docJust because everything is different doesn`t mean that everything has
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Just because everything is different doesn`t mean that everything has
8/27/2015 The ins and outs of the B standards: why and how they make a program better Author: Sue Dojeiji MD MEd Parveen Wasi MD Date: Thursday, October 22, 2015 It’s really about making explicit what is implicit… “Just because everything is different doesn't mean that everything has changed.” Irene Peter The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents Outline • Introductions • B standards • Find the holes - Analyze your program • Fill the holes - Program Blueprint • Get help – Resources and allies The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 1 8/27/2015 Session/Presentation Name | Presenter Name Objectives 1. Describe the purpose underlying the individual standards for program accreditation 2. Identify areas cited as commonly occurring weaknesses among the B standards 3. Develop an approach to identify and address areas for improvement in your program The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 4 Activity Outline • Find our accreditation buddies • Work through the standards • Reflect on own program’s pitfalls • Work on solutions • Share with others The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents Summary of PD Needs Assessment Anxiety around Accreditation 1= not at all 2= somewhat 3= adequate 4= very comfortable 5= knowledgeable and confident The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 2 8/27/2015 Analyzing your Program • How might you find out? The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents Analyzing your Program Ways to establish strengths and areas to improve •previous RCPSC reports and PG Internal Reviews •predecessor(s) •resident and faculty polls, meetings •postgraduate office •personal experience •other program directors •your site •your specialty •Others? The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents What is the Gold Standard? • What makes a strong program? • How do we measure success? The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 3 8/27/2015 Accreditation Standards B.1: Administrative Structure B.2: Goals and Objectives B.3: Structure and Organization B.4: Resources B.5: Clinical/Academic/Scholarly Content B.6: Assessment of Residents The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents “B” Standards 233 Programs Reviewed in 2011-2012 600 500 400 300 200 100 0 B1 B2 B3 B4 B5 Strengths 305 42 82 288 171 74 Weaknesses 166 60 73 94 158 125 The International Conference on Residency Education | B6 La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B1: Administrative Structure • “Program director engaged, enthusiastic, and committed to the residency program and supported by an excellent program assistant.” (B1.1) • “Residency Program Committee does not fulfill its mandates (assessment and promotion of residents, ongoing review of the program). Residency Program Committee does not take into account opinion of residents in rendering decisions.” (B1.3.4; B1.3.8) The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 4 8/27/2015 B1: Administrative Structure Must have: • Program Director » with sufficient time and support • Residency Program Committee (RPC) » Gives direction to PD » Meets quarterly (minimum) • Provides overall responsibility for planning and operation • Develops and revises specific policies and procedures • Monitors program and resident performance The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B1: Administrative Structure RPC Membership • Includes all major stakeholders » hospital, community, program admin » Key academic staff (e.g. research, academic curriculum) • Resident representation » Elected » Chief resident » Junior/senior representation » Small program strategies The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B1: Administrative Structure RPC • Gets the work done • Makes decisions with inclusivity • Moves the program forward • Disseminates info • Transmits new initiatives • Allocates duties Makes the program cohesive Breaks hierarchies Ensures transparency Documents program flow and progress Gets buy-in from trainees and faculty More… » Sub-Committees The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 5 8/27/2015 B1: Administrative Structure RPC Specific Responsibilities • Resident selection • Resident promotion • Resident appeal • Academic curriculum • Objectives of training • Rotation and faculty review The International Conference on Residency Education | Program review Resident health, wellbeing and safety Career counselling Research support Create minutes of discussions and decisions/actions taken La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B1: Subcommittees • Functional working groups • Involve more faculty and residents than on the RPC » Spreading the work » Greater engagement across the department/division • Mechanism of reporting back to the RPC • Examples of common subcommittees » Promotion and Assessment of residents » Evaluation of rotations/assessment of teachers » Curriculum The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 17 B1: Administrative Structure RPC Specific Responsibilities Program review: • Evaluate each curricular component • Faculty evaluation • Anonymized • Document The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 6 8/27/2015 B1: Administrative Structure Pitfalls Program Director: • Perceived as dictator (doesn’t listen) • Runs the show • Not perceived as a resident advocate • Ineffective communication The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B1: Administrative Structure Pitfalls RPC • • • • • • • Dysfunctional – can’t make decisions Not properly constituted Decisions made outside of RPC Service needs drive resident placement Doesn’t meet and doesn’t minute Doesn’t fulfil its mandate Lack of communication with residents and faculty Significant issues with B1 usually lead to problems with the rest The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents Reflection on B1 • Take a moment to look at your program • Try to identify one potential pitfall • Try to identify a potential solution • We’ll discuss shortly as a group The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 7 8/27/2015 B2: Goals and Objectives • Curriculum map is excellent to meet the goals and objectives and highly functional. (B2.2.1) • Rotation specific goals and objectives which have been adopted by the program are not