to 6 months (30% response rate), perceptions of knowledge increase remained unchanged, although participants reported reduced perceived confidence in applying IF skills for half of the learning objectives at 6 months. Conclusions: Findings indicated that we have developed a promising IF training program. Lack of differences in results between virtual and in-person participants indicated the training can be provided to a remote site without loss of knowledge/skills transfer but ongoing support may be needed to help sustain perceived confidence in applying these skills. Plain Language Summary: While implementation scientists are documenting an increasing number of implementation strategies that support the uptake of evidence-based practices and other clinical innovations, little is known about how to transfer this knowledge to those who conduct implementation efforts in the frontline clinical practice settings. We developed, implemented, and conducted a preliminary evaluation of a training program for one strategy, implementation facilitation (IF). The training program targets facilitation practitioners, clinical managers, and researchers. This paper describes the development of the training program, the program components, and the results from an evaluation of IF knowledge and skills reported by a subset of people who participated in the training. Findings from the evaluation indicate that this training program significantly increased trainees' perceived knowledge of and confidence in applying IF skills. Further research is needed to examine whether ongoing mentoring helps trainees retain confidence in applying some IF skills over the longer term.

Training Physician Assistant Students to Provide Evidence-Based, Holistic, Patient-Driven Care: a Novel Curriculum.

Lifestyle and behavior modifications are the primary preventative strategies to mitigate the growing morbidity, mortality, and cost of chronic disease in the USA (Trilk et al., American Journal of Preventive Medicine 56:e169-e175, 2019); hence, there have been multiple calls to train all healthcare professionals in lifestyle medicine (LM). This paper describes and evaluates the implementation of a novel Whole Health/lifestyle medicine (WH-LM) education initiative for physician assistant (PA) students embedded within a clinical rotation at the VA Boston Healthcare System (VABHS). Students demonstrated increased knowledge of WH-LM principles and increased self-efficacy in utilizing these principles following training.

Twelve tips to present an effective webinar.

Educators are increasingly invited to present via webinars rather than in-person. Webinars offer multiple advantages over in-person presentations, including the ability to speak to participants across a wide geographic area and the possibility of reduced financial and time costs for the webinar organizer, speakers, and participants. To capitalize on these advantages, educators need strategies to present effectively using this medium. Here we provide 12 tips for effective webinar presentations based upon best practices identified in the literature and the authors' experience organizing educational webinars. The 12 tips are: (1) Learn webinar logistics, (2) Conduct a needs assessment, (3) Write specific learning objectives, (4) Attend a webinar, (5) Create clear, engaging slides, (6) Develop interactive learning activities, (7) Familiarize yourself with the technology, (8) Practice your presentation, (9) Be organized, prepared, and energetic, (10) Evaluate participant learning, (11) Learn from feedback, and (12) Share your experience with the organizer. We hope these tips help presenters improve the quality and effectiveness of their webinars.

Seeing is believing: an exploration of what residents value when they receive feedback.

OBJECTIVE: The primary purpose of this paper is to report on psychiatry residents' perceptions of what is important when receiving feedback from evaluators. METHODS: In January 2018, as part of the Harvard South Shore Psychiatry Residency Training Program's (HSS) ongoing local quality improvement efforts to enhance the delivery and effectiveness of feedback that residents receive from faculty during training, the authors disseminated a survey to psychiatry residents (n = 31) at HSS. Residents rated the level of importance of 17 statements pertaining to the way feedback is delivered. Two open-ended prompts also allowed respondents to share examples of growth-oriented and unhelpful feedback they have received during residency. RESULTS: Twenty-seven residents responded (87% response rate). Eighty-one percent rated "the evaluator models the same behavior they're encouraging" as "extremely important" when receiving feedback. Many residents also rated the following survey items as "extremely important": "confidence in the evaluator's clinical and interpersonal skills" (63.0%), "amount of time the evaluator observed the resident" (51.9%), "there is a way to fix a performance deficit" (51.8%), and "specific feedback based off the resident's work" (48.1%). Conversely, only 11.1% of residents rated the feedback sandwich as "extremely important." CONCLUSIONS: Despite a small sample size, this project demonstrated that, when receiving feedback, the majority of psychiatry residents strongly value when evaluators model the targeted behavior. The feedback sandwich was least important to residents. This project underscores the importance of evaluators serving as role models in the context of feedback, and findings can be used in faculty development activities focused on feedback delivery best practices.

A National Survey on Didactic Curricula in Psychology Internship Training Programs.

Didactic curricula in psychology doctoral internship training programs in health service psychology are important components of the training experience. However, the nature of didactic curricula, including how they are developed and implemented, is not well understood. The purpose of this study was to describe characteristics of didactic programs, better understand their development, and identify barriers to implementation. This study surveyed psychology doctoral internship program directors about didactic training in their programs. A total of 122 internship directors consented to participate. On average, internship didactics were held for 11 hr per month, during regular work-day hours, and on a weekly basis. Internal faculty members were the most common didactic speakers. Didactic curricula were typically developed to meet profession-wide competencies as established by the accrediting body, the American Psychological Association. Identified barriers to didactic program development and implementation included lack of protected release time for faculty and trainees, presenter- and facility-related challenges, and difficulty addressing learner needs. Ideas for future research in this area are suggested.

