Using Theory-Informed Group Processes to Make TIMELESS Promotion Decisions.

ABSTRACT: Competency-based medical education (CBME) depends on effective programs of assessment to achieve the desired outcomes and goals of training. Residency programs must be able to defend clinical competency committee (CCC) group decisions about learner readiness for practice, including decisions about time-variable resident promotion and graduation. In this article, the authors describe why CCC group decision-making processes should be supported by theory and review 3 theories they used in designing their group processes: social decision scheme theory, functional theory, and wisdom of crowds. They describe how these theories were applied in a competency-based, time-variable training pilot-Transitioning in Internal Medicine Education Leveraging Entrustment Scores Synthesis (TIMELESS) at the University of Cincinnati internal medicine residency program in 2020-2022-to increase the defensibility of their CCC group decision-making. This work serves as an example of how use of theory can bolster validity arguments supporting group decisions about resident readiness for practice.

Strategies to Counteract Impact of Harmful Bias in Selection of Medical Residents.

Human biases impact medical care in ways that perpetuate health disparities. Research has demonstrated that biases negatively affect patient outcomes and stifle diversity across the physician workforce, further compounding health disparities by worsening patient-physician concordance. Taken as one, the application, interview, recruitment, and selection processes employed by residency programs has been one of the critical junctures where bias has exacerbated inequities among future physicians. In this article, the authors define diversity and bias, review the history of bias in residency programs' processes for selecting residents, explore the impact of this history on workforce demographics, and discuss ways to optimize and work toward equity in the practices used by residency programs to select residents.

Reconstructing Neurath's Ship: A Case Study in Reevaluating Equity in a Program of Assessment.

Inequity in assessment has been described as a "wicked problem"-an issue with complex roots, inherent tensions, and unclear solutions. To address inequity, health professions educators must critically examine their implicit understandings of truth and knowledge (i.e., their epistemologies) with regard to educational assessment before jumping to solutions. The authors use the analogy of a ship (program of assessment) sailing on different seas (epistemologies) to describe their journey in seeking to improve equity in assessment. Should the education community repair the ship of assessment while sailing or should the ship be scrapped and built anew? The authors share a case study of a well-developed internal medicine residency program of assessment and describe efforts to evaluate and enable equity using various epistemological lenses. They first used a postpositivist lens to evaluate if the systems and strategies aligned with best practices, but found they did not capture important nuances of what equitable assessment entails. Next, they used a constructivist approach to improve stakeholder engagement, but found they still failed to question the inequitable assumptions inherent to their systems and strategies. Finally, they describe a shift to critical epistemologies, seeking to understand who experiences inequity and harm to dismantle inequitable systems and create better ones. The authors describe how each unique sea promoted different adaptations to their ship, and challenge programs to sail through new epistemological waters as a starting point for making their own ships more equitable.

How Does TIMELESS Training Impact Resident Motivation for Learning, Assessment, and Feedback? Evaluating a Competency-Based Time-Variable Training Pilot.

PURPOSE: As competency-based medical education has become the predominant graduate medical education training model, interest in time-variable training has grown. Despite multiple competency-based time-variable training (CBTVT) pilots ongoing in the United States, little is known about how this training approach impacts learners. The authors aim to explore how their CBTVT pilot program impacted resident motivation for learning, assessment, and feedback. METHOD: The authors performed a qualitative educational case study on the Transitioning in Internal Medicine Education Leveraging Entrustment Scores Synthesis (TIMELESS) program at the University of Cincinnati from October 2020 through March 2022. Semistructured interviews were conducted with TIMELESS residents (n = 9) approximately every 6 months to capture experiences over time. The authors used inductive thematic analysis to develop themes and compared their findings with existing theories of learner motivation. RESULTS: The authors developed 2 themes: TIMELESS had variable effects on residents' motivation for learning and TIMELESS increased resident engagement with and awareness of the program of assessment. Participants reported increased motivation to learn and seek assessment, though some felt a tension between performance (e.g., advancement through the residency program) and growth (e.g., improvement as a physician). Participants became more aware of the quality of assessments they received, in part due to TIMELESS increasing the perceived stakes of assessment, and reported being more deliberate when assessing other residents. CONCLUSIONS: Resident motivation for learning, assessment, and feedback was impacted in ways that the authors contextualize using current theories of learner motivation (i.e., goal orientation theory and attribution theory). Future research should investigate how interventions, such as coaching, guided learner reflection, or various CBTVT implementation strategies, can help keep learners oriented toward mastery learning rather than toward performance.

Training Future Family Physicians to Become Master Adaptive Learners.

This article examines the use of a concept that teaches learners how to learn in the context of family medicine residency training. We describe the four phases of this master adaptive learning framework and its place in educational theory and adaptive expertise, its implications for graduate medical education training and Accreditation Council for Graduate Medical Education competencies, as well as its role in imprinting family medicine residents for career-long learning. We lay out pragmatic strategies supporting this concept with a proposed curricular format for training in family medicine, including small group teaching methods, didactics, the clinic visit, faculty development and an optimal learning environment.

Using skype as an alternative for residency selection interviews.

BACKGROUND: Residency interviews can place significant time and financial burdens on applicants. OBJECTIVE: To determine whether the use of Skype as a screening tool during interview season in a family medicine residency is cost-effective and time-efficient for the applicant and the residency program. METHODS: We surveyed 2 groups of medical students during interviews for our family medicine program. Thirty-two students were interviewed via our face-to-face, traditional interview (TI) process, and 10 students, the second group, who did not meet the program's standard interview selection criteria for TI, underwent our Skype interview (SI) process. RESULTS: Using an unpaired t test, we found that the applicants' costs of an SI were significantly less than a TI, $566 (95% confidence interval [CI] $784-$349, P < .001). Direct cash savings plus indirect salary savings to the program were $5,864, with a time savings of 7 interview days. Three of the applicants who were participants in the SI limb of the study were in our final rank order list. CONCLUSIONS: For interviewing in family medicine residencies, use of Skype may be a cost-effective and time-efficient screening tool for both the applicant and the program. Alternate uses of SI may include the time-sensitive, postmatch Supplemental Offer and Acceptance Program.