being regularly referred to or used to drive learning and assessment. (B2.4.1) The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B2: Goals and Objectives MUST: • Exist in writing • Be visible within program » Learners, faculty » Part of rotation orientation • CanMEDS based • Reflect the activities of the rotation • Inform resident assessment • Be reviewed regularly (supervisors, RPC) The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B2: Goals and Objectives Rotation-Specific Goals and Objectives: • Designed by rotation supervisor/ RPC • Linked to specific assessment • Site-specific (resources) • Block rotations/ longitudinal experiences • Year-specific • Same rotation in different years • Rationale for repeat rotation • CanMEDS- what can be ideally delivered in this rotation? The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 8 8/27/2015 B2: Goals and Objectives Traps and Pitfalls • No goals and objectives for overall program/specific rotations • Research • Longitudinal clinics • Not rotation/experience-based • Not CanMEDS based; generic • Not used by residents/faculty • Rotations not designed around goals and objectives • Not reflected in assessment of residents The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B2: Goals and Objectives Reflection • Take a moment to look at your program • Try to identify one pitfall • Try to identify a potential solution • We’ll discuss shortly as a group The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B3: Program Structure • “Flexible electives allowing residents to fully explore career goals” (B3.7) • “There is a service education imbalance: residents are not protected to attend their academic half-day.”(B3.5.1) The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 9 8/27/2015 B3: Program Structure • Some overlap with B5 standard • Review Specific Objectives of Training/ STR • Mandatory (RC versus program) /elective • Time-based (block vs month vs longitudinal experience) • All rotations have a purpose • Sites have a role • All residents have equal opportunity • Graded responsibility • Educational Environment • Quality of supervision • Service to education balance • Intimidation and harassment The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B3: Program Structure Traps and Pitfalls • No plan for or monitoring of graded responsibility • No obvious planning behind rotation design • Doesn’t adhere to Specialty Training Requirements (STR) • Inequities in resident experience • Politics are driving the design – Service needs versus educational needs • Intimidation/harassment – Area-specific – Faculty The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B3: Program Structure Reflection • Take a moment to look at your program • Try to identify one pitfall • Try to identify a potential solution • We’ll discuss shortly as a group The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 10 8/27/2015 B4: Resources • “Highly qualified teaching faculty from community to subspecialties who are engaged in education.” (B4.1) • “The increased number of learners (both undergraduate and postgraduate) may be limiting access to subspecialty rotations for the residents as well as straining the available number of community preceptors.” (B4.1) • Unsatisfactory call rooms and locker access. (B4.5) The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B4: Resources Faculty • High yield faculty or specialty expertise – all residents should have access (if it’s core) • Protected time to teach and supervise Patients • Design rotations so residents get equal exposure • Get creative if some scenarios scarce • Variety of settings: ER, inpatient, outpatient, community • Community experiences The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B4: Resources Infrastructure – specialty-specific • Adequate resident space • Adequate technology in the area of work • SSA for specific resource needs Other Program Components • Research The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 33 11 8/27/2015 B4: Resources Capacity • Review the bottlenecks in the program • Specialty specific • Specific mandatory rotations; equipment • Can the experience be delivered elsewhere? Specific Experiences • Interuniversity Affiliation • Mandatory rotations Other: Simulation; Academic Half-day; Grouping of patients The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B4: Resources Traps and Pitfalls • No monitoring of resident experience • Faculty too busy to teach • no mechanism to monitor/respond to this • Insufficient important infrastructure • Small centers • inability to provide adequate exposure in an area The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B4: Resources Reflection • Take a moment to look at your program • Try to identify one pitfall • Try to identify a potential solution • We’ll discuss shortly as a group The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 12 8/27/2015 B5: Clinical, Academic, Scholarly • “Deliberate, innovative opportunities for residents to learn about health needs of community.”(B5.5.1) • “Academic half-day is too dependent on residents with inconsistent attendance by faculty.” (B5.1.3) The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B5: Clinical, Academic, Scholarly • CanMEDS-based curriculum • Clinical Curriculum – Specialty Objectives – Overlap with Standard B3 • Academic/Scholarly – Formal Curriculum • Academic Half-day – Rotation-specific The program “ must be able to demonstrate”........... The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B5: Clinical, Academic, Scholarly CanMEDS Myths and Legends • Everything has to be EVERYWHERE!!! • NOPE, but Everything has to be SOMEWHERE • An Overall plan/ curriculum map • Tracking/monitoring system • Visibility • How do you know they EXPERIENCED it? • How do you know they GOT it? The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 13 8/27/2015 B5: Clinical, Academic, Scholarly Map it out! Medical Expert Rotations Communicator Ambulatory Inpatient Subspecialty Collaborator Health Advocate Academic Half-Day Manager External Sessions Scholar Journal Club Professional Research Day The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 40 B5: Clinical, Academic, Scholarly Traps and Pitfalls • No explicit plan to cover all Specialty-specific G&O • Missing CanMEDS Roles • No way to detect ‘holes’ in the program • Assumption that it’s done as part of everyday life • Role-modeling • Needs to be explicit The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B5: