A Survey of Neurological Surgery Residency Program Mentorship Practices Compared to Accreditation Council for Graduate Medical Education Resident Outcome Data.

Mentorship can be a powerful and life-altering experience during residency training, but there are few articles discussing mentorship models within neurosurgery. In this study, we surveyed US neurosurgical department mentorship practices and linked them to resident outcomes from the Accreditation Council for Graduate Medical Education (ACGME), including resident survey responses, board pass rates, and scholarly activity. A 19-question survey was conducted from October to December 2017 with the assistance of the Society of Neurological Surgeons. De-identified data were then obtained from the ACGME and correlated to these results. Out of 110 programs, 80 (73%) responded to the survey and gave informed consent. The majority (65%) had a formal mentorship program and assigned mentor relationships based on subspecialty or research interest. Barriers to mentorship were identified as time and faculty/resident "buy-in." Mentorship programs established for 5 or more years had superior resident ACGME outcomes, such as board pass rates, survey results, and scholarly activity. There was not a significant difference in ACGME outcomes among programs with formal or informal/no mentorship model (P = .17). Programs that self-identified as having an "unsuccessful" mentorship program had significant increases in overall negative resident evaluations (P = .02). Programs with well-established mentorship programs were found to have superior ACGME resident survey results, board pass rates, and more scholarly activity. There was not a significant difference among outcomes and the different models of formal mentorship practices. Barriers to mentorship, such as time and faculty/resident "buy-in," are identified.

From the educational bench to the clinical bedside: translating the Dreyfus developmental model to the learning of clinical skills.

The Accreditation Council for Graduate Medical Education Outcome Project has shifted the focus of residents' education to competency-based outcomes of learning. The challenge of meaningful assessment of learner competence has stimulated interest in the Dreyfus and Dreyfus Model, a framework for assessing skill acquisition that describes developmental stages beginning with novice and progressing through advanced beginner, competent, proficient, expert, and master. Many educators have adopted this model, but no consensus about its adaptation to clinical medicine has been documented. In this article, the authors seek to integrate generally accepted knowledge and beliefs about how one learns to practice clinical medicine into a coherent developmental framework using the Dreyfus and Dreyfus model of skill acquisition. Using the general domain of patient care, the characteristics and skills of learners at each stage of development are translated into typical behaviors. A tangible picture of this model in real-world practice is provided through snapshots of typical learner performance at discrete moments in time along the developmental continuum. The Dreyfus and Dreyfus model is discussed in the context of other developmental models of assessment of learner competence. The limitations of the model, in particular the controversy around the behaviors of "experts," are discussed in light of other interpretations of expertise in the literature. Support for descriptive developmental models of assessment is presented in the context of a discussion of the deconstructing versus reconstructing of competencies.

Implementing goals for non-cognitive outcomes within a basic science course.

OBJECTIVE: An essential principle of competency-based education (CBE) is use of observable outcomes with assessments as judgments of competence based on defined criteria. Faculty are accustomed to using learning objectives as the defining criteria for knowledge, assessing students using written exams. Faculty are less familiar with how the principles of CBE are applied to other competencies. We recently adopted school-wide goals and objectives, modeled after the ACGME Outcomes Project. The present objective was to give faculty first-hand experience in CBE within a basic science course, including both cognitive and non-cognitive outcomes. DESCRIPTION: The format for the learner-centered, first-year Cell and Molecular Biology course was previously described.(1) Course goals were that students: (1) gain an understanding of the principles and concepts of cell and molecular biology, (2) develop an appreciation for how these principles and concepts are important to medicine, (3) demonstrate an ability to think critically using these principles and concepts. Goal 1 was measured by written exams. We assumed goals 2 and 3 were met through small-group problem-solving sessions, and outcomes were not assessed. The revised 2001 course goals were to prepare students for medical knowledge and lifelong learning and communication and professionalism. The goals for medical knowledge and lifelong learning were to: (1) demonstrate ability to use principles and concepts of cell biology, molecular biology, and genetics to analyze medically relevant data, solve problems, make predictions, and determine a course of action; (2) effectively use information technology to search, evaluate, and critically review scientific evidence related to principles and concepts covered in the course; (3) use appropriate techniques to teach peers in a conference setting. The goals for communication and professionalism were to: (1) use appropriate skills and attitudes to collaborate effectively with peers and faculty to accomplish learning goals; (2) maintain a personal learning portfolio to develop habits of reflective learning, broaden understanding of content beyond recall, and enhance communication with faculty; (3) demonstrate personal integrity in meeting course requirements and in interactions with peers and faculty throughout the course. Goals for medical knowledge and lifelong learning were assessed by written exams and by separate tools utilizing four-point Likert scales (novice, advanced beginner, proficient, distinguished) with specific observable criteria for a written research paper and a group PowerPoint presentation. Faculty and student assessments generated a number that was combined with exam grades for a lettered competency grade. A 19-item, five-point Likert scale was used by students to self- and peer-assess goals for communication and professionalism. Small-group faculty facilitators used the tool to give formative feedback midcourse, summative feedback at course conclusion, and competency grades. The tools may be viewed at: . DISCUSSION: Faculty achieved enhanced understanding of students, assisted by descriptive criteria, while suggesting improvements in forms. Better agreement on criteria definitions and consistency in form use is needed. Students developed understanding and improved communication/professionalism skills, based on repeated exposures to criteria and feedback. It remains to be seen whether the skills are used/developed in other courses. A majority of students did not use the learning portfolio as envisioned. Better design and implementation of school-wide rather than course-specific reflective portfolios may increase use and integrate learning in all courses with all six competencies.