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Curriculum, Medical education, Graduate medical education, Emergency medicine, IntroductionIn 2013, the Accreditation Council for Graduate Medical Education (ACGME) implemented its Next Accreditation System (NAS) that requires semiannual evaluation of the milestones that are expected of residents throughout their training ( 1,). This move was due in part to shifting attitudes regarding medical education, specifically moving towards an outcome-driven system of evaluating success ( 2,). For Emergency Medicine (EM), the American Board of Emergency Medicine describes 23 sub-competencies with milestones that range from level 1 (expected of an incoming resident/intern) to level 5 (exceptional residents that demonstrate abilities of an attending).&,nbsp Since implementation of NAS, studies of incoming interns have found that many fall short of meeting level 1 milestones ( 3,- 4,).&,nbsp Santen et al. previously surveyed EM interns across the United States and reported up to 39% of interns reported never receiving instruction on certain milestones ( 3,). Additionally, a previous observational study on incoming EM interns found a wide variability ranging from 48-93% competency in the milestones assessed ( 4,). Challenges in implementing competency-based medical education such as NAS include barriers to creating curricula that individualize learning plans and inconsistent assessment of milestones ( 5,). To our knowledge, there have not yet been studies on introducing a milestones-based curriculum in the pre-clinical years, typically the first and second year of traditional medical school curricula. Here, we describe a curriculum developed for medical students to introduce milestones prior to entering the residency stage. This study took place at a medical school with a robust ultrasound curriculum that showed success in early integration and longitudinal development of ultrasound skills throughout medical school ( 7,- 8,). We sought to determine the effects that a pre-clinical Emergency Medicine Interest Group (EMIG) Milestones Elective would have on preparing students interested in EM as a specialty to meet the level 1 milestones prior to graduating medical school.The EMIG Milestones Elective&,rsquo s objective was to prepare the students who complete the elective to meet 19 of the 23 level 1 milestones (4 were omitted, as they are better suited for MS3 and MS4 years in a clinical setting). As a result of the study, we sought to determine the effect, if any, that the elective had on 1) preparing students to meet milestone expectations, and 2) impacting the level of interest expressed by the student in pursuing Emergency Medicine as a specialty. Additionally, the results of the survey would allow us to identify parts of the curriculum to improve for future years. Here, we report significant increases in self-reported preparedness for meeting the majority of the level 1 milestones included in the study.&,nbsp MethodsThis study was reviewed by the Institutional Review Board and classified as exempt with a waived requirement for signed informed consent. A Study Information Sheet was provided to students via email and on the first page of the electronic survey with response buttons to indicate consent. Students were allowed to participate in the elective regardless of participation in our study without penalty.&,nbsp There were 23 sub-competencies outlined by the ACGME. Four of the 23 were omitted in designing the curriculum because they were better suited for third- and fourth-year training. The four omitted sub-competencies were PC8 multi-tasking, SBP1 patient safety, SBP3 technology, and PROF2 accountability as these are better taught in a clinical setting during the third- and fourth-year medical school training. The decision to omit these sub-competencies was made by the elective coordinator with guidance from the faculty advisor who was also associate residency program director at the time and well-versed in milestone requirements and residency education. The remaining 19 sub-competencies were more broadly categorized into 6 competencies based on ACGME guidelines, patient care, medical knowledge, system-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills. The 19 level 1 milestones are outlined in Table 1,. Data regarding competencies 5 and 6 were combined in our analysis due to the similarity in competency features.