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director
Director's Message: April is National Poetry Month... So What!
In 1996, the Academy of American Poets established April as National Poetry Month. Since then, it has become the largest literary celebration in the world, engaging readers, students, teachers, librarians, booksellers, publishers, bloggers, and, of course, poets.
Poem about medical education
Poetry is just one approach to personal reflection, and as Dr. Colquhoun's word show, poetry readily captures the emotion of experience. There is evidence that creative writing, both poetry and prose, can provide a strategy for personal reflection as well as enhance the cognitive, affective and active components of empathy ( links to articles may require MSU Library EZproxy authentication for access). Without attending to the multiple dimensions of empathy, the harsh realities of medical education and medical practice often test and tatter the newly acquired empathic skills of our students and residents. Poetry, prose, movies and music can all be used in educational settings to enhance intuitive understanding of our learners. 
 
In 2003 Academic Medicine published a special medical humanities issue; the program at University of California at Irvine provides opportunities for third year medical students to reflect through poetry on their relationships with patients and patients' families. The faculty noted that in addition to the many poems about patients and patient care, attending physicians figured prominently in about one-fifth of the poems, including both positive and negative experiences with faculty, again providing additional insight into our learning environments.

The importance of personal stories has long been a part of the tradition of medical practice, though less attention has been paid to the personal stories of medical students, residents and practitioners. There are many examples to learn from. One approach that found traction a decade ago in the popular press is the 55-word story. Writing exactly 55 words of prose or poetry provides a unique yet achievable challenge for capturing personal emotions and insights from our experiences. Examples published in JAMA are available here. The instructions are simple and are available here, as summarized in 2012 by Wolters and Wijnen-Meijer

April is National Poetry Month... and here are some of the poems written by CHM in the past few weeks...not surprisingly many are inspired by the Shared Discovery Curriculum. Feeling inspired to add to the CHM collection of poems for this year? Please send them to me.
 
CHM poem examples
  
Brian Mavis, PhD 
Professor
Director, Office of Medical Education Research and Development
Director, CHM Learning Academy  
announcements
Announcements
- MSU FOD announces programs for the Spring Institute on College Teaching and Learning
 
Visit http://fod.msu.edu/spring-institute-college-teaching-and-learning for the current list of topics related to the best practices in instructional development.

 - New AAMC Publication Series on the Future of Academic Medicine 
 
What future forces will drive the deepest and broadest impact on academic medicine? This report from the Future of Academic Medicine Series examines how key health care trends and five external future forces could lead to major cultural, social, and technological changes over the next ten years.
spotlight
Spotlight: OMERAD Sponsored Medical Education Webinars
OMERAD is pleased to continue to offer free regular medical education webinars throughout the academic year to CHM faculty. The most recent webcast audio seminar series from the International Association of Medical Science Educators (IAMSE) were held from March 3rd through March 31st 2016. IAMSE webinars are theme based and designed for anyone who has responsibility teaching medical students and residents. 
 
This year, the webinars were offered in both Grand Rapids and East Lansing. It took some time for word to spread about the webinars and number of faculty attending increased over the weeks. Matt Emery MD and Ryan Tubbs PhD both attended several of the lunch time webinars.

Ryan Tubbs, Assistant Professor working in the Division of Human Anatomy, wrote: "I was very grateful to have the IAMSE webinars available in the Secchia Center.  The sessions covered topics important to all of us as medical educators and encourage us to be reflective about our own practices.  The topics were particularly relevant this year with the development of the Shared Discovery Curriculum but will continue to be relevant as we review our progress each year."

Matt Emery, with the Department of Emergency Medicine and Director for Simulation, commented that the webinar on how to write essay-questions, "was helpful for me as we are thinking through the pros and cons of using essay-type questions in the Progress Clinical Skills Exam, and also as a method for formative feedback during the half-day of simulation during the Early Clinical Experience and the Middle Clinical Experience of the new curriculum.  Not all of the IAMSE webinar topics were directly relevant to my role, but I do think it is helpful to have them available so that when topics of specific interest are being presented I can try to join."

The online webinars present participants with a great opportunity to learn something new and exchange vital information on timely topics in medical education with local colleagues, other professionals across the country and around the world.
 
Past topics include:
  • Instructional Design - Learning Objectives; Backwards Design, Blooms Taxonomy
  • Planning for Curriculum Mapping
  • Testing your test: Assessing the Quality of Test Items
  • Essay Exams: Beyond Knowledge and Recall of Factual Information
  • Applying Quality Improvement Principles to Advance Faculty Development
  • Value Added Student Roles that Align Education and Health System Needs
  • A Developmental Pursuit of Foundational Scientific Knowledge
  • Closing the Gap Between Undergraduate Medical Education and Practice Realities of Today and Tomorrow
  • An Accelerated Pathway to Produce 21st Century Primary Care Physicians
  • Educating Medical Students in a Clinical Environment Throughout the Entire Curriculum
We hope you can join your colleagues in East Lansing or Grand Rapids for the upcoming series in fall 2016 that would be focusing on strategies for assessment of skills, attitudes, and behaviors across the Health Sciences and the current thinking associated with the evaluation of EPAs, clinical skill sets as well as the evaluation of non-cognitive skill such as such as life-long learning attitude and behaviors that reflect the ideals of health professions.
 
