Volume 15: Issue 4

“Roll a perception check,” says the Game Master.

A 20-sided die tumbles against wood.

“That’s a 17.”

The Game Master smiles knowingly. “On a 17, you notice a hoard of axe-wielding dwarves charging out of the woods. They look angry. What do you do next?”

“I…cast a wall of fire between us and the dwarves!”

Tabletop role-playing games provide a form of play that is shaped by its players’ imaginations. In Dungeons & Dragons, the quintessential tabletop role-playing game, a Game Master serves a facilitative role, informing the player characters about the scenarios, challenges, and other characters they encounter.

Background Residents must understand the social drivers of health in the communities they serve to deliver quality care. While resident orientation provides an opportunity to introduce residents to social and structural drivers of health, inequity, and care delivery relevant to the patient population in their new communities, many graduate medical education orientation curricula do not include this content.

Objective To report the development and implementation of a novel, patient-centered health equity orientation curriculum, including initial feasibility and acceptability data as well as preliminary self-reported outcomes.

Methods The curriculum was developed by academic faculty in collaboration with institutional and local health equity champions. Content centered on the history of inequities and racism within the local communities and included didactic presentations, asynchronous video, and virtual site visits to community resource groups. The curriculum was administered to all 2021 incoming Vanderbilt University Medical Center medical and surgical residents (N=270) over 2 half-days, both in-person and via Zoom. Data were collected anonymously via pre- and post-surveys.

Results A total of 216 residents (80% response rate) provided pre-survey response data, but only 138 residents (51.1%) provided post-survey data, including self-reported demographics (eg, underrepresented in medicine status) and level of agreement with 10 competency-based statements coded as pertaining to knowledge, skills, behaviors, or attitudes (KSBAs). Primary outcomes included improvement in residents’ KSBAs from pre- to post-survey. The greatest increases in percentages occurred with content that was specific to local history and population.

Conclusions In a class of incoming residents, this study demonstrated feasibility, acceptability, and pre-post curriculum improvement in self-reported KSBAs when addressing health equity issues.

Background The transition to telehealth during the COVID-19 pandemic revealed a lack of preexisting telehealth training for clinicians. As a workplace-based simulation methodology designed to improve virtual clinical skills, announced standardized patients (ASPs) may help meet evolving educational needs to sustain quality telehealth care.

Objective We describe the development and implementation of an ASP program to assess and provide feedback to resident and faculty clinicians in virtual practice, and report on performance, feasibility, and acceptability.

Methods From June 2021 to April 2022, resident and faculty clinicians at a VA primary care clinic participated in a video visit in which an ASP portrayed either a 70-year-old man with hearing loss and hypertension or a 60-year-old man with hypertension and financial stress. Following the visit, ASPs provided verbal feedback and completed a behaviorally anchored checklist to rate telehealth and communication skills, chronic disease management, and use of resources. Domain summary scores were calculated as the mean percentage of “well done” items. Participants completed a feedback survey on their experience.

Results Seventy-six televisits (60 primary care residents [postgraduate year 1-3], 16 internal medicine faculty) were conducted from August 2021 to April 2022. Clinicians performed well in communication skills: information gathering (79%, 60 of 76, well done), relationship development (67%, 51 of 76), education and counseling (71%, 54 of 76), and patient satisfaction (86%, 65 of 76). They performed less well in telemedicine skills (38%, 29 of 76). Participants agreed that the experience was a good use of their time (88%, 67 of 76).

Conclusions An ASP-facilitated training for resident and faculty clinicians assessed telehealth skills and clinical practice and identified areas for intervention. Clinicians responded well to the training and feedback.

Background The Clinical Competency Committee (CCC) provides accountability to the general public that physicians completing a training program have achieved competence. CCC processes and features that best identify resident outcomes along a developmental spectrum are not well described.

Objective This study sought to describe CCC features associated with effective and efficient CCC performance.

Methods The study was conducted as part of the 2022 Council of Academic Family Medicine Educational Research Alliance survey of family medicine residency program directors. The survey assessed CCC methods, policies, faculty development, structure, and overall CCC time required. The outcomes were identification of residents along a spectrum of development, from failing to exceeding expectations. Ordinal logistic regressions were used to explore the relationship between CCC characteristics and CCC outcomes.

