ABSTRACT

Background

Professionalism, which encompasses behavioral, ethical, and related domains, is a core competency of medical practice. While observer-based instruments to assess medical professionalism are available, information on their psychometric properties and utility is limited.

Objective

We systematically reviewed the psychometric properties and utility of existing observer-based instruments for assessing professionalism in medical trainees.

Methods

After selecting eligible studies, we employed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria to score study methodological quality. We identified eligible instruments and performed quality assessment of psychometric properties for each selected instrument. We scored the utility of each instrument based on the ability to distinguish performance levels over time, availability of objective scoring criteria, validity evidence in medical students and residents, and instrument length.

Results

Ten instruments from 16 studies met criteria for consideration, with studies having acceptable methodological quality. Psychometric properties were variably assessed. Among 10 instruments, the Education Outcomes Service (EOS) group questionnaire and Professionalism Mini-Evaluation Exercise (P-MEX) possessed the best psychometric properties, with the P-MEX scoring higher on utility than the EOS group questionnaire.

Conclusions

We identified 2 instruments with best psychometric properties, with 1 also showing acceptable utility for assessing professionalism in trainees. The P-MEX may be an option for program directors to adopt as an observer-based instrument for formative assessment of medical professionalism. Further studies of the 2 instruments to aggregate additional validity evidence is recommended, particularly in the domain of content validity before they are used in specific cultural settings and in summative assessments.

ABSTRACT

Background

Residents graduate from medical school with increasing levels of debt and also may possess poor financial knowledge and practices. Prior studies have assessed resident financial knowledge and interest in financial education, yet additional information regarding their attitudes about personal finance and financial planning could be essential for the development of relevant curricula.

Objective

We assessed baseline financial attitudes and planning behaviors of internal medicine and internal medicine–pediatrics residents in 3 geographically diverse academic programs.

Methods

A modified version of the Financial Industry Regulatory Authority National Financial Capability survey was administered anonymously to residents in 3 programs in spring 2017. Outcomes included levels of educational debt, positive financial planning behaviors, perception of finances and debt, and education about personal finance.

Results

Response rate was 62% (184 of 298). Rates of educational debt were high, with 81% (149 of 184) of respondents reporting educational debt, and the majority owing more than $100,000. Residents' financial practices were variable, and residents could be grouped into 1 of 3 categories—concerned-engaged, concerned-unengaged, and unconcerned-unengaged—based on their engagement with debt and financial management. Residents with high debt (> $250,000) had a bimodal distribution of respondents who strongly agreed and those who strongly disagreed they were concerned about debt.

Conclusions

Resident financial attitudes and practices are variable, ranging from highly engaged residents actively managing their financial wellness to unengaged residents who have low concern, despite high educational debt.

ABSTRACT

Background

Quality improvement and patient safety (QI/PS) competencies have been proposed separately for undergraduate medical education (UME) and graduate medical education (GME). The work forms a foundation at each educational level, yet curriculum development would benefit from more specific guidance that considers the continuum of physician training.

Objective

We identified a core set of QI/PS items to be taught during medical school, residency, and independent practice, with specificity to guide curriculum development at each level.

Methods

A panel of 12 QI leaders and educators with backgrounds in internal medicine from 10 academic institutions participated in consensus development using a modified Delphi technique. Three rounds of anonymous surveys were conducted, followed by a teleconference and then a fourth survey round, until consensus regarding the relevance of candidate items was reached. Items considered relevant were recommended for teaching at 1 of the 3 stages.

Results

The panel identified 30 QI/PS items for learners. Of the 30 (80%), 24 were unanimously agreed on as relevant, while 6 of 30 (20%) had the agreement of 11 of the 12 experts and the assent of the remaining expert. Thirteen items were identified as appropriate for undergraduate medical education, 14 for graduate medical education, and 3 for the continuing professional development level.

Conclusions

There was a high degree of agreement among 12 internists from geographically diverse institutions on the relevance of 30 QI/PS items identified for trainees in competency-based educational settings.

The Challenge

The Accreditation Council for Graduate Medical Education (ACGME) expects sponsoring institutions to conduct effective Graduate Medical Education Committee (GMEC) meetings. While the Institutional Requirements (IR) Section I.B–I.B.6 delineates Core, Detail, and Outcome statements, including the structure, composition,

Winning Paper

A Grounded Theory Study of Assessment Anchors in Postgraduate Medical Education: Forthcoming Opportunities and Ongoing Tensions

Introduction: Traditional workplace-based assessment (WBA) tools have well-documented problems. A notable reconsideration of the role and design of assessment anchors is taking place in medical education. Although research has demonstrated that entrustment-based assessment tools are more reliable than traditional ones, a dearth of evidence exists for how and why these anchors actually work. This qualitative study explored the form, function, and experience of assessment anchors, aiming to develop a theoretical framework for affordances and barriers related to the adoption of entrustment-based