For more information about the IAMSE fall series, please visit:
http://www.iamse.org/web-seminars/

Stay tuned for OMERAD announcements in the fall with information about when, and where seminars would be held.

For additional questions or information, please contact:
ProgramEval
Core Entrustable Professional Activities for Entering Residency: A Preliminary Look at the Entrustability of CHM Graduates
In 2014, the Association of American Medical Colleges released a consensus document for undergraduate medical education outlining thirteen core entrustable professional activities for entering residency ( Core EPAs). The Core EPAs describe 13 professional activities that all entering residents should be expected to perform on Day 1 of residency without direct supervision, regardless of specialty. The ACGME distinguishes direct supervision as supervision when the attending physician is physically present with the resident and the patient. The Core EPAs include:
  1. Gather a history and perform a physical examination
  2. Prioritize a differential diagnosis following a clinical encounter 
  3. Recommend and interpret common diagnostic and screening tests 
  4. Enter and discuss orders/prescriptions 
  5. Document a clinical encounter in the patient record
  6. Provide an oral presentation of a clinical encounter
  7. Form clinical questions and retrieve evidence to advance patient care
  8. Give or receive a patient handover to transition care responsibility
  9. Collaborate as a member of an inter-professional team
  10.  Recognize a patient requiring urgent or emergent care, and initiate evaluation and management
  11.  Obtain informed consent for tests and/or procedures
  12. Perform general procedures of a physician
  13. Identify system failures and contribute to a culture of safety and improvement
CHM is one of ten schools participating in a pilot project to operationalize the assessment of EPAs. To better understand where we are in achieving these graduation competencies, 21 specific functions sampled from the 13 Core EPAS were added to the survey of program directors for our 2014 graduates, surveyed in 2015. Program directors were asked to indicate the level of supervision required by the CHM graduate for each of the 21 functions. Each function was rated as requiring (a) direct supervision, (b) indirect supervision, or (c) no supervision.
  
We received completed surveys from 140 program directors (82%); 136 contained usable data. The percentage of our graduates rated as entrustable, i.e., not requiring direct supervision, is shown in Figure 1 below. Sixty-four percent of graduates did not require direct supervision for at least 20 of the 21 functions, while almost one-in-ten graduates were entrustable in five or less of the 21 functions.

table with number figures
Figure 1
The most entrustable functions are listed below (Figure 2), along with the percentage of graduates rated as entrustable:
  • Respectful communication with team members (95%)
  • Performs focused and relevant physical examination (93%)
  • Speaks up about potential errors (92%)
  • Obtains a complete history (92%).
Figure 2
Overall among the 2014 graduates, the least entrustable functions are presented below (Figure 3):
  • Care plan for a decompensating patient (82%)
  • Assesses evidence in published studies (81%)
  • Recommends cost-effective diagnostic evaluation (78%)
  • Demonstrates skills for common procedures (69%).
Figure 3
In addition to the Core EPAs, program directors were asked the following question; "Overall, how would you rate this resident compared to others in this first year cohort?" The rating scale was 1= substantially below average, 2= a little below average, 3= average,4= a little above average and 5= substantially above average.  The overall rating was correlated with the number of Core EPAs not requiring direct supervision (r=.34, p<.001). More impressive was the relationship between the number of graduates who were entrustable in 20 or more functions and the overall rating by the program director ( Figure 4 ). Of the graduates rated as substantially above average (N=48), 79% were entrustable in 20 or more functions, whereas only one graduate of the five graduates rated substantially below average was entrustable in 20 or more functions.

Figure 4
The findings suggest that while a majority of graduates were entrustable, there was large variability within the graduating class. We also found that the ratings of entrustability based on level of required supervision were associated with the more typical peer-based normative ratings provided by programs directors. It is worth noting that at this time, the CHM curriculum is not competency-based and was not organized specifically around the Core EPAs. It is also noteworthy that the program directors were surveyed on average on Day 216 of the program, in contrast to the Core EPAs, which focus Day 1 ready graduates. Thus, it is difficult to delineate the contribution of the residency program to ratings of entrustability. And for those almost one-in-ten graduates who were generally not entrustable (five or fewer functions), the additional time in the residency program had not helped them achieve a level of entrustability comparable to their peers. The findings, while preliminary and limited to a single graduating class, can be used to inform undergraduate and graduate medical education. A brief introduction to competencies, milestones and Core EPAs is available here.

resources
OMERAD Resources
An interactive gallery featuring examples of CHM blended and online learning projects by B-CLR.
 
Resources are arranged by topic, addressing issues common to educational scholarship, including definitions of scholarship, formulating resource questions, methodology and research design as well as dissemination via poster or publication. 
   
DR-ED 
A medical education listserv maintained by OMERAD.
 
Peer-reviewed international open access journal for disseminating information on the education and training of physicians and other health care professionals.
 
Click on the link to view past issues of our newsletter.
 
Medical Education Scholarship Group
Meets first Wednesday of each month in room A116 East Fee Hall (East Lansing) and 451 Secchia Center (Grand Rapids) from 1:30 pm to 3:00 pm. The purpose is to develop and support scholarship related to our educational program. Got an idea?  Need an inspiration?  Looking for collaborators? Join us! For questions about this group contact Dr. Brian Mavis:   mavis@msu.edu .  
 

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