How Does TIMELESS Training Impact Resident Motivation for Learning, Assessment, and Feedback? Evaluating a Competency-Based Time-Variable Training Pilot

Abstract

Purpose As competency-based medical education has become the predominant graduate medical education training model, interest in time-variable training has grown. Despite multiple competency-based time-variable training (CBTVT) pilots ongoing in the United States, little is known about how this training approach impacts learners. The authors aim to explore how their CBTVT pilot program impacted resident motivation for learning, assessment, and feedback. Method The authors performed a qualitative educational case study on the Transitioning in Internal Medicine Education Leveraging Entrustment Scores Synthesis (TIMELESS) program at the University of Cincinnati from October 2020 through March 2022. Semistructured interviews were conducted with TIMELESS residents (n = 9) approximately every 6 months to capture experiences over time. The authors used inductive thematic analysis to develop themes and compared their findings with existing theories of learner motivation. Results The authors developed 2 themes: TIMELESS had variable effects on residents’ motivation for learning and TIMELESS increased resident engagement with and awareness of the program of assessment. Participants reported increased motivation to learn and seek assessment, though some felt a tension between performance (e.g., advancement through the residency program) and growth (e.g., improvement as a physician). Participants became more aware of the quality of assessments they received, in part due to TIMELESS increasing the perceived stakes of assessment, and reported being more deliberate when assessing other residents. Conclusions Resident motivation for learning, assessment, and feedback was impacted in ways that the authors contextualize using current theories of learner motivation (i.e., goal orientation theory and attribution theory). Future research should investigate how interventions, such as coaching, guided learner reflection, or various CBTVT implementation strategies, can help keep learners oriented toward mastery learning rather than toward performance.

Using Theory-Informed Group Processes to Make TIMELESS Promotion Decisions

“…Not every pilot resident contributed to each time period; for example, some residents entered TIMELESS in PGY-2 or PGY-3, while others did not reach PGY-3 during the pilot period. As previously reported, 54 56% (n = 5) of the 9 TIMELESS residents were promoted early (2 PGY-1 residents to indirect supervision and 3 PGY-3 residents to unsupervised practice).…”

Competency-Based Time-Variable Anesthesiology Residency Training: Identification of Problems and Solutions

“…5,13,26,27 A small qualitative case study on a pilot CB-TVT at a single program in internal medicine found that residents increased feedback seeking and were more aware of the amount and quality of direct observation feedback they received and its clear connection to promotion, thus increasing the stakes of assessments. 13 The residents, however, also reported feeling a misalignment of goals between performance (defined as advancement through the residency program) and their growth (defined as their improvement as a physician). This study depended on subjective responses from residents and faculty, which may make it difficult to generalize.…”

“…10,11 In GME, several pilots of CB-TVT are being conducted including the Education in Pediatrics Across the Continuum (EPAC) pilot, the TIMELESS pilot in internal medicine, and a newly formed Consortium for competency-based medical education (CBME) in plastic surgery. [12][13][14] In August of 2022, the ACGME and the American Board of Medical Specialties (ABMS) held a joint summit and invited residency review committee (RRC) members, specialty board members, and key GME leaders from all specialties. At the summit, they encouraged member boards and RRCs to consider the implications of CB-TVT and to consider what changes would need to be made in program requirements or policies and procedures to implement CB-TVT.…”

“…10,11 In GME, several pilots of CB-TVT are being conducted including the Education in Pediatrics Across the Continuum (EPAC) pilot, the TIMELESS pilot in internal medicine, and a newly formed Consortium for competency-based medical education (CBME) in plastic surgery. 12–14…”

Josiah Macy Jr. Foundation Conference on Ensuring Fairness in Medical Education Assessment: Conference Recommendations Report

“…In “Reconstructing Neurath’s Ship: A Case Study in Re-evaluating Equity in a Program of Assessment,” 9 the authors describe efforts to evaluate and enable equity in assessment within the internal medicine residency program at the University of Cincinnati. They consider equity in assessment through 3 different epistemological lenses: postpositivist, constructivist, and critical.…”