GME Concentrations: A Collaborative Interdisciplinary Approach to Learner-Driven Education
ABSTRACT
Background
Graduate medical education (GME) programs may struggle to provide the knowledge, skills, and experiences necessary to meet trainee career interests and goals beyond a clinical focus. Sponsoring institutions can partner with programs to deliver content not included in typical clinical experiences of GME programs.
Objective
To perform a needs assessment and to develop, implement, and measure acceptability and feasibility of an institution-wide GME Concentrations curriculum.
Methods
In response to the needs assessment, GME leadership developed 4 concentrations: (1) Resident-as-Teacher; (2) Patient Safety and Quality Improvement; (3) Law, Ethics, and Health Policy; and (4) Leaders in Medicine. We formed advisory committees that developed curricula for each concentration, including didactics, experiential learning, and individual project mentoring. Participants completed pre- and postassessments. We assessed feasibility and evaluated participant presentations and final projects.
Results
Over the course of 3 years, 91 trainees (of approximately 1000 trainees each year) from 36 GME programs (of 82 accredited programs) have participated in the program. The number of participants has increased each year, and 22 participants have completed the program overall. Cost for each participant is estimated at $500. Participant projects addressed a variety of education and health care areas, including curriculum development, quality improvement, and national needs assessments. Participants reported that their GME Concentrations experience enhanced their training and fostered career interests.
Conclusions
The GME Concentrations program provides a feasible, institutionally based approach for educating trainees in additional interest areas. Institutional resources are leveraged to provide and customize content important to participants' career interests beyond their specialty.
Editor's Note: The online version of this article contains the 13-question survey of GME Concentrations program and the 2014 GME Concentrations program final evaluation tool.
Introduction
Trainees commonly report career interests that transcend their chosen specialty, and smaller or resource-limited programs may be challenged to respond. Several academic medical centers have attempted to address gaps in the graduate medical education (GME) curriculum and individual needs with institution-wide offerings.1–8 However, many of these include only 1 content area.
Here we describe the development and implementation of an institution-wide program for trainees in response to resident and program preferences. The Duke University Hospital GME Concentrations program has an emphasis on content not traditionally included in GME, with a goal of partnerships to provide interdisciplinary content and mentorship. Institutions may benefit from utilizing the program described here as a model to implement similar offerings.
Methods
Needs Assessment
A 13-question survey (provided as online supplemental material) was sent electronically to all 93 existing Accreditation Council for Graduate Medical Education (ACGME) accredited and internally sponsored GME program directors querying their program needs, current related initiatives, and suggestions for content and format.
A total of 33 of 93 (35%) program directors completed the survey, with 19 (58%) indicating their departments lacked a program to educate residents in nonclinical interest areas. Respondents noted that an institution-wide initiative would help fulfill GME requirements and better prepare trainees for what lies ahead. We also asked respondents to volunteer or suggest advisory committee members.
Development
The needs assessment identified 4 areas: (1) Resident-as-Teacher; (2) Patient Safety and Quality Improvement; (3) Law, Ethics, and Health Policy; and (4) Leaders in Medicine. Individuals were recruited from those identified in the needs assessment along with other experts across the institution to participate on concentration-specific advisory committees. Forty individuals, representing 7 clinical departments and a variety of leadership positions, were asked to serve on the 4 advisory committees.
Advisory committee members identified program objectives for each concentration. To address each learning objective, the advisory committees used literature reviews, their content expertise, and the needs assessment data to develop curricula. Committees were encouraged to incorporate a variety of activities to meet different learning styles, and the committees created concentration requirements involving didactics, group activities, practical experiences, readings, and a capstone project (table 1).
Guidelines for program format and rigor were provided by the program manager (M.R.) and first author (A.N.) who have experience in curriculum development and GME.
Common Curriculum
All concentrations have the following common curricular expectations:
Directed Readings
The advisory committees maintain a core list of required readings for each concentration.9
Committee Participation
Participants are expected to observe or participate in program, departmental, and institutional committees related to their specific interests.
Individual Project
With mentor guidance, an emphasis on outcomes, and an eye toward publication-worthy scholarship, each trainee is expected to develop a capstone project anticipated to benefit the program or institution. Institutional Review Board approval, data collection, data analysis, and preparation of an abstract or manuscript are expected. In lieu of a project, the Leaders in Medicine participants work through team-based case studies.