Clinical, Academic, Scholarly Reflection • Take a moment to look at your program • Try to identify one pitfall • Try to identify a potential solution • We’ll discuss shortly as a group The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 14 8/27/2015 B6:Assessment • “ITERs not based on specific goals and objectives.” (B6.1) • “Evaluation of residents is not done in a timely fashion and is not done face-toface consistently.” (B6.3) • “The evaluation of CanMEDS Intrinsic Roles remains challenging.” (B6) The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B6: Assessment • Systematic assessment approach • feedback principles training • Faculty and trainees • Direct observation is critical • clear assessment policy • Combination of • informal and formal • formative and summative The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B6: Assessment • Should be multimodal – many options • Reviewed/endorsed by the RPC • Methods match the content • Match Goals and Objectives • Progress checks built in The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 15 8/27/2015 B6: Assessment • ITER: – Rotation-specific – N/A- not working – Year-specific – Verbal feedback – face to face meeting critical • CanMEDS roles – Must be formally assessed – Other health professionals/students/managers – Not all rotations have to assess all CanMEDS roles formally • Teaching- written student evaluations The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B6: Assessment CanMEDS Assessment Matrix Med Exp Comm Written Tests X Oral Exam X Direct Observ. X X OSCE/S P X X 360 Peer X X X X Portfolio Sim Coll H Adv Mgr Scholar Prof X X X X X The International Conference on Residency Education X X X X X X X X X (essay) (essay) X X X | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 47 B6: Assessment Traps and Pitfalls • Direct Observation – How is it happening – Residents will be asked – Connected to specific feedback • Timely completion of ITERs – WEB-Evaluation • Lack of verbal feedback- or not helpful The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 16 8/27/2015 B6: Assessment Traps and Pitfalls • Some G & O not assessed • Overreliance on generic ITER • No mechanism to: • Monitor • Promote • Remediate the residents The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B6: Assessment Traps and Pitfalls • Lack of RPC involvement in assessment issues • Role of the Sub-Committee in larger programs • RPC needs to approve assessment forms/ promotion criteria; remediation protocols • Resident in difficulty: needs to be discussed at the RPC • Role of the Resident Representative during discussions of Resident evaluation • Role of faculty mentor The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents B6: Assessment • Take a moment to look at your program • Try to identify one pitfall • Try to identify a potential solution • We’ll discuss shortly as a group The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 17 8/27/2015 Group Exercise • Each table has a number on it • This represents one of the B standards • At your table, discuss your pitfalls and potential solutions for that B standard • If you’d like to discuss another B standard, you may switch • We’ll debrief as group The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents Group Exercise • Pick a recorder • Outline the problem • Present potential solution • Discussion The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 53 Tips on Filling the Holes • Make CanMEDS explicit • Make time for it • Don’t make it an add-on • Tailor it • Start with one and build • Start with in-the-moment • Move to formal curriculum The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 18 8/27/2015 Your Support System • You’re not alone! • Other PDs in your Faculty of Medicine • Other Canadian PDs in your discipline • Your predecessor • Members of your RPC • Your university or hospital HR department • Other health professionals The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents Your Allies • Administrative Support – program admin • Postgraduate Dean • Assistant to the PG Dean • Department Head • Division Head The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents What’s Ahead!!!!!!!!! • CanMEDS 2015 » MILESTONES • Competency-Based Medical Education Resources: - Postgraduate office - Specialty committees - Program Directors - ICRE The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 57 19 8/27/2015 Take Home Messages • Take a bird’s eye look at the program • It’s all about process • Involve the committee • Make it transparent • Have a reason for everything • Root decisions in principles • Build collaborations with stakeholders (hospitals/ rotations/specialties/etc) The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents Session/Presentation Name | Presenter Name Objectives Revisited 1. Describe the purpose underlying the individual standards for program accreditation 2. Identify areas cited as commonly occurring weaknesses among the B standards 3. Develop an approach to identify and address areas for improvement in your program The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 59 References • The Royal College Program Directors Handbook: A Practical Guide for Leading an Exceptional Program • CanMEDS Publications: » Time Management guide » CanMEDS Assessment Tool Handbook » Educational Design: A CanMEDS Guide for the Health Professions • ICRE: “What Works” The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 20 8/27/2015 Engaging Faculty • RCPSC says so! • Find your champions • Include explicitly in ITER/practice exam • Ask them what they need • Pay them! • Get the trainees on board – see next slide • Explain it » Education committee » Business meetings Teach it • » Faculty Development opportunities » Grand rounds with guests from like specialty » Sneak it in! Orient new faculty • The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents Engaging Trainees • RCPSC says so! • Find your champions • Include explicitly in the ITER/practice exam • Pride of ownership - ask them • Bring in examples to sessions » But don’t stop there! » Communication skills challenges » Conflicts » Ethics • Get their feedback on how to improve • Culture of open feedback » » Formalize program/session evaluation See the benefits and results of this feedback The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents The International Conference on Residency Education | La conférence Conférence internationale internationale sur sur la la formation formation des des résidents résidents 63 21
