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 surgundergrad@hsc.mb.ca

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 - surgundergrad@hsc.mb.ca