Concentration-Specific Curricula
Each concentration has specific goals, objectives, learning activities, and evaluation methods to meet unique learning needs. Participants upload documentation of completed work into a personal online portfolio for review by advisory committee members. Examples of concentration-specific curricula include the following:
Teaching Triangles (RAT)
Modeled after work in the Duke University Graduate School,10 Resident-as-Teacher (RAT) participants form triads responsible for observing and providing feedback on teaching encounters.
Journal Club (RAT)
Each RAT trainee presents once yearly during the quarterly journal club, using a template to organize his or her 20-minute presentation followed by 10 minutes of discussion. Evaluations include peer feedback on teaching skills.
Patient Safety and Quality Improvement Training (PSQI)
Participants complete TeamSTEPPS Essentials or Master Trainer courses and the Physician Leadership in Patient Safety and Quality course. Members also participate on the Resident Institutional Patient Safety and Quality Committee.
Health Policy Lecture Series (LEHP)
Participants attend the GME Health Policy Lecture Series consisting of ten 1-hour lectures.
Leadership Book Club (LIM)
Participants read and analyze books related to leadership skills and effective leadership.
Implementation
A 0.25 full-time equivalent project manager, with a bachelor's degree and 5 years of experience in medical education program planning and implementation, facilitates all logistics. This includes, but is not limited to, development of marketing materials, in-person events, evaluation, and a webpage housing curricular components, resources, and an electronic portfolio for each participant. Marketing materials are provided to GME programs to assist with recruitment efforts.
Enrollment
Interested trainees complete an application, which is reviewed by the pertinent advisory committee. As long as the program director supports participation, and applicants have completed all paperwork, they are extended an invitation to participate. The advisory committee also identifies mentors for each participant. In the initial proposal for funding, the investigators estimated 10 participants per concentration area per year for 3 years, with some expected variability.
The design of each program includes a number of components and requirements for successful completion (figure), beginning with an orientation. The program can span 1 to 2 years with periodic deadlines, group meetings, and mentoring. A final session culminating in project presentations and the awarding of Certificates of Completion is held at the end of the academic year.
Citation: Journal of Graduate Medical Education 7, 3; 10.4300/JGME-D-14-00599.1
Evaluation
An evaluation tool (provided as online supplemental material) was developed to gather feedback from participants and attempted to determine success of the program. In addition, there is monitoring of the number of applications, completion rates, faculty participation and time, any costs, and related scholarly productivity. Participants answer 2 open-ended questions regarding expectations for their experience, and the concentration component they believe will (pre) and has (post) been most meaningful. Participants' project presentations are evaluated on clarity, content, and overall presentation skills.
Our study was declared exempt by the Duke Hospital Institutional Review Board.
Analysis
Due to the relatively small number of graduates in each concentration area, we report descriptive statistics, aggregate outcomes, and qualitative findings.
Results
Feasibility
The program is currently funded from a previously described Quasi-Endowment11 with plans to move to more permanent funding sources through the institutional hospital budget. Advisory committee members (semiannual 90-minute meetings and periodic e-mail correspondence) and mentors (2 to 4 hours per month with mentee) volunteer their time. Cost per participant is estimated at $500. Funds are allocated to refreshments, general and specific research support, books and other resources for participants, and certificate framing.
To date, all trainees who applied and received program director approval have been accepted into the program. While funding initially supported 10 participants per concentration area per year, we have been able to use existing resources and exercise fiscal responsibility to increase the number of participants. Seventeen trainees began the program in July 2012; 31 in July 2013; and 45 in July 2014 (table 2). Five participants in 2013 and 16 in 2014 successfully completed their requirements and graduated from the program. Graduates reported that participation in the program required a 2- to 6-hour monthly time commitment. Another 29 participants graduated in June 2015 whose survey results and project outcomes are not included in this article.
Effectiveness
Participants' individual projects have included enduring educational initiatives, practice improvement recommendations, and administrative oversight (table 3).
