Current Milestones Assessment Practices, Needs, and Challenges of Program Directors: A Collective Case Study in a Pediatric Hospital Setting.

Introduction Accreditation Council for Graduate Medical Education's (ACGME's) Milestones assessment requirement has placed new demands on Program Directors (PDs), especially those with limited knowledge of assessment and evaluation activities. There is a lack of clarity on how Program Director (PDs)/Associate PDs (APDs) are effectively implementing milestones assessment and evaluation practices in the Graduate Medical Education programs. The purpose of this study was to investigate current assessment practices, needs, and challenges of PDs in implementing milestones assessment within their residency and fellowship programs in a pediatric hospital setting. Methods This study used a collective case study approach to obtain information from PDs, APDs, and Clinical Competency Committee (CCC) Chairs in 19 graduate programs at a pediatric hospital. We used structured meetings with planned agendas and a pre-formatted template to itemize program needs/difficulties/challenges in the milestone assessment. We used cross-case thematic content anal-ysis to identify categories and themes to compare differences and commonalities across programs. Results A total of 38 PDs, APDs, and CCC Chairs from 19 different specialties/subspe-cialties participated in this study. Thirteen types of assessment and evaluation tools were consistently used across programs. Three categories emerged in relation to those assessment and evaluation types (direct, indirect, and multi-source). Rotation evaluation (84.2%), direct observation (73.2%), and 360-degree assessment (68.4%) were primarily used for measuring patient care among the six core competencies. Programs' needs varied from curriculum and assessment tool development to alignment of milestones items, and to creating a sys-tematic assessment management plan. The most common challenges were difficulties related to logistics and tracking of evaluation in the survey management system (52.6%), challenges with time management (47.3%), and difficulty in determining and interpret-ing the milestones' numbers and levels (31.5%). Conclusions Milestones assessment and evaluation in medical education can be a challenge, but a priority for many training programs. Our study indicated that milestones assessment and evaluation in medical education are far more com-plex than we expect. Multiple assessment methods must be utilized to evaluate all essential competencies for accurate measurement of trainees' performance abilities. Our study uncovered several issues PDs faced during the implementation of milestones assessment and needs and challenges.

Medical Leaders Identify Personal Characteristics and Experiences that Contribute to Leadership Success in Medicine.

This article was migrated. The article was marked as recommended. Introduction: The approach of medical educators to preparing learners for leadership reflects the emphasis leadership theories once placed on experiential learning. But, contemporary theories now also show a renewed interest in the role of personal characteristics in effective leadership. This shift raises questions explored here: What characteristics mark top medical leaders? What experiences nurture those characteristics? Method: In a 2015 qualitative study, 48 University of Missouri-Kansas City (UMKC) medical graduates who met criteria for outstanding leadership participated in semi-structured interviews. Investigators applied directed content-analysis to their responses. Then, using iterative open-coding, investigators identified personal characteristics leaders said contributed to their leadership, clustered them into types, and counted the number of leaders who spoke to each type. Next, they coded and categorized experiences leaders discussed and counted the number of leaders who mentioned each type of experience. Finally, they identified leaders' comments about which types of experiences helped develop which types of characteristics. Results: Most leadersmentioned four types of characteristics: openness to new ideas/opportunities/astute risk-taking; intense motivation/active involvement/commitment; people-orientation; and capability/competence/ intelligence. Many discussed two additional types: self-awareness and service-orientation. Leaders said these types of experiences nurtured their characteristics: family traditions, high-school co-curricular activities, participation in medical school learning communities plus interaction with role models/mentors and authentic opportunities to practice leadership, innovation, and excellence throughout their education and in the workplace. Conclusions: Medical leaders' views of the role of personal characteristics in outstanding leadership and the power of educational and workplace experiences, especially informal ones, to mold those characteristics have enriched understanding how to prepare tomorrow's leaders.

Medical School Factors That Prepare Students to Become Leaders in Medicine.

PURPOSE: To identify medical school factors graduates in major leadership positions perceive as contributing to their leadership development. METHOD: Using a phenomenological, qualitative approach, in August-November 2015 the authors conducted semistructured interviews with 48 medical leaders who were 1976-1999 baccalaureate-MD graduates of the University of Missouri-Kansas City School of Medicine (UMKC). At UMKC, they participated in longitudinal learning communities, the centerpiece for learning professional values and behaviors plus clinical skills, knowledge, and judgment, but received no formal leadership instruction. The authors subjected interview comments to directed, largely qualitative content analysis with iterative coding cycles. RESULTS: Most graduates said their experiences and the people at UMKC positively influenced their leadership growth. Medical school factors that emerged as contributing to that growth were the longitudinal learning communities including docents, junior-senior partners, and team experiences; expectations set for students to achieve; a clinically oriented but integrated curriculum; admission policies seeking students with academic and nonacademic qualifications; supportive student-student and student-faculty relationships; and a positive overall learning environment. Graduates viewed a combination of factors as best preparing them for leadership and excellence in clinical medicine; together these factors enabled them to assume leadership opportunities after graduation. CONCLUSIONS: This study adds medical leaders' perspective to the leadership development literature and offers guidance from theory and practice for medical schools to consider in shaping leadership education: Namely, informal leadership preparation coupled with extensive longitudinal clinical education in a nurturing, authentic environment can develop students effectively for leadership in medicine.