Posts in Curriculum Design
Where Did All the LPs Go?

Physicians must be competent to perform the skills of their respective specialties before completing residency training. Educators struggle to understand just how many procedures are required of a trainee to become competent. Is there a minimum number? Does it differ by procedure for each trainee? How many is ‘enough’? And what should educators do if there are too few procedures to go around???

Our accreditation systems are designed to ensure patient safety, as a societal responsibility. Residency program directors attest to their trainees’ competence before graduation — as a safeguard. I was a program director and I lost sleep worrying about this expectation of my role. Were my residents ready? What if my mistakes assessing them led to their mistakes with vulnerable patients?

The worry – how many procedures is enough? – was a tough one for me. Every trainee is different and they each require a unique set of training experiences to become competent. The BIG however: there are a limited number of cases for trainees to learn from in teaching hospitals.

There, I said it. There are only so many chest tubes, crics, and LPs to go around.

As medicine advances, there is a slow decrease in the number of necessary bedside and surgical procedures required to diagnosis and treat a variety of acute illnesses.

Thanks vaccines and CTAs, but where did all the LPs go?

The math is as follows: if X is the number of procedures required to train a class of residents per year, and Y is the total number of procedures available, your program is fine if Y > X.

But if X > Y… you need to think outside the box.

Medical education has fundamentally changed in the last several decades. There are more trainees. There *may* be more patients. And there are certainly more training programs and teaching hospitals, sponsored by health systems that were previously and decidedly non-teaching. This represents both a challenge and an opportunity for educators who need to be creative in their search for ‘enough’ procedures for their trainees.

My research collaborators and I have some potential solutions for teaching hospitals and program directors to consider, in our article, “More Learners, Finite Resources, and the Changing Landscape of Procedural Training at the Bedside” in Academic Medicine.

Co-Authors: Linda Regan, MD – Johns Hopkins University, Jeremy Branzetti, MD – New York University, Laura Hopson, MD – University of Michigan

May 26, 2019

Aiming Beyond Competent

One of the most exciting recent advancements in physician training was the introduction of CBME: competency-based medical education. But is it enough? How might medical educators build on the best of CBME… and help their students aim beyond competent?

Competency-Based Medical Education (CBME) is a widely-accepted framework for training physicians that relies on measurable outcomes for confirmation of learning. In CBME, learning outcomes are clearly defined and students are expected to demonstrate competency by achieving these desired outcomes.

For a student to be competent in a particular skill, they must be able to demonstrate all of the necessary components of that skill. Let’s consider laceration repair: to be competent, learners must demonstrate proper wound cleaning, the technical skills necessary to repair the wound, recognition of potential complications, pertinent physician-patient communication about wound care, and documentation of the encounter, among many other steps.

But is this the best way to measure the competence of a physician? Or does CBME suffer from reductionism, the loss of the very nature of being a physician by reducing the practice of medicine into discrete measurable parts?

Jeremy Branzetti, Laura Hopson, Linda Regan, and I suggest that CBME might be strengthened by the use of a complementary curriculum design framework, L. Dee Fink’s Taxonomy of Significant Learning. We argue that educators might ensure a more holistic assessment of their students by using Fink’s Taxonomy when designing CBME curricula.

Read about this curriculum design proposal in our article, “Aiming Beyond Competent: The Application of the Taxonomy of Significant Learning in Medical Education” in Teaching and Learning in Medicine.

Co-Authors: Jeremy Branzetti, MD - New York University, Laura R. Hopson, MD - University of Michigan, Linda Regan, MD - Johns Hopkins University

March 11, 2019