Special Report separate commentary papers published in 2008.14,15 Touted
positive effects included the project’s guidelines which allow for standardization among programs, multi-source feedback (MSF), providing a more comprehensive analysis of fellow performance, and the requirement for academic productivity from identified key faculty. Negative effects were dominated by demands placed on the time of trainees and faculty. With more restricted hours, shift coverage, and increased handoffs for interns and residents, fellows and faculty have had to fill in the gaps in patient care. Perhaps most important was the acknowledgment that program directors have begun to ‘drown in data,’ where time spent acquiring and analyzing information is time spent away from the actual work of educating trainees. Revisions to all curricula, organization and implementation of MSF across the program, documentation of continuous professional development for key faculty, and exploring methods of assessing clinical competency beyond procedure numbers alone have resulted in an explosion of paperwork and corresponding time commitment, stressing the capacity of program directors and coordinators to manage the information.
Our Approach to Managing this Challenge— Targeted, Collaborative, Data-driven Educational Reform
Aside from the commentary pieces referenced, there are very few data describing educational methods among cardiology fellowship training programs. A PubMed search using the terms ‘cardiology fellowship’ and ‘education’ yields 104 articles, the vast majority of which are either similar commentary papers or panel consensus statements on number of months/procedures required for clinical competence in a specific area of cardiology. None of them describe an educational intervention studied in rigorous fashion. The key for our fellowship program when weathering the educational improvement mandates of the Outcome Project has been collaboration. Our divisional faculty and program leadership represent somewhat of a paradox, probably similar to other academic divisions in the US—highly skilled clinicians and nationally recognized content experts with largely minimal training in adult learning, curriculum development, and educational research. Simply put, while we are in support of data tracking and analysis to make targeted, efficient changes to improve how we teach, we need help from educational experts.
With the institutional license for the TurningPoint® Audience Response System (Turning Technologies, Youngstown, OH) purchased by the medical center, our fellowship program has full access to the hardware and
102 Cardiology Fellowship Education
The American Heart Hospital Journal
software for interactive question-and-answer activities during conferences. We have employed this every morning during conferences, where the first 10 minutes of the hour have been designated for board review, with a single ECG and multiple-choice question (MCQ) posed by the chief fellows and answered by the core fellows. Anecdotally, the practice of using TurningPoint has improved conference attendance and fellow satisfaction with board review. We also host visiting residents and fellows during morning conferences and this provides an anonymous forum for them to participate without concern for being called upon in an unfamiliar environment.
When re-evaluating our ECG interpretation curriculum, it became clear that there were several approaches to managing the challenges posed by fellows having to acquire two separate sets of skills: patient-centered interpretation, which often involves subtleties and ambiguity; and facility with the American Board of Internal Medicine (ABIM) answer sheet used during the board certification examination, which comprises very straightforward coded options but is non-intuitive and may cloud measurement of content knowledge. As the board examination for cardiovascular disease is split between MCQs and ECGs and is non-compensatory—a candidate can achieve a 100 % score on the MCQs and still fail the overall examination if they fail the ECG section—there is a major emphasis placed on competent ECG interpretation skill. Because there was a lack of data to guide our revisions, we partnered with the ACC to survey fellowship program directors in the US about how they taught ECG interpretation and used the ABIM answer sheet in their curriculum. The results showed that most programs (92 %) used the ABIM answer sheet when teaching their fellows, but only 42 % performed formal testing of skills.16
The information gained from this joint
venture with the College led to our use of a proctored ECG test using the ABIM answer sheet under timed conditions. This is given twice annually and has been received positively by the fellows, who note that the board simulation conditions give them better insight into time management during test taking. We hope to review data on certification examination performance after the intervention, to see if scores demonstrate statistical improvement.
A relatively recent innovative effort launched within The Ohio State University College of Medicine, the Center for Education and Scholarship (CES), has also served as a valuable resource for educators within the medical center (
http://medicine.osu.edu/faculty/ces/pages/index.aspx). Its stated goals are to:
Winter 2011
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68