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1.
Fam Med ; 52(1): 43-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914183

RESUMO

BACKGROUND AND OBJECTIVES: Direct observation is a critical part of assessing learners' achievement of the Accreditation Council for Graduate Medical Education (ACGME) Milestones and subcompetencies. Little research exists identifying the content of peer feedback among residents; this study explored the content of residents' peer assessments as they relate to ACGME Milestone subcompetencies in a family medicine residency program. METHODS: Using content from a mobile app-based observation tool (M3App), we examined resident peer observations recorded between June 2014 and November 2017, tabulating frequency of observation for each ACGME subcompetency and calculating the proportion of observations categorized under each subcompetency, as well as for each postgraduate year (PGY) class. We also coded each observation on three separate dimensions: "positive," "constructive," and "actionable." We used the χ2 test for independence, and estimated odds ratios and 95% confidence intervals for two-by-two comparisons to compare numbers of observations within each category. RESULTS: Our data include 886 peer observations made by 54 individual residents. The most frequently observed competencies were in patient care, communication, and professionalism (56%, 47%, and 38% of observations, respectively). Practice-based learning and improvement was observed least frequently (16% of observations). On average, 97.25% of the observations were positive, 85% were actionable, and 6% were constructive. CONCLUSIONS: When asked to review their peers, residents provide comments that are primarily positive and actionable. In addition, residents tend to provide more feedback on certain subcompetencies compared to others, suggesting that programs may rely on peer feedback for specific subcompetencies. Peers can provide perspective on the behaviors and skills of fellow residents.

3.
Fam Med ; 51(6): 509-515, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31184765

RESUMO

BACKGROUND AND OBJECTIVES: The Accreditation Council for Graduate Medical Education Common Residency Program Requirements stipulate that each faculty member's performance be evaluated annually. Feedback is essential to this process, yet the culture of medicine poses challenges to developing effective feedback systems. The current study explores existing and ideal characteristics of faculty teaching evaluation systems from the perspectives of key stakeholders: faculty, residents, and residency program directors (PDs). METHODS: We utilized two qualitative approaches: (1) confidential semistructured telephone interviews with PDs from a convenience sample of eight family medicine residency programs, (2) qualitative responses from an anonymous online survey of faculty and residents in the same eight programs. We used inductive thematic analysis to analyze the interviews and survey responses. Data collection occurred in the fall of 2017. RESULTS: All eight (100%) of the PDs completed interviews. Survey response rates for faculty and residents were 79% (99/126) and 70% (152/216), respectively. Both PD and faculty responses identified a desire for actionable, real-time, frequent feedback used to foster continued professional development. Themes unique to faculty included easy accessibility and feedback from peers. Residents expressed an interest in in-person feedback and a process minimizing potential retribution. Residents indicated that feedback should be based on shared understanding of what skill(s) the faculty member is trying to address. CONCLUSIONS: PDs, faculty, and residents share a desire to provide faculty with meaningful, specific, and real-time feedback. Programs should strive to provide a culture in which feedback is an integral part of the learning process for both residents and faculty.


Assuntos
Docentes de Medicina/normas , Internato e Residência , Ensino , Acreditação/normas , Educação de Pós-Graduação em Medicina , Retroalimentação , Humanos , Desenvolvimento de Pessoal , Inquéritos e Questionários
4.
Fam Med ; 51(3): 227-233, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30676638

RESUMO

BACKGROUND AND OBJECTIVES: There are several trends compelling physicians to acquire team-based skills for interprofessional care. One underdeveloped area of team-based skills for physicians is integrated behavioral health (IBH) in primary care. We used a Delphi method to explore what skills were needed for residents to practice integrated behavioral health. METHODS: We conducted a literature review of IBH competencies and found 41 competencies across seven domains unique to physicians. Using a modified Delphi technique, we recruited family medicine educators to rate each competency as "essential," "compatible," or "irrelevant." We also shared findings from the Delphi study with a focus group for additional feedback. RESULTS: Twenty-one participants (12 physicians, nine behavioral health providers) completed all three rounds of the Delphi survey resulting in a list of 21 competencies. The focus group gave additional feedback. CONCLUSIONS: Participants chose skills that required physicians to share responsibilities across the entire care team, were not redundant with standard primary care, and necessitated strong communication ability. Many items were revised to reflect team-based care and a prescribed physician role as a team facilitator. Next steps include determining how these competencies fit with a variety of medical providers and creating effective training programs that develop competency in IBH.


