Resources for More Information
The sources of help listed below are not specific to HPM – most are generic to the medical profession and will need to be adapted and applied to HPM fellowship programs. Hopefully they will provide some new ideas and serve as a catalyst for improving and fine-tuning your curriculum.
Competence
ACGME Outcome Project
The Outcome Project is a long-term initiative by which the ACGME is increasing emphasis on educational outcomes in the accreditation of residency education programs. The Project has developed a set of six general competencies, which serve as the basis for residency programs.
Defining and Assessing Professional Competence (Ronald M. Epstein, MD, and Edward M. Hundert, MD. JAMA, 2002; Vol. 287, No 2; pp. 226-235)
This article defines competence as “the habitual and judicial use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served.” The authors propose that competence is contextual and that it is defined by the interaction of the task, the clinician’s abilities, and the health system. When assessing competence, they believe an important component of any evaluation method is that it is useful in fostering future learning. The article also includes an interesting grid where the level of assessment for clinical skills can be categorized by “Knows, Knows how, Shows how, Does.”
A Framework for Teaching Medical Students and Residents about Practice-based Learning and Improvement, Synthesized from a Literature Review (Greg Ogrinc, MD,; Linda A Headrick, MD, MS, Sunita Mutha, MD, Mary T. Coleman, MD, PhD; Joseph O'Donnell, MD; Paul V. Miles, MD. Academic Medicine, 2003. 78(7):748-756). (Abstract only).
The authors of this research report conducted a Medline search to find articles that would be helpful in developing a framework for teaching practice-based learning and improvement to medical students and residents. An expert panel reviewed the articles and proposed a series of educational objectives from the beginning medical student through residency. The article includes a table of the recommended objectives for systems-based practice as well as practice-based learning and improvement.
Assessment Methods and Evaluation Tools
Toolbox of Assessment Methods (ACGME Outcomes Project and American Board of Medical Specialties (ABMS), 2000).
This 25-page document describes 13 assessment methods that can be used for evaluating residents. In addition to a description, the following is included for each assessment tool: how it is useful, its psychometric qualities, its feasibility and practicality, and suggested references.
Suggested Best Methods for Evaluation is a companion piece to the ACGME toolbox. It contains a 3-page table that lists each of the six ACGME competencies, and suggests one or more of the 13 assessment methods for the required skills within each competency.
Outcomes-based Evaluation in Resident Education: Creating Systems and Structured Portfolios (Eric S. Holmboe, MD, William Rodak, PhD, Glenn Mills, MD, Michael J. McFarlane, MD, and Henry J. Schultz, MD. The American Journal of Medicine, 2006; 119(8): 708-714)
The authors describe the attributes of a comprehensive evaluation system for resident-level training, stressing that it should consist of multiple tools, including self-assessment. The characteristics and components of a “structured portfolio” are explained in detail, providing an excellent guide for programs wanting to incorporate this method as part of their evaluation system. A big advantage to using a structured portfolio is that it can be used to evaluation several of the 6 ACGME general competencies.
Assessment in Medical Education (Ronald M. Epstein, MD, New England Journal of Medicine, 2007; 356:387-96.)
The main point Dr. Epstein makes is that assessment should use a variety of methods implemented longitudinally. He discusses assessment in terms of competence, and describes several common methods focusing on their intrinsic strengths and flaws. One of the most useful aspects of this article is the suggestions as to how to mitigate the weaknesses of a particular method. For example, with multiple choice exams he suggests including “script-concordance items,” which attempt to evaluate clinical reasoning by asking the examinee to assess how a new piece of information increases or decreases the probability of a particular outcome. Also included is a very useful table that describes each of the assessment methods, the domain it attempts to assess, how it can be used, and its strengths and weaknesses.
Evaluating Competence Using a Portfolio: A Literature Review and Web-Based Application to the ACGME Competencies. (Carol Carraccio, MD and Robert Englander, MD, Teach Learn Med. 2004 Fall; 16(4):381-7). (Abstract only).
In searching for methods to evaluate competence, the authors identified portfolio assessment as having the greatest promise in attempting to evaluate competence in the six broad and diverse ACGME domains. A portfolio must have both a creative, self-reflective component and a structured, quantitative component. Carracio and Englander developed a web-based portfolio evaluation tool that incorporates both components.
Writing Behavioral Objectives
How to Write Learning Objectives that Meet Demanding Behavioral Criteria, Kizlik, Bob, 2006, retrieved from the Internet Nov. 20, 2006
How to Write Great Objectives, Kruse, Kevin
Bloom’s Taxonomy of Educational Objectives
Learning Domains or Bloom’s Taxonomy
Bloom's Taxonomy of Educational Objectives, Center to Teaching and Learning, Stanford University, Stanford, CA
Major Categories in the Taxonomy of Educational Objectives (Bloom 1956)
Dreyfus’ Model of Skill Acquisition
Dreyfus Model of Skill Acquisition, (PowerPoint presentation) Craig McClure, MD, EOSG, University of Arizona, 2005
Skill Acquisition Model, based on Dreyfus Hubert L, Dreyfus Stuart E, Mind over Machine
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