Pediatricians preferred closer collaboration with psychiatrists for managing children with anxiety and depression, but not ADHD. The communication gap between psychiatrists and pediatricians raises concerns about quality of care for children with psychiatric conditions.

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The author reviews the many forces that have driven contemporary medical education approaches to evaluation and places them in an adult learning theory context. After noting their strengths and limitations, the author looks to lessons learned from manufacturing on both efficacy and efficiency and explores how these can be applied to the process of trainee assessment in medical education.Building on this, the author describes the rationale for and development of the Educational Kanban (EK) at Children's Hospital Boston--specifically, how it was designed to integrate adult learning theory, Japanese manufacturing models, and educator observations into a unique form of teacher-student collaboration that allows for continuous improvement. It is a formative tool, built on the Accreditation Council for Graduate Medical Education's six core competencies, that guides educational efforts to optimize teaching and learning, promotes adult learner responsibility and efficacy, and takes advantage of the labor-intensive clinical educational setting. The author discusses how this model, which will be implemented in July 2009, will lead to training that is highly individualized, optimizes faculty and student educational efforts, and ultimately conserves faculty resources. A model EK is provided for general reference.The EK represents a novel approach to adult learning that will enhance educational effectiveness and efficiency and complement existing evaluative models. Described here in a specific graduate medical setting, it can readily be adapted and integrated into a wide range of undergraduate and graduate clinical educational environments.

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M&Ms appear to be a potentially productive venue for self-appraisal and case review to aid psychiatry programs in patient safety efforts and clinician education.