Building the Plane As We Fly It

Iobst, William

doi:10.4300/jgme-d-15-00095.1

Cited by 4 publications

(6 citation statements)

References 15 publications

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“…Indeed, early efforts in the shift to milestones have been likened to ''building a plane in flight.'' 12,13 Like previous work, this study underscores the importance of clear guidance when implementing a complex service intervention, such as a CBME program. 7,8,27 Many challenges program leaders described are not unique to milestones and relate to both CBME and assessment.…”

Section: Challenges Persistsupporting

confidence: 64%

“…Program leaders experienced less success when they attempted to work the verbatim milestones language into assessment instruments, which is not consistent with the intended use of the milestones. 12,13 This provides another caution against using milestones verbatim for frontline assessment purposes. Program leaders also perceived easier success when they already had a CCC-like structure in place to support change.…”

Section: Adaptation Has Occurredmentioning

confidence: 99%

“…32 This allowed these programs to provide more guidance to residents, including a roadmap for their development, which has been described as a benefit in multiple specialties to date. 13,33 Program leaders also saw the potential that milestones offer increased transparency to learners. They felt that milestones fostered a better shared understanding and common language with learners about where they are on the path to unsupervised practice and specific areas that may require attention.…”

Section: Challenges Persistmentioning

confidence: 99%

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Rising to the Challenge: Residency Programs' Experience With Implementing Milestones-Based Assessment

Dzara

Huth

Kesselheim

et al. 2019

Journal of Graduate Medical Education

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Background Changes to assessment efforts following the shift to milestones-based assessment in the ACGME Next Accreditation System have not been fully characterized.Objective This study describes themes in initial milestones-based assessment practices with the goal of informing continued implementation and optimization of milestones-based assessment.Methods Semistructured interviews were conducted with 15 residency program leaders in 6 specialties at 8 academic medical centers between August and December 2016. We explored what was retained, what was added, and what was changed from premilestones assessment efforts. We also examined the perceived impact of the shift to milestones-based assessment on the programs. Thematic analysis began after the first 5 interviews and ended once thematic sufficiency was reached. Two additional authors reviewed the codes, offered critical input, and informed the formation and naming of the final themes.Results Three themes were identified: (1) program leaders faced challenges to effective implementation; (2) program leaders focused on adaptability and making milestones work in what felt like a less than ideal situation for them; and (3) despite challenges, program leaders see value and utility in their efforts to move to milestones-based assessment. We describe a number of strategies that worked for programs during the transition, with perceived benefits acknowledged.Conclusions While adaptation to milestones has occurred and benefits are noted, negative impacts and challenges (eg, perceived lack of implementation guidance and faculty development resources) persist. There are important lessons learned (eg, utilizing implementation experiences formatively to improve curricula and assessment) in the transition to milestones-based assessment.

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Section: Challenges Persistsupporting

confidence: 64%

Section: Adaptation Has Occurredmentioning

confidence: 99%

Section: Challenges Persistmentioning

confidence: 99%

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Rising to the Challenge: Residency Programs' Experience With Implementing Milestones-Based Assessment

Dzara

Huth

Kesselheim

et al. 2019

Journal of Graduate Medical Education

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“…32 We agree that the distinction between formative and summative lies in the purpose or intended use of assessments as reflected in contemporary CBME vernacular, which has shifted away from “formative/summative” toward “assessment for learning” and “assessment of learning,” respectively. 11,14,33–36 The oft-emphasized of/for distinction draws a contrast in intent, and hence purpose.…”

Section: Purpose: From “Formative” To “Summative”mentioning

confidence: 99%

Entrustment Unpacked: Aligning Purposes, Stakes, and Processes to Enhance Learner Assessment

et al. 2021

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Educators use entrustment, a common framework in competency-based medical education, in multiple ways, including frontline assessment instruments, learner feedback tools, and group decision making within promotions or competence committees. Within these multiple contexts, entrustment decisions can vary in purpose (i.e., intended use), stakes (i.e., perceived risk or consequences), and process (i.e., how entrustment is rendered). Each of these characteristics can be conceptualized as having 2 distinct poles: (1) purpose has formative and summative, (2) stakes has low and high, and (3) process has ad hoc and structured. For each characteristic, entrustment decisions often do not fall squarely at one pole or the other, but rather lie somewhere along a spectrum. While distinct, these continua can, and sometimes should, influence one another, and can be manipulated to optimally integrate entrustment within a program of assessment. In this article, the authors describe each of these continua and depict how key alignments between them can help optimize value when using entrustment in programmatic assessment within competency-based medical education. As they think through these continua, the authors will begin and end with a case study to demonstrate the practical application as it might occur in the clinical learning environment.

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“…A baseline skill set is necessary, but it is important to move quickly from this to continuing to build that skill set while actually engaging in efforts to make improvements. This approach is akin to the implementation of ACGME milestones, where it has been suggested that the plane is being built in flight ( 10 , 11 ). Despite this perhaps less-than-ideal approach, the early improvements in assessment practices, outcomes, and scholarship that the Milestone project has spearheaded have been exceptionally noteworthy ( 12 – 14 ).…”

Section: When Peripheral Participation Is Not Legitimate: Optimizing mentioning

confidence: 99%

Patient safety and quality improvement: a ‘CLER’ time to move beyond peripheral participation

Schumacher

Frohna

2016

Medical Education Online

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In the United States, the Accreditation Council for Graduate Medical Education (ACGME) has instituted a new program, the Clinical Learning Environment Review (CLER), that places focus in six important areas of the resident and fellow working and learning environment. Two of these areas are patient safety and quality improvement (QI). In their early CLER reviews of institutions housing ACGME-accredited training programs, ACGME has found that despite significant progress in patient safety and QI to date much work remains, especially when it comes to meaningful engagement of medical trainees in this work. In this article, the authors argue that peripheral involvement of trainees in patient safety and QI work does not allow the experiential learning that is necessary for professional development and the ultimate ability to execute performance that meets the needs of patients in contemporary clinical practice. Rather, as leaders in patient safety and QI have advocated since early in this movement, embedded and immersed experiences are necessary for learning and success.

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Building the Plane As We Fly It

Cited by 4 publications

References 15 publications

Rising to the Challenge: Residency Programs' Experience With Implementing Milestones-Based Assessment

Rising to the Challenge: Residency Programs' Experience With Implementing Milestones-Based Assessment

Entrustment Unpacked: Aligning Purposes, Stakes, and Processes to Enhance Learner Assessment

Patient safety and quality improvement: a ‘CLER’ time to move beyond peripheral participation

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