Assuntos
Medicina do Comportamento , Prestação Integrada de Cuidados de Saúde/métodos , Técnica Delfos , Medicina de Família e Comunidade/educação , Internato e Residência , Grupos Focais , Humanos , Equipe de Assistência ao Paciente , Médicos
6.
Int J Psychiatry Med ; 50(1): 115-27, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26142286

RESUMO

Beginning behavioral science faculty, who are critical residency program contributors, face significant immediate challenges that often diminish their effectiveness and increase the time it takes to translate and reformat their expertise into relevant and meaningful educational presentations. Residency program culture and competency-based learning are quite different from the educational objectives and teaching environments found in most behavioral health training programs. The goal of this article is to provide beginning behavior science faculty, who are typically on their own and learning on the job, with a guide to the core educational perspectives and skills required as well as key resources that are available to them. Since a significant portion of behavioral science faculty's teaching time revolves around small and large group presentations, our guide focuses on how to incorporate key strategies and resources into relevant, evidenced-based and, most importantly, effective behavioral health presentations for the program's resident physicians. Specifically, our recommendations include selection of content, methods of content organization, techniques for actively engaging resident physicians in discussing the significance of the topics, and descriptions of numerous Internet resources for the primary mental health topics that concern family medicine trainees. Finally, it is emphasized that the relevant and effective use of these recommendations is dependent upon the behavioral science faculty educator's first understanding and appreciating how physicians' think, speak, and prioritize information while caring for their patients.


Assuntos
Ciências do Comportamento/educação , Educação de Pós-Graduação em Medicina/métodos , Docentes de Medicina , Comunicação Interdisciplinar , Atitude do Pessoal de Saúde , Cultura , Humanos
7.
J Surg Educ ; 72(1): 108-16, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25139607

RESUMO

OBJECTIVE: The Communication Assessment Tool (CAT) has been used and validated to assess Family and Emergency Medicine resident communication skills from the patient's perspective. However, it has not been previously reported as an outcome measure for general surgery residents. The purpose of this study is to establish initial benchmarking data for the use of the CAT as an evaluation tool in an osteopathic general surgery residency program. Results are analyzed quarterly and used by the program director to provide meaningful feedback and targeted goal setting for residents to demonstrate progressive achievement of interpersonal and communication skills with patients. DESIGN: The 14-item paper version of the CAT (developed by Makoul et al. for residency programs) asks patients to anonymously rate surgery residents on discrete communication skills using a 5-point rating scale immediately after the clinical encounter. Results are reported as the percentage of items rated as "excellent" (5) by the patient. SETTING: The setting is a hospital-affiliated ambulatory urban surgery office staffed by the residency program. PARTICIPANTS: Participants are representative of adult patients of both sexes across all ages with diverse ethnic backgrounds. They include preoperative and postoperative patients, as well as those needing diagnostic testing and follow-up. RESULTS: Data have been collected on 17 general surgery residents from a single residency program representing 5 postgraduate year levels and 448 patient encounters since March 2012. The reliability (Cronbach α) of the tool for surgery residents was 0.98. The overall mean percentage of items rated as excellent was 70% (standard deviations = 42%), with a median of 100%. CONCLUSIONS: The CAT is a useful tool for measuring 1 facet of resident communication skills-the patient's perception of the physician-patient encounter. The tool provides a unique and personalized outcome measure for identifying communication strengths and improvement opportunities, allowing residents to receive specific feedback and mentoring by program directors.


