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The Medical School Accreditation Process
andThe Surgery Resident's Rolein Teaching Medical Students
Larry Tan, MDDirector, Surgery Undergraduate
Deparment of SurgeryUniversity of Manitoba
March 2010
Objectives
Medical school accreditation process
Description of Education Directive 24
How ED-24 applies to residents who act as teachers
How ED-24 is implemented in the Department of Surgery.
Resident's role in teaching medical students in the clerkship rotation and in formal teaching sessions
Feedback on resident teaching from the medical students
Note – blue text are hyperlinksED-24
Medical School Accreditation
Medical School Accreditation
Liaison Committee on Medical Education is the accrediting body for all North American medical schools
LCME determines whether medical schools meet established standards for structure, resources and education delivery.
Educational Objectives are outlined in ED-01 to ED-47 ED-24 is an objective found to be poorly implemented
in accreditation of other North American medical schools
ED-24
LCME Accreditation Actions
Possible outcomes of accreditation are: Grant accreditation status (full, preliminary or
provisional) or deny accredition – for new schools Continue accreditation status, with or without
specifying terms Continue accreditation, with warning of probation Continue accreditation, with probation Withdraw accreditation
ED-24
University of Manitoba Accreditation Schedule
Previous accreditation – 2004 – full approval, with areas of partial non-compliance, including ED-24
Upcoming accreditation LCME secretariat visit – March 1-2, 2010 Mock accreditation (voluntary) – November 2010 Database submission to LCME – January 2011 LCME accreditation visit – April 2011 Accreditation report – June 2011
ED-24
Accreditation Probation
Probation for One or more areas of noncompliance that must be corrected
in 12-24 months Previously identified areas of noncompliance that have not
been corrected
Medical schools placed on probation must inform the public within 24 hours, e.g. Dalhousie University 2009
Failure of probation can lead to withdrawal of accreditation
University of Manitoba was in partial non-compliance with ED-24 in 2004.
ED-24
What Is ED-24?
An Educational Directive that governs oversight of teaching interactions between residents and medical students.
Residents must know the objectives for the medical students they are teaching.
Residents must be given training in how to teach. In cases where performance is weak, residents must be given remedial training.
Students should provide feedback on residents who teach them.
Residents should receive feedback on their teaching performance from faculty and students
ED-24
ED-24
Minimal expectation #1
Residents and other instructors who do not hold faculty ranks (such as graduate students and postdoctoral fellows) should receive a written copy of the course/clerkship objectives and clear guidance from the course/clerkship director about their roles in teaching and evaluating medical students.
From www.lcme.org
ED-24
ED-24
Minimal Expectation #2
The institution and/or relevant departments provide resources such as workshops/written materials to enhance the teaching and evaluation skills of residents and other non-faculty instructors.
From www.lcme.org
ED-24
ED-24
Other Expectations
There should be central monitoring of the level of resident/other instructor participation in activities to enhance their teaching/evaluation skills.
The LCME encourages formal assessment of the teaching and evaluation skills of residents and other non-faculty instructors, with opportunities provided for remediation if their performance is inadequate.
From www.lcme.org
ED-24
Implementation of ED-24
ED-24 implementation is a shared responsibility of: Faculty Undergraduate Medical Education office Faculty Postgraduate Medical Education office Department of Surgery Undergraduate program The surgical residency and fellowship programs The surgery residents and fellows
ED-24
ED-24 - Implementation
In the Department of Surgery, ED-24 must be implemented across: 24 clerkship rotations at seven sites six Royal College primary residency programs two Royal College fellowship programs and ~ 10 other fellowship programs.
ED-24
The Surgery Resident's Role in Teaching Medical Students
CanMEDS Scholar Role
Physicians...facilitate the learning of ...students... Describe principles of learning relevant to medical education
Collaboratively identify the learning needs and desired learning outcomes of others
Select effective teaching strategies and content to facilitate others' training
Demonstrate an effective lecture or presentation
Assess and reflect on a teaching encounter
Provide effective feedback
Describe the principles of ethics with respect to teaching
ED-24From http://rcpsc.medical.org
Three Types of Teaching Responsibilities
Service- or rotation-based teaching Ex. supervising a clerk rotating on your service
Formal teaching sessions assigned by service or residency program Ex. presenting at service rounds or grand rounds to
an audience that includes medical students Formal teaching sessions assigned by
Department of Surgery Education Office Ex. teaching knot-tying or the breast examination
to medical students
Service- or Rotation-Based Teaching
Patient-centered, ward-based, often informal Daily opportunity for teaching Clerkship objectives are available for each
rotation – residents must read these objectives Residents must know their own objectives in
the CanMEDS scholar domain
ED-24
Written Copy of the Course/Clerkship Objectives
Latest versions of the clerkship rotation descriptions are found on the undergraduate webpage for the Department of Surgery
Residents must read the clerkship objectives and rotation information for the general surgery and selective rotations in which they supervise medical students
Feedback and corrections are welcome – please email [email protected]
ED-24
Teaching Assigned by Service or Residency Program
Formal, scheduled sessions Occur weekly or monthly Residents should provide objectives for
academic presentations e.g. objective page on a powerpoint presentation
Objectives can be developed in conjunction with the residents' preceptors
Please keep the students' educational goals in mind.
ED-24
Teaching Assigned by Department of Surgery Education Office
At present, very few teaching sessions assigned to residents, pending development of comprehensive objectives and teaching scripts for each session
In the future, the objectives and the teaching material for all teaching sessions will be available through OPAL, allowing more resident participation
ED-24
Evaluation of Medical Students
MITERs are discussed at mid-point of rotation – formative feedback
FITERs are completed by the attending staff at the end of the rotation – summative feedback
Residents provide feedback on student performance FITERs are divided into cognitive domains similar to
CanMeds Resident feedback is incorporated into the FITER Copy of Surgery Clerkship FITER and MITER
available on Department of Surgery Undergraduate Education webpage
ED-24
Educational Resources
New resident orientation TIPS program Surgery Foundations Seminar Series
One-minute preceptor Giving effective feedback
Faculty development workshops Public-speaking workshop for PGY3s OPAL (Online Portal for Advanced Learning) training
and workshops
ED-24
Feedback on Resident Teaching Performance
Comprehensive online mechanism under development by Faculty of Medicine, implemented via OPAL
Most residency and fellowship programs have a mechanism for providing feedback on resident teaching performance (e.g. paper-based forms, T-Res, WebEval, One45).
The students on service should also provide feedback. Feedback should be collected and reported every 6-12
months to allow anonymity for the student responders.
ED-24
Summary
ED-24
Implementation of ED-24 will require cooperation and coordination among the students, residents, program directors, teaching staff, the Department of Surgery and the Faculty of Medicine
Please review the clerkship objectives and evaluation forms for your rotation, available through the surgery clerskhip webpagewww.umanitoba.ca/faculties/medicine/units/surgery/education/undergrad/rotation/index.html
Feedback and comments - [email protected]