Cross educational boundaries! Clinical professional school rotations:

1. Personalized Multi-modal Assessment to Foster Individual Learning Plans Martha Illige, MDRose Family Medicine Residency, University of Colorado Denver October 2012 Abstract In the 21st century, degrees, credentials, or certifications do not guarantee competence or workplace performance. Professional and governmental accountability organizations for professionals ask for demonstrations of knowledge, skills, and attitudes. “Show me!” And plan to show over the course of a lifelong career the ongoing professional development that is appropriate for a specific practice. Where a climate of entitlement in the final year of professional school prevails, not all learners plan a rigorous elective schedule to prepare for the next step in training. Duty-hours rules impact and limit clinical experiences. Self-regulated learning approaches from educational psychology, behavior change models, and experience with peer review and American Board of Family Medicine Maintenance of Certification processes led to this program. This report summarizes a graduate medical education program in the United States and its lessons about formative assessment and linked learning plans. Lessons Assessment & Remediation Data on 124 residents highquality Ask, check, don’t assume Look at all areas needed for practice – competencies from ACGME or CANMEDS Structure and schedule assessments and feedback regularly Use behavior change models Intervene early Trust learners and encourage curiosity Remember that we are all learners gray area unsafe • Consider • Maturity • Health • Circumstances • Stress • Past issues • Program resources and limitations • Pick your battles • Modalities with planned data capture and feedback • Assessment • MCQ tests • Structured oral interviews • Video analysis • Direct observations of care (like Mini-CEX) • Direct observations of procedures • Multi-source feedback (360s) • Chart audit • Leadership analysis • Teamwork analysis • Individual Learning Plan • Direct supervision • Coaching • Tutoring • Practice with simulated patients • Focused elective block rotations • Formal courses • Guided study • Talk-out-loud protocol • Case-based analysis • Small group learning • Teach a topic • Self-analysis and reflective activities • Counseling support Work ethic and response to criticism Cross educational boundaries! Clinical professional school rotations: Relevant? Planned? Ready for next step? Residency Practice Teaching Non-success Success • Learner owns the issues • Insight • Congruent values • Openness and transparency • Rapport • Limited or discreet needs • Danger to patients • External locus of control • Passivity • Extensive needs • Pervasive disorganization • Undertreated health problems • Disagreement about goals References • Sandars & Clearly Self-regulations theory: application to medical education AMEE Guide 50 Medical Teacher 2011 • Van derVleuten et al A model for programmatic assessment fit for purpose Medical Teacher 2012 • Hauer et al Remediation of the deficiencies of physicians across the continuum from medical school to practice: a thematic review of the literature Academic Medicine 2009 • Wachter & VergheseThe attending physician on the wards: finding a new homeostasis JAMA 9/12/12 History at RFMR 60 years of Graduate Medical Education 1970 ABFM approval 1998 Personalized assessment starts 1999-2012 yearly evaluation and improvement 2010 Everybody has a learning plan Goals – Institute of Medicine 2003 Deliver patient-centered care Work as part of interdisciplinary teams Practice evidence-based medicine Focus on quality improvement Use information technology Acknowledgements Iwould like to acknowledge the following for their help and support: Brian Bacak, program director; Rose Family Medicine faculty members and the Departments of Family Medicine and Graduate Medical Education at UCD School of Medicine. Martha.illige@healthonecares.com