Biomedical subjects

Robert Englander

Publications and source records attributed to Robert Englander.

5 recordsLinked to original sources

PubMed2006

Teaching residents systems-based practice through a hospital cost-reduction program: a "win-win" situation.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project challenges residency programs to teach and evaluate competence in 6 domains, including systems-based practice (SBP). One element of SBP is to "practice cost-effective health care ... that does not compromise quality." Institutional cost-reduction efforts included targeting laboratory fees by using point-of-care testing with an iSTAT machine rather than in the central laboratory. Predicted cost savings were 50,000 US dollars per month. Because residents are primary users of laboratory resources, the authors engaged them in the process and implementation of system redesign. DESCRIPTION: The residents identified barriers to use of the iSTAT and solutions to overcome those barriers. EVALUATION: As a result of resident solutions, use of the iSTATwent from 40% of potential iSTATtests being ordered on the iSTAT to 98%, with an estimated 549,780 US dollars per year in savings to the hospital. CONCLUSION: Involving residents in hospital cost-reduction efforts allows both teaching and evaluation of competence in SBP while realizing significant cost savings.

Clinical Laboratory Techniques↗

PubMed2004

Evaluating competence using a portfolio: a literature review and web-based application to the ACGME competencies.

BACKGROUND: The Accreditation Council for Graduate Medical Education is shifting its focus from a structure and process system of graduate medical education to one that is outcomes based, requiring all residents in training to achieve competence in six broad domains and presenting educators with the challenge of evaluation. SUMMARY: We searched the literature and reviewed all articles relating to portfolio assessment in medicine. In addition, we reviewed articles that addressed standard tools currently in use for resident performance assessment. The use of a portfolio allows one to incorporate a variety of assessment tools needed to evaluate the diverse domains of competence and also fosters reflective learning, which is key to professional development. From lessons learned through this review, we developed a Web-based evaluation portfolio for residency training that we describe here in the hope of facilitating this process for others. CONCLUSIONS: Web-based portfolio assessment provides an ideal venue for the evaluation of competence and has the ability to provide educators with a research infrastructure to practice evidence-based education.

Benchmarking↗

PubMed2004

Educating the pediatrician of the 21st century: defining and implementing a competency-based system.

PURPOSE: The final product of the Accreditation Council for Graduate Medical Education (ACGME) Outcomes Project is to improve health care through ensuring the competence of physicians during their training and beyond. Its success depends on a paradigm shift to a competency-based model of medical education. This article presents an overview of the model and describes the first stages of this multistep transition in a university setting. Our hope is to raise awareness of the impact on the pediatric community at large and provide a foundation on which other educators can continue to build. METHODS: The ACGME established 6 domains of competence as the first step in the paradigm shift. To begin work on the second step of establishing benchmarks for evaluation of competence and thresholds at which they should be achieved, the educational leadership from the primary care departments formed a work group with the support of a Health Resources and Services Administration grant. RESULTS: Review of the literature led us to embark on a stepwise process for initiating a competency-based system of medical education. We established the benchmarks by a process of individual effort followed by group consensus. These benchmarks, in the aggregate, permit an evaluator to determine whether a given competency has been achieved. The next phases of step 2 required setting thresholds for the demonstration of competence and finally establishing consensus regarding the threshold for competence at each level of training for each specific benchmark. To accomplish the latter, we surveyed the program directors of the 202 accredited pediatric training programs that are members of the Association of Pediatric Program Directors. Eighty-one members (40%) completed our survey. Although some controversy existed for thresholds during the postgraduate-year-1 level, majority consensus was reached for nearly all benchmarks at the upper levels of training. Impact of the shift to competencies for medical students and practicing physicians is also reviewed. CONCLUSION: Having defined the benchmarks and thresholds for the 6 ACGME domains of competence, we are well positioned to move to step 3: developing the necessary tools to evaluate competence. The move to competency-based education impacts the entire pediatric community. Lessons learned from our experience may be generalized and thus be of value to the community at large.

Benchmarking↗

PubMed2003

Guiding medical students through the match: perspectives from recent graduates.

OBJECTIVE: Little has been written about the counseling of medical students as they go through the process of selecting and ranking residency programs for the National Resident Matching Program. The Association of Pediatric Program Directors (APPD) and the Council on Medical Student Education in Pediatrics jointly sought to evaluate the current status of advice and counseling for students going through the Match, and to elicit suggestions for improvement. METHODS: Surveys evaluating satisfaction with aspects of and advice received regarding the Match were sent to each of the 199 Accreditation Council for Graduate Medical Education accredited member programs of the APPD with a request that they be distributed to all first-year pediatric residents during the orientation process for the 2001-2002 academic year. Surveys were both voluntary and anonymous. Results were compiled by the administration of the APPD. RESULTS: We received responses from 42% of all US pediatric categorical or combined residents entering pediatric residency in July of 2001. Respondents included at least 1 representative from every US medical school. Ninety-seven percent of respondents were either very satisfied (88%) or somewhat satisfied (9%) with where they matched, whereas 82% were either very (42%) or somewhat (40%) satisfied with the advice they received regarding the match. The Fellowship and Residency Interactive Database, the faculty advisor, and resident-to-student counseling were the top 3 resources identified by the respondents. Of 12 resources listed in the survey, only the Green Book was rated as unhelpful. Four areas for improvement regarding the advising process were identified: timing, standardization, and quantity of advice and accuracy of online information resources, with specific suggestions given for each. CONCLUSIONS: Overall, recent medical school graduates are quite satisfied with both where they matched in pediatrics and the process that got them there. However, several areas for improvement in the advising/counseling system were identified. Potential approaches to these concerns or resources to develop approaches to them were identified.

Counseling↗

PubMed2002

Shifting paradigms: from Flexner to competencies.

Realizing medical education is on the brink of a major paradigm shift from structure- and process-based to competency-based education and measurement of outcomes, the authors reviewed the existing medical literature to provide practical insight into how to accomplish full implementation and evaluation of this new paradigm. They searched Medline and the Educational Resource Information Clearinghouse from the 1960s until the present, reviewed the titles and abstracts of the 469 articles the search produced, and chose 68 relevant articles for full review. The authors found that in the 1970s and 1980s much attention was given to the need for and the development of professional competencies for many medical disciplines. Little attention, however, was devoted to defining the benchmarks of specific competencies, how to attain them, or the evaluation of competence. Lack of evaluation strategies was likely one of the forces responsible for the three-decade lag between initiation of the movement and wide-spread adoption. Lessons learned from past experiences include the importance of strategic planning and faculty and learner buy-in for defining competencies. In addition, the benchmarks for defining competency and the thresholds for attaining competence must be clearly delineated. The development of appropriate assessment tools to measure competence remains the challenge of this decade, and educators must be responsible for studying the impact of this paradigm shift to determine whether its ultimate effect is the production of more competent physicians.

Clinical Competence↗