Assuntos
Comunicação , Cirurgia Geral/educação , Internato e Residência , Medicina Osteopática/educação , Relações Médico-Paciente , Adulto , Feminino , Humanos , Masculino , Centros Cirúrgicos , Inquéritos e Questionários
8.
J Grad Med Educ ; 6(3): 495-500, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26279775

RESUMO

BACKGROUND: The Communication Assessment Tool (CAT), a paper-based patient survey, is 1 method to assess residents' interpersonal and communication skills. To further enhance the interpretation of the CAT, benchmark data are needed. OBJECTIVE: We sought to expand upon initial benchmarking data for the use of the CAT as an evaluation tool in family medicine residency programs. METHODS: Data were collected on 120 residents from 7 family medicine residency programs. Following an appointment with a resident, 1703 patients completed the CAT. RESULTS: The overall mean percentage of items rated as excellent was 73%. Significant differences were found in the overall percentage of items rated as "excellent" based on location of training (78% US graduate versus 71% international medical graduate) and native language of the resident (76% English speaking versus 69% non-English speaking). There were no significant differences found in the overall percentage of items rated as excellent based on the year of training or sex of the residents. CONCLUSIONS: These benchmarking data allow family medicine residency programs to compare the performance of their residents with other programs. The CAT can be used as an evaluation and a learning tool in family medicine and may be applicable to other specialties.

9.
Int J Psychiatry Med ; 45(4): 367-76, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24261270

RESUMO

Integrating behavioral health into primary healthcare offers multiple advantages for patients and health professionals. This model requires a new skill set for all healthcare professionals that is not emphasized in current educational models. The new skills include interprofessional team-based care competencies and expanded patient care competencies. Health professionals must learn new ways to efficiently and effectively address health behavior change, and manage behavioral health issues such as depression and anxiety. Learning environments that co-train mental health and primary care professionals facilitate acquisition of both teamwork and patient care competencies for mental health and primary care professional trainees. Family Medicine Residency programs provide an excellent opportunity for co-training. This article serves as a "how to" guide for residency programs interested in developing a co-training program. Necessary steps to establish and maintain a program are reviewed, as well as goals and objectives for a co-training curriculum and strategies to overcome barriers and challenges in co-training models.


Assuntos
Medicina do Comportamento/educação , Currículo/normas , Medicina de Família e Comunidade/educação , Internato e Residência/normas , Adulto , Competência Clínica/normas , Comportamento Cooperativo , Humanos , Desenvolvimento de Programas/normas
10.
Fam Med ; 42(8): 567-73, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20830622

RESUMO

BACKGROUND AND OBJECTIVES: The Communication Assessment Tool (CAT), developed by Makoul et al assesses patient perceptions of physicians' interpersonal and communication skills. The objective of this study was to gather initial benchmarking data for the use of the CAT in family medicine residency programs. METHODS: Data were collected from patients seeing 127 residents from six family medicine residency programs. A total of 1,931 patients completed the paper and pencil version of the CAT following an appointment with a resident; 1,880 of the CAT forms met the inclusion criteria for analysis. RESULTS: The overall mean percentage of items from which residents were rated as excellent was 69.7%. Significant differences were found in the overall percentage of items rated as excellent based on training year, with PGY-1 (77.0%) residents being rated significantly higher than PGY-2 (69.5%) and PGY-3 (68.1%) residents. There were no significant differences found in the overall percentage of items rated as excellent based on the native language or gender of the residents. CONCLUSIONS: This initial benchmarking data can allow family medicine residency programs to compare the performance of their residents with the performance of residents from other programs. We recommend that the results of the CAT be used as both an evaluative and learning tool.


Assuntos
Comunicação , Medicina de Família e Comunidade/educação , Internato e Residência/estatística & dados numéricos , Relações Interpessoais , Percepção , Relações Médico-Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Benchmarking , Competência Clínica , Barreiras de Comunicação , Educação de Pós-Graduação em Medicina , Medicina de Família e Comunidade/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
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