Results The response rate was 43.3% (291 of 672). Eighty-nine percent (258 of 291) of program directors reported their CCC is successful in identifying residents not meeting expectations; 69.3% (201 of 290) agree their CCC identifies residents who are exceeding expectations. Programs with written policies for synthesizing data (OR=2.53; 95% CI 1.22-5.22; P=.012) and written policies for resident feedback (OR=19.91; 95% CI 3.72-106.44; P<.001) were more likely to report successfully identifying residents below expectations. Programs whose members spent fewer than 3 hours per 6-month interval on CCC meetings were less likely to report being able to identify failing residents (OR=0.37; 95% CI 0.19-0.72; P=.004).

Conclusions This survey of family medicine program directors suggests that formal policies, faculty development, and adequate time for CCC faculty are associated with an effective CCC, especially if goals beyond “identifying failure” are desired.

The great thing about getting older is that you don’t lose all the other ages you’ve been.

—Madeleine L’Engle

The Challenge

Mid- to late-career clinician educators (CEs) face many transitions, successes, and setbacks with variable guidance. Inflection points, or times of pivotal decision, occur during transitions between junior, mid, senior, and emeritus phases. Unanticipated inflection points can occur with new performance expectations, direct report changes, and evolving family responsibilities. These transitions can be particularly difficult for historically marginalized faculty. Over a CE’s career, professional and personal priorities often evolve and may conflict with those of employers, potentially creating times of

Interstitial Skills: Preparing Trainees for All Aspects of Clinical Practice

Post-Dobbs: The Consequences of Abortion Bans on Complex Family Planning Training

The Teaching Health Center Graduate Medical Education Program: A Permanent Funding Imperative

Excellent vs Excessive: Helping Trainees Balance Performance and Perfectionism

Medical Educator as Game Master: What Dungeons & Dragons Can Teach Us About Small Group Learning

Delineating Blurred Lines: The Experience of Defining Core Competencies in Canadian Surgical Residency Programs

Program Misrepresentation in the Doximity Residency Navigator

Introduction

The Conundrum of Divergent Signaling by Couples Applicants

A Graduate Medical Orientation Intervention Focused on Local Health Inequities

Rounding in the Time of COVID

The Theoretical Integrative Review—A Reader’s Guide

The Theoretical Integrative Review—A Researcher’s Guide

Implementing an Experiential Telehealth Training and Needs Assessment for Residents and Faculty at a Veterans Affairs Primary Care Clinic

Features of Effective Clinical Competency Committees

Using a Consensus-Driven Approach to Incorporate Holistic Review Into an Internal Medicine Residency Program

Association of a Gamified Journal Club on Internal Medicine Residents’ Engagement and Critical Appraisal Skills

Near-Peer Supervision in Primary Care: Bringing Teaching Teams From the Wards to the Clinic

Comparing Machine Learning Models and Human Raters When Ranking Medical Student Performance Evaluations

Residents’ Report of COVID-19 Associated Training Disruptions, Stressors, and Opportunities During the Pandemic—The Singapore Experience

Does the Degree Matter? MD and DO Students Who Match Into OB/GYN Report Different Experiences in US Undergraduate Medical Education

Mid to Senior Clinician Educator Career Transitions and Vitality

The Challenge

Management of Acute on Chronic Imposter Syndrome

Making Decisions

Erratum

The Trainee Perspective on Getting Started With Scholarship in Graduate Medical Education

Scholarship in Graduate Medical Education

Rouge on the Lips of Silence

Evaluating Methodology for Increasing Diversity in US Residency Training Programs: A Scoping Review

Scoping Review of Simulation-Based Training for Social Determinants of Health Within Residency Programs

Career Outcomes Among Graduates of 2 Urban Health Primary Care Training Programs

Trends in MedEdPORTAL Faculty Development Resources for Clinician Educators

The Effect of Paging Reminders on Fellowship Conference Attendance: A Multi-Program Randomized Crossover Study

A Values Affirmation Intervention to Improve Female Residents' Surgical Performance

Improving Residents' Safe Opioid Prescribing for Chronic Pain Using an Objective Structured Clinical Examination

Integrating a Resident-Driven Longitudinal Quality Improvement Curriculum Within an Ambulatory Block Schedule

Skills for Interviewing Adolescent Patients: Sustainability of Structured Feedback in Undergraduate Education on Performance in Residency