Faculty development for implementation of an EPA-based program

PurposeThe faculties are crucial to education. They should have enough training facilities and be encouraged to actively contribute to high-quality education and successful learning. Faculty engagement and development activities should be explored and included in learning organizations and employee engagement in India. This paper aims to describe higher education as a learning organization. The research will also assess how faculty development programs affect faculty engagement behaviors in these institutions and if professional development mediates this effect, which has not been previously examined.Design/methodology/approachThis study was conducted with quantitative data collected from 267 faculties through reliable and validated adapted questionnaires. Semistructured interviews were conducted with heads and professor-level faculties to gain insights into faculty development and engagement. Partial least squares structural equation modeling technique (PLS-SEM 3.3.6 version) was used to test the conceptually drafted model.FindingsFaculty professional development programs shown to improve higher education faculty engagement and professional progress. The studies also showed that higher education institutions must prioritize faculty development to become learning organizations. Professional development reduced the direct effects of faculty development program (FDP) on faculty engagement. This suggests that professional growth mediates the research.Practical implicationsThis research emphasizes and professional development to boost teacher involvement in B-Schools. Management must design faculty development programs to construct professional development and learning organizations, according to the results. Developing and writing rules that encourage faculty engagement in such internal and external programs would also enhance their academic and administrative abilities and assist higher education institutions become learning organizations.Originality/valueThe study is one of the few to examine the impact of faculty development programs and professional development on faculty engagement in higher education institutions, particularly B-Schools, and its competitive mediating role.

The goal of postgraduate training is the development of competency necessary for independent practice. To achieve this goal, the Accreditation Council for Graduate Medical Education (ACGME) in 2013 implemented the Milestones assessment framework and mandated the development of clinical competency committees (CCCs), tasked with biannual review of evaluation and assessment data of trainees.1 The CCC, which consists of a chair and committee members, plays a critical role in assisting the program director in decision-making regarding resident or fellow advancement through the training period. Importantly, the committee makeup may span junior and senior faculty and include interprofessional representation, thus providing a spectrum of input.1To date, most of the literature regarding CCCs focuses on optimizing CCC function in terms of workflow and decision-making. Best practices for CCC function have been proposed, including use of varied assessment tools, structured meetings, and diverse members.2,3 Other work has outlined strategies for effective group decision-making necessary for CCC function.4–6 Ongoing faculty development has been proposed as an essential component of CCC function, yet little is known about which particular elements are necessary to optimize organization of meetings, decision-making, and to effectively utilize assessment processes.In order for the CCC to optimally operationalize the Milestones for individual learner development, members of the committee require intentional faculty development. This must span multiple domains important for the CCC process, including knowledge of assessment (and the use of the Milestones), understanding of group decision-making, awareness of how biases interplay with these factors, and the effect of their decisions on patient care (Box). While it remains unknown how often and who should develop such faculty development sessions, we would advocate for at least an annual review of these topics given faculty turnover and need to maintain a shared mental model of best practices. Faculty development remains essential for both new and longstanding members, as participants will likely have different levels of understanding of the assessment process and Milestones themselves.2We therefore aim to provide guidance for specific areas of faculty development for CCC members, including strategies for novel approaches to professional development for the committee. This includes: (1) the purpose and structure of the CCC itself; (2) the strategies, strengths, and weaknesses of the assessments employed by the program; and (3) the development of a shared mental model of the Milestones of the relevant specialty. Beyond this, the CCC chair will also need to understand (4) the best practices of an effective group discussion.7Faculty need to understand the purpose of the CCC meetings, which often employ 1 of 2 strategies: problem identification, where the committee focuses on identifying learners who may require additional remediation, or a developmental approach, where the committee discusses all learners to identify next steps for advancement.3 Members also need to understand the process of decision-making, including who will make the recommendations regarding remediation.In addition to understanding the intent of the Milestones, committee members must also be aware of the program's evaluation process (as related to each Milestone). Knowledge of the individual assessment methods and awareness of the data synthesis for each Milestone will improve a shared mental model and ideally minimize differences in individual