VA Boston Healthcare System First Friday Faculty Development Presentation Series.

A multidisciplinary online and in-person continuing education program utilizing the teaching, research, awards, interprofessional, networking (TRAIN) framework has provided nearly 1,000 credits for health care professionals across multiple specialties.

Interprofessional Health Care Education at Academic Medical Centers: Using a SWOT Analysis to Develop and Implement Programming.

Introduction: Health care is increasingly being provided by interprofessional teams. Academic medical centers (AMCs) need to offer educational experiences for trainees to work on these teams. Few resources exist to guide educational leaders in developing and implementing these experiences to meet the unique needs of their AMC. A commonly used planning tool is the strengths, weaknesses, opportunities, and threats (SWOT) analysis, which can help organizations identify issues and develop strategies that overcome barriers to program implementation. Methods: This workshop focuses on teaching participants to use a SWOT analysis to develop interprofessional learning activities. The workshop contains both a didactic component and an experiential component. The workshop was offered as a 60-minute webinar and a 120-minute in-person presentation. The additional hour during the in-person presentation was used for experiential learning activities. Eighty-four educators from a number of health professions attended the webinar, and approximately 50 medical educators attended the in-person presentation. Results: Participants reported satisfaction with the workshop and found its content met stated learning objectives. Participants believed they gained both the knowledge to develop a strategic plan to implement interprofessional educational programming and the ability to apply this knowledge at their AMC. Participants reported that their confidence in using strategic planning increased due to workshop participation. Discussion: This workshop represents a first step in helping educational leaders learn and use strategies to develop and implement interprofessional educational programming unique to their AMC. This programming is important for training future health care providers to work on interprofessional health care teams.

A framework for faculty development programming at VA and non-VA Academic Medical Centers.

VA and non-VA Academic Medical Centers (AMCs) serve as training environments for learners from many different professions and academic affiliates, including regional medical campuses. Faculty members at these AMCs need programming to help create and enhance the educational environment for learners. In this paper, we provide a framework for AMCs to develop and implement faculty development programming and provide a case example of how this programming was implemented at one VA AMC. It is the hope that this framework and programming can be adopted by other AMCs to provide faculty members with the programming needed to sustain high quality training environments.

Treatment of Women Veterans with Posttraumatic Stress Disorder and Serious Mental Illness in an Inpatient Mental Health Treatment Setting: A Case Study.

This article discusses the challenges of providing treatment for women with complex dual diagnostic mental health needs. In particular, the focus is on the intersections between posttraumatic stress disorder (PTSD), serious mental illness (SMI), female gender, and veteran status. Utilizing a clinical case example, we focus our discussion on psychotherapy goals and interventions, including the advisability of engaging in trauma-focused therapy on an inpatient unit with a patient who carries an SMI diagnosis. We also address benefits and challenges of providing this type of treatment, provider reactions including burnout and diagnostic bias, and recommendations for future care for persons with similar presentations and needs.

Irritability and elation in a large bipolar youth sample: relative symptom severity and clinical outcomes over 4 years.

OBJECTIVE: To assess whether relative severity of irritability symptoms versus elation symptoms in mania is stable and predicts subsequent illness course in youth with DSM-IV bipolar I or II disorder or operationally defined bipolar disorder not otherwise specified. METHOD: Investigators used the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children to assess the most severe lifetime manic episode in bipolar youth aged 7-17 years who were recruited from 2000 to 2006 as part of the Course and Outcomes of Bipolar Youth prospective cohort study (N = 361), conducted at university-affiliated mental health clinics. Subjects with at least 4 years of follow-up (N = 309) were categorized as irritable-only (n = 30), elated-only (n = 42), or both irritable and elated (n = 237) at baseline. Stability of this categorization over follow-up was the primary outcome. The course of mood symptoms and episodes, risk of suicide attempt, and functioning over follow-up were also compared between baseline groups. RESULTS: Most subjects experienced both irritability and elation during follow-up, and agreement between baseline and follow-up group assignment did not exceed that expected by chance (κ = 0.03; 95% CI, -0.06 to 0.12). Elated-only subjects were most likely to report the absence of both irritability and elation symptoms at every follow-up assessment (35.7%, versus 26.7% of irritable-only subjects and 16.9% of those with both irritability and elation; P = .01). Baseline groups experienced mania or hypomania for a similar proportion of the follow-up period, but irritable-only subjects experienced depression for a greater proportion of the follow-up period than did subjects who were both irritable and elated (53.9% versus 39.7%, respectively; P = .01). The groups did not otherwise differ by course of mood episode duration, polarity, bipolar diagnostic type, suicide attempt risk, or functional impairment. CONCLUSIONS: Most bipolar youth eventually experienced both irritability and elation irrespective of history. Irritable-only youth were at similar risk for mania but at greater risk for depression compared with elated-only youth and youth who had both irritability and elation symptoms.