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The game is highly modifiable, as other measurable, specialty-specific behaviors can be easily substituted for a particular competency, and additional assessment outcomes can be used.The Assessment and the ACGME Competencies game provided an engaging and interactive way to provide comparisons of multiple assessment tools in the context of the ACGME competency outcomes in a short period of faculty development time. Kristen K. Patton, MD Setting and ProblemResidents play an important role in the clinical education of medical students, and residents teaching in the ambulatory setting face unique challenges to sustain clinical quality and efficiency. Residents-asTeachers (RAT) programs have emerged to support residents in their education role(s), but the programs are increasingly at risk as residents' curricular time is NEW IDEAS allocated to other programmatic requirements. To prepare residents to teach in the ambulatory setting, we developed a ''just-in-time'' approach that stimulates workplace-based training of teachers. InterventionTeaching tokens provide just-in-time learning focused on efficient teaching behaviors to enhance the ambulatory educational experience. Tokens are optional paper reminders jointly selected by students and their resident preceptors to stimulate resident teaching. Each token identifies a specific focus followed by specific teaching behaviors to support that focus, with an extra line for resident/student co-generated strategies (FIGURE). Token teaching behaviors were derived from a literature review of ambulatory precepting strategies. Initially, tokens focused on strategies that promote meaningful student contributions to patient care and support teachers' clinical efficiency while aligning with student and resident competencies. These strategies included (1) priming learners and framing the patient visit; (2) incorporating students into systems-based practice; (3) using effective microteaching techniques (eg, the ''One-Minute Preceptor''); and (4) integrating the consideration of social determinants of health into teaching and care.Prior to introducing teaching tokens into the RAT curriculum, we piloted the intervention with ambulatory preceptors (n ¼ 9) and their assigned medical students at 3 teaching sites affiliated with the Medical College of Wisconsin. Preceptors and students were oriented to the purpose and process of the tokens, and they were asked to use tokens for at least 1 clinic session. Based on feedback from this pilot, we refined the token content, determined an optimal strategy for token distribution, and designed an orientation for implementation within the Waukesha Family Medicine Residency Program. The teaching token orientation was then incorporated into an existing RAT workshop for postgraduate year 1 through 3 residents. During this 20-minute session, residents received a brief presentation on the teaching tokens, including the background, purpose, and process for use in an ambulatory clinic. Residents divided into dyads and triads to practice using the tokens. ...

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