interpretation of assessment data.6 This will also allow the committee to identify times when the assessment data is difficult to interpret requiring further group discussion.8Committee members should not only understand each of the relevant Milestones but also have a shared model of what a competent trainee looks like at their institution.9 It is evident that competencies are developed differently in different contexts and at different institutions.10 Therefore, a shared mental model is important for each CCC to minimize variation in how each member interprets the same assessment data.Effective committee groups understand the purpose, structure, and process of their work.4 However, sometimes groups encounter incomplete or otherwise difficult to interpret assessment data; therefore, group discussion is needed to draw a conclusion. The chair of the committee needs to lead the discussion and approach how decisions are made transparently. The chair should also be cognizant of the member composition of the group.4 A homogenous group is unlikely to present different views or opinions, which may be necessary in drawing fair conclusions.Additional faculty development topics for the CCC chair may be helpful in maximizing success of the committee. It is incumbent upon the chair to refine their own ability to synthesize feedback as well as interpret and gauge performance in specialty-specific Milestones. General leadership skills, such as how to effectively lead a committee or run a meeting, remain paramount.11,12 It is important for the CCC chair to adapt their mindset from the frame of educator to that of the “educator-leader.” The CCC chair plays a pivotal role in ensuring that the committee functions through fair and informed decision-making processes based on the data and facts, rather than emotional decision-making.Beyond this unique CCC training for the chair and members, all faculty educators must understand the intersection of biases on the assessment process. It is well-known that biases can manifest in a variety of ways through our traditional mechanisms of assessment. For example, in graduate medical education (GME), this has been highlighted in several settings showing differential Milestone achievement based on trainee gender,13–15 as well as gender differences in narrative evaluation.16 Similarly, standardized patient assessments, which are often included in CCC discussions, have highlighted differential findings by gender, race, and ethnicity.17 Knowledge of such biases and the potential ramifications on Milestones ratings, narrative evaluation, remediation referrals, and progression decisions is imperative for faculty development in the CCC process.Faculty development using bias reduction workshops or training, such as those employing the Implicit Association Test, could represent an avenue to initiate discussions,18 as these training programs have shown to be effective in mitigating biased decision-making in other settings.18–20 The potential quantitative and qualitative differences in assessment should be considered in recurring CCC reviews. Additionally, faculty participants should be versed in the potential impact of system-wide and personal biases on trainee assessments. Beyond an individual training level, CCC structure, including the diversity of CCC members, as well as process measures, including program assessment and trends, should be regularly reviewed for biased tendencies.2There are a multitude of topics important in faculty development for CCC chairs and members and implementation often requires novel solutions. One such approach was recently implemented within the MedStar Health GME Consortium in the Baltimore, MD and Washington, DC region, which includes more than 70 ACGME-accredited programs. The consortium conducted a half-day faculty development retreat specifically for CCC chairs. Topics addressed included a primer on evaluation of competence, a panel discussion of CCC best practices (for varied sizes of programs), small group discussions on CCC decision-making processes, and strategies for running effective meetings. The program also allowed for identification of distinct needs for various CCC stakeholders, as outlined in the Table. These sessions allowed for shared knowledge, highlighted knowledge gaps, and identification of distinct faculty training needs for success of CCCs. Such an approach allowed for sharing of best practices, strategies to overcome real or perceived challenges (such as time constraints to effective discussion in larger scale programs), and dissemination of knowledge throughout the sponsoring institution.Overall, the optimal functioning of a CCC requires dedicated faculty time, education, and investment in faculty development. CCCs form a critical component of GME assessment and play a pivotal role in ensuring readiness for independent practice. Given this critical role, we advocate for an appropriate fraction of protected time (or productivity) from clinical or other administrative duties for CCC chairs and similar key leaders to accomplish the important responsibilities of the role.We have highlighted some overarching themes of essential faculty development for CCC success, but recognize that the needs are varied based on role within the CCC, experience level, and size of the program, among other considerations. It is critical to acknowledge differing faculty development needs across levels of experience of faculty (junior versus senior members), as well as the unique training needs of interprofessional members. Additionally, future scholarship is needed to determine the optimal timing, content, and subsequently the impact of such faculty development on CCC processes. We believe that the continued development of expertise for both the CCC chair and its members remain critical to the success of the Milestones assessment system.

