Laying The Foundation to Maximize Learning in the General Internal Medicine (GIM) Transition to Discipline Phase using Entrustable Professional Activities (EPAs).

GOT Foundations Authors: Sharon E Card and Heather A Ward

Date: September 30th, 2016

I do not have an affiliation (financial or otherwise) with a

pharmaceutical, medical device or communications organization.

Je n’ai aucune affiliation (financière ou autre) avec une

entreprise pharmaceutique, un fabricant d’appareils

médicaux ou un cabinet de communication.

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Objectives

• Describe G(eneral Internal Medicine) O(rientation)T(ransition)

Foundations

Development

Implementation

Successes

Challenges and Future

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Transitions

• Difficult1,2

Knowledge

Skills

Attitudes

Professional Identity

• Solutions3

Boot Camps

Skill Sessions

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1. The Association of Faculties of Medicine of Canada. 2012. The Future of Medical Education in Canada: A Collective Vision for Postgraduate Medical Education in Canada. Ottawa, Ontario. 2. Frank JR, and Harris KA, eds. Competence by Design: Reshaping Canadian Medical Education. Ottawa: Royal College of Physicians and Surgeons of Canada; 2014. 3. Blackmore C et al. Reviews. Effects of Postgraduate Medical Education “Boot Camps” on clinical Skills, Knowledge, and Confidence: A Meta-Analysis. J Grad Med Educ. 2014: 6(4): 643-52.

Competence Continuum

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University of Saskatchewan General Internal Medicine

(GIM) 2 year Residency Program

3 Year Internal Medicine

Undergraduate Medicine Reference: RCPSC CBD Website http://www.royalcollege.ca/rcsite/cbd/cbd-tools-resources-e Slide developed and property of RCPSC for use in presentations.

Phase One

EMR Introduction Procedural Skills

Motivational Interviewing Electrodiagnostics

Quality Improvement Medical Knowledge

Patient Safety Ultrasound

Research Exam Skills

Professionalism Fellows Clinic Introduction

Simulation Collaboration

Learning Skills Library Skills

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Photo Credit to: Kris De La Pena; Clinical Learning Assistant Clinical Learning Resource Centre, University of Saskatchewan

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Learning Experiences

Future Context

Phase Two – Use of Entrustable Professional Activities (EPAs).

Tasks (EPAs) of GIM

• Surveys

• Focus Groups

• Interviews

• RCPSC GIM Specialty Committee.

Develop 10 End of Residency EPAs

• Synthesized Information to 10 Local Ideal End of Discipline Tasks.

Map to Curriculum

•Map Competencies in GIM OTR (RCPSC) to 10 EPAs.

•Map Learning Activities to EPAs.

Develop GOT Foundations

Activities

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“EPAs are those professional activities that together constitute the mass of critical elements That operationally define a profession.” ten Cate O and Scheele F. Competency-Based Postgraduate Training: Can We Bridge The Gap between Theory and Clinical Practice? Acad Med. 2007; 82: 542-547.

Example

EPA # 5 – Demonstrates ability to meet the need of the community in which they practice.

Can MEDs Competencies (ETC).

1.4.2. Describe how to perform a needs assessment as to which procedures are needed in their

practice, and how to recognize the need to attain further training if new

procedural skills are needed

Learning Experiences.

Academic Half Day

Personal Learning Projects

GIM Journal Club

GIM Rotations

Fellows Clinic

GOT Foundations.

Facilitated discussion on Scope of Practice of GIM as a discipline and as

an individual.

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Outputs

• Procedural Skills Sessions

• Simulation Sessions

• Facilitated Discussions

• Library Sessions

Outcomes

• High Satisfaction.

• Residents ready for “Core” GIM Rotations .

• Linked to future residency learning experiences.

• Reflective Portfolios Initiated.

• Sustainable Rotation.

• Diverse Faculty Engagement.

Desired Impact – Linked to EPAs.

• Employment linked to community needs.

• Depth and Breadth in Scope of Practice

• Resilience in practice, Engagement.

• GIM Professional Identity.

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Perceived Keys to Success and Challenges.

