The Challenges of Graduate Program Directors in Health Professions Education (HPE)
In April 2018, the Journal of Graduate Medical Education published an article on the challenges healthcare provider education (HPE) program managers face regarding practitioner training, board exam pass-rates, scores, assessment, evaluation and – program leadership. Here are a few important passages:
Consider the following scenario:
You are a physician with the goal of becoming a program director. You have been a clinical leader in your field, publishing dozens of articles in your subspecialty. Despite having attended only a few workshops on how to teach, you have consistently scored in the top 10% of your program’s attending physicians, as rated by the residents. You have been on your program’s clinical competency committee for a few years, and you are familiar with the processes required to run the program.
Imagine now that you achieved your goal—you have been selected to be a program director at your institution—but the program is struggling. The board pass rate is 20% below the review committee’s requirement. Postrotation evaluations are completed only intermittently, and rarely do the residents report receiving feedback. Furthermore, it is not clear how the annual program assessment is used to improve the program. The most recent Accreditation Council for Graduate Medical Education (ACGME) accreditation letter warns that the program’s accreditation status is in jeopardy unless these areas have been satisfactorily addressed.
Question?How will you, as the program director, approach this challenge?
Program directors, deans for graduate medical education (GME), and core faculty have diverse responsibilities for residency or fellowship program oversight and assurance. One fundamental responsibility is to prepare graduates for unsupervised practice. Program directors, in particular, play a key role in this preparation and, ultimately, in the delivery of high-quality GME and first-class health care. This pivotal role is even more salient when one considers the current health care challenges, including rising costs, low-value care, and the persistent problem of diagnostic and technical errors leading to patient harm.
A Growing Educational Need
Graduate programs in HPE—including certificate and degree programs—are viewed by many as a key strategy to contribute to a health professional’s conversion from competent clinician to transformational academic leader. The so-called “professionalization” of the HPE workforce has been driven by a number of institutional and regulatory dynamics.
The first is that many clinicians have made education the focus of their professional roles, and institutions have responded by creating career tracks, such as clinician educator/scholar.
Second, accreditation bodies increasingly require that residency leaders have the “requisite specialty expertise and documented educational and administrative experience.”
With this explicit requirement, and with the need to “maintain an educational environment conducive to educating the residents in each of the ACGME competencies,” US institutions, as well as those abroad, have recognized the value of employing leaders who possess advanced training in education to maintain and improve their residency programs.
In addition, with the advent of the Next Accreditation System and the Clinical Learning Environment Review program, program directors are expected to thoroughly understand how to review curriculum, grow and develop educational expertise among their own faculty, and create and maintain a robust evaluation system for milestones reporting.
Core Content Areas for Programs in Health Professions Education
Mapping Program Director Competencies With Core Content Areas for Programs in Health Professions Education
Continuing the Scenario…
In our scenario, the board pass rate is low.
Reasons may include the program accepting residents at higher risk of failing or a curriculum that does not reflect the examination’s expected knowledge base.
Alternatively, is the learning environment not conducive to learning and effective clinical reasoning?
Or perhaps the educational strategies are not appropriate for the learners or the content that is being taught?
Even if a program’s graduates perform well on the examination, there always is new knowledge that needs to be taught and mastered.
A program director with a strong clinical and education knowledge base, and with formal and mentored experience in teaching methods, curriculum development, and learner assessment, may be in a better position to correctly identify which aspects in the above scenario require attention.
In addition, a program director with formal HPE training may be in a better position to select and deploy the most effective ways to improve those aspects and possess the skills to implement these changes, compared with an individual without these hands-on experiences.
Leadership Requires Performance Data as well as Program Knowledge
Education program leadership also requires understanding tools and resources that can bring critical information to the forefront.
In addition to curricula development – there is curricula utilization – and that brings us to DATA.
Even the most decorated educators need systemic tools for assessment and evaluation of program progress and training outcomes.
Given the rise of online education systems, leadership also involves multi-site communications and activity tracking. Leadership requires an understanding of their students, their strengths and weaknesses.
Program leaders can get that information from leading online medical education platforms.
As the complexity of GME continues to grow, it is essential that academic leaders have the requisite competencies and data-based tools needed to lead effectively.
Examples of this added complexity include new frameworks for assessment of learners and competencies (eg, competency-based medical education and milestones), increasing sophistication in program evaluation models, patient safety programs, and attention to the instruction and remediation of professionalism.
Additionally, accreditation standards will undoubtedly continue to evolve, furthering the argument that as physicians move into educational leadership positions, they require supplemental education to prepare them for these roles. It is no longer enough for GME leaders to be “good teachers,” a skill that is often gained in vivo, or informally, over one’s career.
Instead, GME leadership—the kind that is outlined in the ACGME’s Next Accreditation System and the Royal College of Physicians and Surgeons of Canada CanMEDS physician competency framework—requires “new approaches to problems and ways of thinking” that we believe HPE programs can instill through an integrated, holistic approach to leader preparation.
Anthony R. Artino Jr, Ronald M. Cervero, Kent J. DeZee, Eric Holmboe, and Steven J. Durning (2018) Graduate Programs in Health Professions Education: Preparing Academic Leaders for Future Challenges. Journal of Graduate Medical Education: April 2018, Vol. 10, No. 2, pp. 119-122.
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