&,nbsp CompetencySub-competencyLevel 1 Milestone1, Patient CarePC1, Emergency stabilizationRecognizes abnormal vital signs. PC2, Performance of focused H&,amp PPerforms and communicates a reliable, comprehensive history and physical exam. PC3, Diagnostic studiesDetermines the necessity of diagnostic studies. PC4, DiagnosisConstructs a list of potential diagnoses based on chief complaint and initial assessment. PC5, PharmacotherapyKnows the different classifications of pharmacologic agents and their mechanism of action. Consistently asks patients for drug allergies. PC6, Observation and reassessmentRecognizes the need for patient re-evaluation. PC7, DispositionDescribes basic resources available for care of the emergency department patient. PC8, Multi-taskingManages a single patient amidst distractionsa PC9, General approach to proceduresIdentifies pertinent anatomy and physiology for a specific procedure. Uses appropriate Universal Precautions.&,nbsp PC10, Airway managementDescribes upper airway anatomy. Performs basic airway maneuvers or adjuncts (jaw thrust/chin lift/oral airway/nasopharyngeal airway) and ventilates/oxygenates patient using BVM. PC11, Anesthesia and acute pain managementDiscusses with the patient indications, contraindications and possible complications of local anesthesia. Performs local anesthesia using appropriate doses of local anesthetic and appropriate technique to provide skin to sub-dermal anesthesia for procedures. PC12, Other diagnostic and therapeutic procedures, Goal-directed Focused UltrasoundDescribes the indications for emergency ultrasound. PC13, Other diagnostics and therapeutic procedures, Wound managementPrepares a simple wound for suturing (identify appropriate suture material, anesthetize wound and irrigate). Demonstrates sterile technique Places a simple interrupted suture. PC14, Other diagnostics and therapeutic procedures, Vascular accessPerforms a venipuncture. Places a peripheral intravenous line Performs an arterial puncture.2, Medical KnowledgeMK, Medical knowledgePasses initial national licensing examinations (e.g., USMLE Step 1 and Step 2 or COMLEX Level 1 and Level 2).3, System Based PracticeSBP1, Patient safetyAdheres to standards for maintenance of a safe working environment Describes medical errors and adverse eventsa. SBP2, Systems based managementDescribes members of ED team (e.g., nurses, technicians, and security). SBP3, TechnologyUses the Electronic Health Record (EHR) to order tests, medications and document notes, and respond to alerts Reviews medications for patientsa.4, Practice Based Learning and ImprovementPBLI, Practice-based performance improvementDescribes basic principles of evidence-based medicine.5, ProfessionalismPROF1, Professional valuesDemonstrates behavior that conveys caring, honesty, genuine interest and tolerance when interacting with a diverse population of patients and families. PROF2, AccountabilityDemonstrates basic professional responsibilities such as timely reporting for duty, appropriate dress/grooming, rested and ready to work, delivery of patient care as a functional physician. Maintains patient confidentially. Uses social media ethically and responsibly Adheres to professional responsibilities, such as conference attendance, timely chart completion, duty hour reporting, and procedure reportinga.6, Interpersonal and Communication SkillsICS1, Patient centered communicationEstablishes rapport with and demonstrate empathy toward patients and their families. Listens effectively to patients and their families.ICS2, Team managementParticipates as a member of a patient care team. EMIG, Emergency Medicine Interest Group ACGME, Accreditation Council for Graduate Medical Education |
| نویسندگان مقاله |
CHRISTINA Y. CANTWELL |
University of California Irvine Medical Center, Department of Emergency Medicine, 101 The City Drive South, Orange, CA 92868, USA
JONATHAN B. LEE |
University of California Irvine Medical Center, Department of Emergency Medicine, 101 The City Drive South, Orange, CA 92868, USA
SOHEIL SAADAT |
University of California Irvine Medical Center, Department of Emergency Medicine, 101 The City Drive South, Orange, CA 92868, USA
NICHOLAS BOVE |
University of California Irvine Medical Center, Department of Emergency Medicine, 101 The City Drive South, Orange, CA 92868, USA
SANGEETA SAKARIA |
University of California Irvine Medical Center, Department of Emergency Medicine, 101 The City Drive South, Orange, CA 92868, USA
WARREN WIECHMANN |
University of California Irvine Medical Center, Department of Emergency Medicine, 101 The City Drive South, Orange, CA 92868, USA
ALISA WRAY |
University of California Irvine Medical Center, Department of Emergency Medicine, 101 The City Drive South, Orange, CA 92868, USA
SHANNON TOOHEY |
University of California Irvine Medical Center, Department of Emergency Medicine, 101 The City Drive South, Orange, CA 92868, USA
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