BE A “GIM”

Experiential Learning &

Opportunities for Practice

Relevance to Future

Intentional Community

Building

Relatedness Longitudinal

Opportunities for Reflection

11 • Cook DA & Artino AR. Motivation to learn: an overview of contemporary theories. Medical Education 2016; 50: 997-1014. • Cruess RL, Cruess SR, Steinert Y. Amending Miller’s Pyramid to Include Professional Identity Formation. Acad. Med. 2016; 91(2): 180-5. • Schumacher DJ, Englander R and Carracio C. Developing the Master Learner: Applying Learning Theory to the Learner, the Teacher, and the Learning Environment. Acad Med. 2013: 88:00-00. • Steinert Y et al. A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME Guide No. 40. Medical Teacher. 2016; 38:8; 769-786.

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Tasks of GIM - EPAs

Linked to Learning Activities

Foundational Rotation

Context Impact Discussed

BE a GENERAL INTERNAL MEDICINE SPECIALIST

Selected References GENERAL INTERNAL MEDICINE:

Card SE, Ward HA, Broberg L. Preparing General Internal Medicine Residents for the Future – Aiming to Match Training to Need – A Pilot Study in Saskatchewan.

Card SE and N Kassam. The Future is Bright for Competency-based Education in General Internal Medicine. Canadian Journal of General Internal Medicine. 2016; 11(1): 25 – 29.

Anderson L, Ward H, Card SE. Discussion Paper - Linking General Internal Medicine Residency Training to Human Resource Needs and Roles in a Changing Health Landscape Lindsey.

University of Saskatchewan Undergraduate Research Journal. 2015;1(2):01-07.

Card SE, PausJenssen A, Ottenbreit R. Determining specific competencies for General Internal Medicine residents (PGY 4 and PGY 5). What are they and are programs currently teaching

them? A survey of practicing Canadian General Internists. BMC Res Notes. 2011, 4: 480. doi: 10.1186/1756-0500-4-480. online. 2011 Nov 3. Epub 2011 Nov 3.

Card SE, Snell L, O'Brien B. Are Canadian General Internal Medicine training program graduates prepared for their future careers? BMC Medical Education 2006, 6:56. 2006.

General Internal Medicine Objectives of Training. Royal College of Physicians and Surgeons of Canada. http://www.royalcollege.ca/rcsite/home-e

OUTCOMES BASED MEDICAL EDUCATION:

Frank JR and Harris KA. Competence by Design: Reshaping Canadian Medical Education. Ottawa: Royal College of Physicians and Surgeons of Canada; 2014.

ten Cate O et al. Curriculum development for the workplace using Professional Activities (EPAs): AMEE Guide No. 99. Medical Teacher. 2015; 37: 983-1002.

Cutrer WB et al. Fostering the Development of Master Adaptive Learners: A Conceptual Model to Guide Skill Acquisition in Medical Education. Acad Med. 2016; First published online.

CPM Van der Vleuten and EW Driessen. What would happen to education if we take education evidence seriously? Perspectives on Medical Education. 2014.

Holmboe ES and P Batalden. Achieving the Desired Transformation: Thoughts on Next Steps for Outcomes-Based Medical Education.

Van Melle E. Using a Logic Model to Assist in the Planning, Implementation, and Evaluation of Educational Programs. Acad. Med. 2016 91(10)

FEEDBACK:

Watling C, et al. Beyond individualism: professional culture and its influence on feedback. Medical Education 2013; 47: 585-594.

TRANSITIONS:

Ceresnak SR, et al. Pediatric Cardiology Boot Camp: Description and Evaluation of Novel Intensive Training Program for Pediatric Cardiology Trainees. Pediatr Cardiol (2016) 37:834-844.

Carraccio C et al. Building a Framework of Entrustable Professional Activities, Supported by Competencies and Milestones, to Bridge the Educational Continuum. Acad Med. 2016 March 8.

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• GIM Faculty & Residents.

• Lesley Reynolds Program Administrative Assistant

• Photos of CLRC Courtesy of Kris De La Pena; Clinical

Learning Assistant. Clinical Learning Resource Centre,

University of Saskatchewan.

For more information contact Sharon Card sharon.card@usask.ca 14

Acknowledgements

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