2014 Research Projects
Darlene Tad-y, MD
University of Colorado, School of MedicineDepartment of Medicine
Division of General Internal Medicine – Section of Hospital Medicine
12401 E. 17th Avenue, Mailstop F782
Aurora, CO 80045
(720) 848- 4289
Evaluating Internal Medicine Residents' Competence and Readiness for Unsupervised Practice
Since the introduction of Tomorrow’s Doctors in 1993, medical education has embraced competency-based medical education (CBME). This paradigm shift focuses on the attainment of knowledge, attitudes and skills relevant to the profession, rather than the amount of time or process of training. 1-5 Graduate medical education has also adopted the tenets of CBME, fundamentally changing the way residents should be considered competent to practice medicine in their specialties without supervision.6 Importantly, this change requires residents to demonstrate competence in the professional activities of our specialty, which has critical implications for the assessment and evaluative process of trainees. In 2012, the Accreditation Council for Graduate Medical Education (ACGME) announced that the Next Accreditation System (NAS) would be implemented 7, requiring internal medicine residency training programs (IMRPs) to implement the NAS by July 2013.The American Board of Internal Medicine (ABIM) and the ACGME convened task forces which defined the Entrustable Professional Activities (EPAs) of an Internal medicine physician and also the developmental milestones to guide progression to competence and ultimately unsupervised practice8,9.
My work will focus on the development of a comprehensive assessment framework for determining trainee competence and readiness for graduation from residency training, and will meet requirements for the Reporting Milestones to the ACGME. The framework, in its entirety, will allow residency program leadership and faculty to successfully assess residents’ developmental progress through training and ultimately provide the information needed to determine trainees’ readiness for unsupervised practice.
Because the training activities of residents are diverse and not always data driven, I anticipate that a comprehensive framework will require a variety of assessment tools, such that the framework could include a “toolbox” that will include valid and reliable direct observation tools for clinical settings that will simultaneously encourage relevant formative feedback to the learners. Additionally, educational methods such as portfolios, resident written reflection, scholarly products, all require a standard method of assessment, which currently do not exist. The framework I propose will include these assessment tools and a described method for implementation. I anticipate that as I undertake this project, I will encounter many more assessment tools that will help our program accurately describe our residents’ progression through the milestones and finally achievement of competence in the professional activities of our specialty. Inevitably, implementation of this framework will require an accompanying faculty development program, which I intend to create as a companion to the framework itself.
In addition to the review of the literature as briefly described above, I also plan to incorporate these methods:
- Review of all published direct observational tools for clinical and non-clinical activities related to graduate medical training
- A needs assessment survey of our faculty to determine their gaps in knowledge about CBME, the NAS, milestones and EPAs
- Pilot assessment tools and elicit feedback from faculty and trainees, revise as needed for improvement and applicability
- Collaborate with other IMRPs to share and define best practices
Dissemination and Scholarship
Opportunities exist for peer-reviewed dissemination of the tools, including Med Ed Portal. The American Association of Medical Colleges also hosts iCollaborative which is an online clearinghouse for educational works-in-progress that would allow me to vet my work along the way. I would also hope to share this framework with fellow program directors around the country by presenting at national program directors’ meetings, and hosting workshops. With regards to publication of outcomes, I hope this would be eligible for publication in a journal such as Medical Teacher or the Journal of Graduate Medical Education.
About the Author
My fellowship training provided me with training in curriculum development and teaching skills. In the 3 years since joining CU’s SOM, I have developed small-scale programs, such as the Phase I Quality Improvement Elective (9 learners per yer), and large scale programs such as the Hospitalist Training Program Didactic Curriculum (24 total learners per year) and the IMRP’s Quality and Safety Curriculum (~160 learners per year). As an Associate Program Director of CU’s IMRP, I will be able to implement and study the proposed framework directly. I am committed to attending all required meetings for participants in the PTLC.
1. Snell LS, Frank JR. Competencies, the tea bag model, and the end of time. Med Teach. 2010;32(8):629–630. doi:10.3109/0142159X.2010.500707.
2. Taber S, Frank JR, Harris KA, Glasgow NJ, Iobst W, Talbot M. Identifying the policy implications of competency-based education. Med Teach. 2010;32(8):687–691. doi:10.3109/0142159X.2010.500706.
3. Holmboe ES, Sherbino J, Long DM, Swing SR, Frank JR. The role of assessment in competency-based medical education. Med Teach. 2010;32(8):676–682. doi:10.3109/0142159X.2010.500704.
4. Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: theory to practice. Med Teach. 2010;32(8):638–645. doi:10.3109/0142159X.2010.501190.
5. Frank JR, Mungroo R, Ahmad Y, Wang M, De Rossi S, Horsley T. Toward a definition of competency-based education in medicine: a systematic review of published definitions. Med Teach. 2010;32(8):631–637. doi:10.3109/0142159X.2010.500898.
6. Iobst WF, Sherbino J, Cate OT, et al. Competency-based medical education in postgraduate medical education. Med Teach. 2010;32(8):651–656. doi:10.3109/0142159X.2010.500709.
7. Nasca T, Philibert I, Brigham T, Flynn T. The Next GME Accreditation System - Rational and Benefits. New England Journal of Medicine. 366(11):1051–1056.
8. Caverzagie KJ, Iobst WF, Aagaard EM, et al. The internal medicine reporting milestones and the next accreditation system. Ann Intern Med. 2013;158(7):557–559. doi:10.7326/0003-4819-158-7-201304020-00593.
9. Green ML, Aagaard EM, Caverzagie KJ, et al. Charting the road to competence: developmental milestones for internal medicine residency training. Journal of Graduate Medical Education. 2009;1(1):5–20.