To date, 13 of 16 graduates have completed a pre and post self-assessment and evaluation to gather feedback on opportunities for program enhancement. Prior to participating, individuals predicted that live sessions and personal project components would be the most meaningful. Postsurvey, most trainees reported that the greatest impact was from personal projects and mentor relationships. A majority of respondents (71%, 10 of 14) noted the critical importance of the mentor-mentee relationship, and 64% (9 of 14) reported that they built relationships with individuals outside their specialty that enhanced their training and or patient care.
Many respondents (57%, 8 of 14) indicated that they incorporated new skills and knowledge acquired into daily work, and 36% (5 of 14) anticipated encouraging others to pursue knowledge and skills in the concentration area. The program met the expectations of all respondents.
Discussion
The GME Concentrations program experience has been positive. The program provides a unique, collaborative, institutionally based approach to providing 4 critical content areas. It allows participants to learn in multidisciplinary communities and have mentor relationships with content experts from different specialties and health professions. While a small percentage of residents participate overall (given Duke has approximately 1000 trainees), the GME Concentrations program meets the needs of trainees motivated to gain additional skills and knowledge in 1 of these areas.
Specific ACGME requirements, including scholarly activity, can be addressed through work in concentrations such as the ones we developed. Participants' online portfolio can be used as evidence of scholarship. Many individual projects have resulted in national presentations and manuscripts, and individual trainees can build a portfolio and networks tailored to their career goals.
Harnessing interdisciplinary resources and expertise and encouraging collaboration provides efficiencies that individual departments cannot easily offer. The institution benefits from participants' projects, some of which have yielded sustainable hospital process changes and enhanced educational programs (eg, a resiliency program, national survey data regarding specialty-specific training needs, new medical student rotations, and education modules). In terms of Kirkpatrick's hierarchy of program evaluation, products of the GME Concentrations program generate changes at the levels of individual behavior and the system.12
Participants reported the mentored projects as the most impactful component, with the program creating a system that promotes collaborative efforts among programs much in the same way that faculty academies improve networking and collaboration in academic medical centers.13 We are hopeful that the program provides an infrastructure for long-term projects with multiple collaborators and sustainable interventions in quality, safety, and medical education research.14,15 These activities have the potential to impact patient care by improving collaboration among trainees and their mentors.6,16
An exciting and unintended consequence of the GME Concentrations program is interdepartmental faculty collaboration, and additional faculty members have asked to join. We are hopeful that relationships will persist and result in interdepartmental efforts beyond the program.
The intervention has some limitations in terms of generalizability. We are fortunate to have strong institutional support through the Innovations Grant process, allowing for statistical support, meals during meetings, relevant books, and small travel grants. Funding may be challenging to sustain in increasingly resource-constrained academic medical centers. As interest grows, we face the possibility of a program that outgrows its resources. We have not at this time capped participation, but would have to consider doing so if interest exceeded funds and available resources such as time and mentors.
An important component of this program is capitalizing on freely available institutional resources, such as TeamSTEPPS and monthly health policy lectures sponsored by the GME office. Partnering with other educators and sharing resources will be important to successfully implementing and sustaining similar programs.
We learned that identifying reasonable criteria and deadlines for participants is critical to the success of individuals and the program as a whole. Initially, participants were allowed to select the length of time (up to 3 years) to complete the requirements, yet we experienced an unexpectedly low graduation rate. This led us to institute more stringent completion criteria with concrete deadlines, which has resulted in improvements in successful completion as illustrated by 29 participants who graduated in June 2015.
Conclusion
The GME Concentrations program leverages institutional resources and faculty, helps trainees identify and deepen areas of nonclinical interest, and results in sustainable projects. Other institutions may be able to replicate our approach to the benefit of institutions, programs, and trainees.
Components and Requirements for Successful Completion of Concentrations Program
Author Notes
Funding: The authors report no external funding source for this study.
Conflict of interest: The authors declare they have no competing interests.
The content of this manuscript has appeared as a poster at the ACGME Educational Conference in National Harbor, Maryland, February 28–March 2, 2014; at the AAMC Medical Education Meeting in Chicago, Illinois, November 6–7, 2014; and as a presentation at the AAMC Southern Group on Educational Affairs Regional Conference in Miami, Florida, March 12–16, 2014.
The authors would like to thank the members of the Concentrations Advisory Committees who shared their time and expertise to make this program a success.
