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News from the Academy of Medical Educators and Faculty Affairs


Graduation Level Competencies for the School of Medicine
Task Force to Continue Work in Implementing Competencies across the Curriculum

Medical education provides students, residents and fellows with the opportunity to learn and practice in a supervised work environment so that they can acquire the knowledge, skills, attitudes and behaviors necessary to treat patients independently within the scope of their medical discipline. In a competency-based system of training, outcomes are derived from the abilities and standards required of physicians for safe and effective practice. Educators, informed and guided by the needs of patients and learners, provide the framework, curriculum, instruction, and supervision for this training[1]. Educators are also responsible for assessing whether trainees are progressing appropriately toward independence, and ultimately determining whether they are prepared for unsupervised practice[2].

The Accreditation Council for Graduate Medical Education (ACGME) introduced the Outcomes Project in 1999, requiring resident training programs to assess trainee accomplishment of learning objectives across six general domains of competence[3]. The Next Accreditation System of the ACGME began this year, and includes competency-based reporting using milestones, a criterion-based developmental framework for reporting a resident’s progress toward independent practice[4],[5]. In 2013, the Association of American Medical Colleges (AAMC) further defined competencies for health professionals, adding two new competency domains[6]. These domains have subsequently been adopted by the Liaison Committee for Medical Education (LCME), the accreditation body of medical schools. Integration of these competencies into medical student education is a required element for LCME accreditation.

A task force of the Curriculum Steering Committee, consisting of 16 faculty with expertise in competency development and spanning the continuum of medical education has worked for the last year to develop graduation level competencies for the University of Colorado School of Medicine. These competencies describe the minimum expectations required of a student prior to graduation from this medical school.

To develop the competencies, they reviewed the extensive literature, including the milestones of all specialties currently available. They developed draft competencies for each competency domain. These were reviewed iteratively using a modified Delphi technique. The final competencies were approved by the Clerkship Block Directors and the Curriculum Steering Committee in May, and presented in total for assent by the Faculty Senate. (View the final version of the competencies.​)

There is much work still to be done—this is only the first step. Over the next two years, the task force will be mapping the competencies to course and block level goals and objectives and assessments. In addition, "hard stops” at each phase of medical school will be identified with associated assessment tools. The work of the committee will be critical to the upcoming LCME self-study and accreditation process. 


Medical Students Suggest “6 Best Practices” of Preceptorship at the Golden Stethoscope Banquet

Kristin Furfari, MD

Medical students from the Foundations of Doctoring curriculum recognized and thanked their program’s volunteer and full-time clinical preceptors at the Golden Stethoscope banquet on May 5.

Students in all phases of the three-year Foundations of Doctoring curriculum were asked to write letters in support of their preceptors and nominate them for various awards. The following themes emerged as student’s reported what they learned and valued as well as what makes for a successful clinical preceptorship experience.

  1. Investment in relationships, both with patients and with students. “My preceptor is aware of my particular interests, strengths and weaknesses.”
  2. The value of listening. “It is far more efficient and more effective at building trust between the patient and physician to remove the assumptions, to be quiet, and truly discover the patient, the person, and their understanding of their disease.”
  3. Creating a safe teaching environment. “My preceptor challenges me to move beyond my comfort level in order to improve my clinical and communication skills, while maintaining a safe and respectful environment for the patient. His feedback is always constructive and directed – even when I, for example, completely bomb the neuro exam I am attempting. Instead of simply dictating how to do something, he always explains why.”
  4. The importance of goal development. “We talk about my goals frequently. Every day he encourages and validates my selections. As a student, the list of things I’d like to be better at is endless, but equally valid are the skills that are less concrete.”
  5. The value of the human touch. “After a heartfelt talk about a patient’s [challenging] situation and options, my preceptor’s next move surprised me. ‘Your heart must feel broken right now – do you mind if I listen to it?’ With one hand on her stethoscope, the other rested reassuringly on the patient’s shoulder, a seamless integration of compassion and doctoring.”
  6. Demonstrating humanism. “Every time we spoke and every shift I was with her, my preceptor asked about the most crucial parts of medical school – how I was coping, what I was eating, how much exercise I was getting, and what medicine still meant to me. It seemed completely natural because she did the exact same thing with her coworkers and her patients.”


Reminder: Faculty Should Review Payment Data Reported to the Centers for Medicare and Medicaid Services

Physicians on our faculty should take time to review information reported by pharmaceutical and medical-device manufacturers to the federal government about payments for research, consulting, gifts, travel or speaking honoraria, and entertainment. The Physician Payment Sunshine Act, which is part of the Affordable Care Act, requires the manufacturers to report such payments. As of June 1, physicians can register on the Centers for Medicare and Medicaid Services (CMS) website to review and dispute any of the data reported about them. CMS will make the data public on September 30, 2014. Dean Krugman urges you to review as, based on previous news reports, we expect intense interest in the information.

Faculty Affairs has prepared a useful summary of the issue.


Now Seeking Nominations for Faculty Professionalism Award

The Faculty Senate last week announced its call for nominations for the School of Medicine Faculty Professionalism Award. The award recognizes a full-time faculty member who has served as a role model for professionalism. It is presented in August at the School of Medicine matriculation ceremony. Award criteria and nomination packets are available online. Nominations are due by 5 p.m., Friday, July 11, to Director of Faculty Affairs, Cheryl Welch.


 
 

[1] Frank, J. R., et al. (2010). "Competency-based medical education: theory to practice." Med Teach 32(8): 638-645.

 

[2] Holmboe, E. S., et al. (2010). "The role of assessment in competency-based medical education." Med Teach 32(8): 676-682.

 

[3] Swing, S. R. (2007). "The ACGME outcome project: retrospective and prospective." Med Teach 29(7): 648-654.

 

[4] Nasca, T. J., et al. (2012). "The next GME accreditation system--rationale and benefits." N Engl J Med 366(11): 1051-1056.

 

[5] Caverzagie, K. J., et al. (2013). "The internal medicine reporting milestones and the next accreditation system." Ann Intern Med 158(7): 557-559.

 

[6] Englander, R., et al. (2013). "Toward a common taxonomy of competency domains for the health professions and competencies for physicians." Acad Med 88(8): 1088-1094.

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