To examine the impact of social networks and a two-day faculty development course on clinical supervisors' adoption of an educational innovation. During 2007-2010, 571 residents and 613 clinical supervisors in four specialties in the Netherlands were invited to complete a Web-based questionnaire. Residents rated their clinical supervisors' adoption of an educational innovation, the use of structured and constructive (S&C) feedback. Clinical supervisors self-assessed their adoption of this innovation and rated their communication intensity with other clinical supervisors in their department. For each supervisor, a centrality score was calculated, representing the extent to which the supervisor was connected to departmental colleagues. The authors analyzed the effects of supervisor centrality and participation in a two-day Teach-the-Teacher course on the degree of innovation adoption using hierarchical linear modeling, adjusting for age, gender, and attitude toward the S&C feedback innovation. Respondents included 370 (60%) supervisors and 357 (63%) residents. Although Teach-the-Teacher course participation (n=172; 46.5%) was significantly related to supervisors' self-assessments of adoption (P=.001), it had no effect on residents' assessments of supervisors' adoption (P=.371). Supervisor centrality was significantly related to innovation adoption in both residents' assessments (P=.023) and supervisors' self-assessments (P=.024). A clinical supervisor's social network may be as important as faculty development course participation in determining whether the supervisor adopts an educational innovation. Faculty development initiatives should use faculty members' social networks to improve the adoption of educational innovations and help build and maintain communities of practice.

Keck School of Medicine of the University of Southern California.

The Milestones Development team at the Accreditation Council for Graduate Medical Education (ACGME) has periodically surveyed the graduate medical education (GME) community and volunteers, during and after development of the specialty-specific Milestones 2.0, to check with members of each specialty on the implementation of the new Milestones. As we approached the conclusion of Milestones 2.0 development, it was decided to have broader survey dissemination for all specialties. Although still only 10 questions, 2 major changes were made to the quality assurance feedback questionnaire: (1) It solicited comments and impressions from the approximately 26 000-member email distribution list that receives the ACGME e-communications rather than only those who volunteer to be respondents; and (2) It had a more summative focus meant to be the start of the upcoming program evaluation stage of Milestones, rather than soliciting formative input for any further changes to Milestones 2.0. The survey was open for 6 weeks in the fall of 2022 and resulted in 215 responses, which, after clearing the data of collection errors and detectable duplications, produced 211 valid responses from 27 specialties across the GME community. At the time of distribution, email and survey tracking metrics were not available to produce a meaningful response rate. Respondents provided general descriptions of their specialties and specific roles, their program enrollment, and the membership of their Clinical Competency Committees (CCCs). They were then asked open-ended questions that allowed them to describe any challenges with Milestones 2.0 and to make suggestions for the program as a whole. The intent of this 10-item questionnaire was to collect data that will direct conversations on change and help guide this first step, as well as further program evaluation projects that explore the relationships between Milestones and the GME community. The results of the qualitative analysis of this questionnaire are based on those who chose to respond to the ACGME e-communication request for feedback. The subsequent findings should not be generalized to the GME community or be made to represent thoughts or reactions of any subpopulation therein.Of 211 valid responses, roughly half (n=105, 49.8%) identified as program directors (Table 1) from a dropdown list of options (Question [Q]3), and 46 (21.8%) indicated that they were their CCC chair (Q4). The most represented ACGME core specialties (Q1) were internal medicine (n=46, 21.8%), family medicine (n=35, 16.6%), pediatrics (n=24, 11.4%), and surgery (n=17, 8.1%). Additionally, 80 (37.9%) respondents self-identified a subspecialty (Q2) in the open text question following the specialty question.The responses to (Q5) “Indicate the number of residents or fellows you are currently assessing in your program using the Milestones” ranged from 2 to 170. This question was asked to obtain an approximate number of residents and fellows being assessed, and it was beyond the purview of this project to check a respondent's accuracy regarding this data point.When asked to describe the roles within their current CCC membership (Q6), 181 (85.8%) of the respondents listed their committee as having a program director, 162 (76.8%) indicated a program coordinator, 161 (76.3%) listed an assistant or associate program director, and 199 (94.3%) specified a core faculty member (Table 2). While the survey question had a “public member” option, no respondents indicated as such.Two open-ended questions guided the major focus of the survey: (Q8) “Indicate any challenges you have