Lost in Transition: The Experience and Impact of Frequent Changes in the Inpatient Learning Environment

Bernabeo, Elizabeth; Holtman, Matthew C.; Ginsburg, Shiphra; Rosenbaum, Julie R.; Holmboe, Eric S.

doi:10.1097/acm.0b013e318212c2c9

Cited by 128 publications

(134 citation statements)

References 22 publications

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“…The workplace structure and pace can further impede performance assessment. 3,4 Entrustable professional activities (EPAs) are a strategy to operationalize competencies and milestones in the workplace and focus supervisors and learners on key activities to be assessed. 5,6 Graduate medical educators have started to implement EPAs as a framework for assessment across specialties.…”

Section: Introductionmentioning

confidence: 99%

Using a Curricular Vision to Define Entrustable Professional Activities for Medical Student Assessment

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Using a Curricular Vision to Define Entrustable Professional Activities for Medical Student Assessment

et al. 2015

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“…Kennedy et al [24] identified that faculty grant residents independence based on the resident's knowledge and skill as well as their insight into limitations. Clearly, long rotations are often required to build sufficient relationships to determine a trainee's strengths and limitations [5]; brief and fragmented facultyÀresident contact is often not an ideal way to draw valid, reliable conclusions [22]; however, such close contact between a single resident and faculty can be limited, making a simulated entrustable professional activity valuable in determining a resident's abilities.…”

Section: Discussionmentioning

confidence: 99%

Cognitive and Psychomotor Entrustable Professional Activities: Can Simulators Help Assess Competency in Trainees?

Dwyer

Wadey

Archibald

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background An entrustable professional activity describes a professional task that postgraduate residents must master during their training. The use of simulation to assess performance of entrustable professional activities requires further investigation. Questions/purposes (1) Is simulation-based assessment of resident performance of entrustable professional activities reliable? (2) Is there evidence of important differences between Postgraduate Year (PGY)-1 and PGY-4 residents when performing simulated entrustable professional activities? Methods Three entrustable professional activities were chosen from a list of competencies: management of the patient for total knee arthroplasty (TKA); management of the patient with an intertrochanteric hip fracture; and management of the patient with an ankle fracture. Each assessment of entrustable professional activity was 40 minutes long with three components: preoperative management of a patient (history-taking, examination, image interpretation); performance of a technical procedure on a sawbones model; and postoperative management of a patient (postoperative orders, management of complications). Residents were assessed by six faculty members who used checklists based on a modified Delphi technique, an overall global rating scale as well as a previously validated global rating scale for the technical procedure component of each activity. Nine PGY-1 and nine PGY-4 residents participated in our simulated assessment. We assessed reliability by calculating the internal consistency of the mean global rating for each activity as well as the interrater reliability between the faculty assessment and The institution of one or more of the authors (TD, MN) has received, during the study period, funding from a Core Competency Innovation Grant from the OMeGA Medical Grants Association. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and informed consent for participation in the study was obtained. This work was performed at the University of Toronto, Toronto, Ontario, Canada. Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® blinded review of videotaped encounters. We sought evidence of a difference in performance between PGY-1 and PGY-4 residents on the overall global rating scale for each station of each entrustable professional activity. Results The reliability (Cronbach's a) for the hip fracture activity was 0.88, it was 0.89 for the ankle fracture activity, and it was 0.84 for the TKA activity. A strong correlation was seen between blinded observer video review and faculty scores (mean 0.87 [0.07], p \ 0.001). For the hip fracture entrustable professional activity, the PGY-4 group had a hi...

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“…Nonetheless, the entire team turns over every 2 to 4 weeks, and continuity is disrupted daily, detracting from residents' ability to relate to patients. 19 With the adoption of the Accreditation Council for Graduate Medical Education (ACGME) duty hour restrictions, handoffs have increased, 20 and patients are often confused about who their physicians are and who is ''in charge.'' 21,22 While reduced hours certainly have positive consequences, residents have fewer opportunities to connect meaningfully with patients and witness the longitudinal course of illnesses.…”

Section: The Current Reality: Discontinuities Of Carementioning

confidence: 99%

Continuity of Care as an Educational Goal but Failed Reality in Resident Training: Time to Innovate

Ellman¹,

Tobin²,

Stepczynski³

et al. 2016

Journal of Graduate Medical Education

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Lost in Transition: The Experience and Impact of Frequent Changes in the Inpatient Learning Environment

Cited by 128 publications

References 22 publications

Using a Curricular Vision to Define Entrustable Professional Activities for Medical Student Assessment

Using a Curricular Vision to Define Entrustable Professional Activities for Medical Student Assessment

Cognitive and Psychomotor Entrustable Professional Activities: Can Simulators Help Assess Competency in Trainees?

Continuity of Care as an Educational Goal but Failed Reality in Resident Training: Time to Innovate

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