experienced with Milestones 2.0, or related concerns,” and (Q9) “What changes or resources would you like to see in the Milestones?” Finally, respondents could self-identify under (Q10) “Enter your email and full name to be notified of future Milestones feedback opportunities,” which produced a list of volunteers for future research projects.Researchers from the Milestones department used emergent, in vivo coding to categorize the open-ended responses describing challenges and providing suggestions. While responses reflected specific and individual experiences, some patterns emerged from similar data during analysis that helped paint a picture of the challenges facing the GME community around Milestones. Guided by a heuristic inquiry methodology, the research team performed the coding in the MAXQDA software (VERBI Software GmbH) to label the open-ended responses and look for the patterns using a constant comparative analysis approach.1 The most prevalent challenges and suggestions are discussed below with exact verbiage lifted from the responses.The first prominent idea uncovered in the response data involved faculty use and interpretation of the Milestones. Particularly, many respondents mentioned faculty not being fully invested in the Milestones as an assessment tool and that faculty may consider the goals of the Milestones as too lofty or unachievable.Another common topic from the data highlighted issues with specific subcompetencies, namely those that measure advocacy or well-being. Some respondents called out a few Milestones that were difficult to observe as well as directly assess, particularly those speaking to system management and the physician role in the health care system. Similarly, there were comments that described the Milestones as being too vague or subjective and too difficult to transfer to the provided scale. One comment stated: “Based on how these are worded many of our residents hit a level 3 at PGY-2 and then stay there despite continuing to improve in their abilities.” (internal medicine)Data also reflected issues with the amount of time required to adequately assess residents and fellows on each Milestones subcomeptency. This may be related to other comments where respondents felt there were too many Milestones to assess or that the Milestones were too long or wordy. “Too many Milestones! Takes way too long to complete them twice a year for all of our residents.” (diagnostic radiology)Some respondents described challenges with transitioning from Milestones 1.0 to 2.0, such as making adjustments to their assessment practices and software tools to reflect the changes. One comment pointed out that it would get easier: “There are some that don't correlate perfectly with the new milestones, so this made tracking resident improvement over time difficult. This should get easier once we use the 2.0 version for all 3 resident years.” (pediatrics)There were also a few respondents who felt as though the Milestones were not applicable to actual clinical practices. For example: “I find the wording of the Milestones 2.0 incredibly hard to apply to real world resident performance.” (internal medicine) and “The verbiage is still extremely convoluted and often does not apply to real life.” (family medicine) Others indicated that the Milestones do not capture the context of the resident's “rotation experience.” (family medicine)Similarly, data from the survey described issues with few opportunities for residents to be assessed or actually observed within specific Milestones contexts. They also spoke of other challenges: “Bias from prior milestone evaluations. Some CCC members may evaluate residents that they have not personally worked with over the past 6 months.” (surgery–surgical oncology) and “Finding ways for residents to achieve, and for us to observe and document, some milestones elements (ex. SBP2, SBP3, PROF1, ICS1), especially those in the upper levels.” (pathology–surgical pathology)There remained some responses that did not fall into a particular pattern or theme but still highlighted concerns worth mentioning:The survey respondents' suggestions were just as varied as their challenges, but some themes were evident. The most prominent area for suggestions centered around the need for clearer applications and more examples for the Milestones levels, either beyond the existing supplemental guidebooks or an updated version of them.Another common thread among the suggested changes was the inclusion of either additional Milestones or a new focus reflected within Milestones. Particularly, these responses spoke to skills development in leadership, teaching, and scholarly activities.Respondents also focused their suggestions on language simplification and applying more realistic language as well as condensing Milestones, making them shorter or even reducing the overall number of them.Another theme identified the need for more faculty development and education that address “goals, changes, and interventions to address failure to progress.” (surgery–acute care surgery) Responses also spoke to the need for evaluation forms that would be easy to use and implement into the learner's record automatically. Some respondents suggested using the Milestones as the assessment tool: “Evaluation tools would be helpful, not just the milestones but also some suggested way to assess. Or just let us use the milestones as assessment tools, because the rubrics are built out well enough now that they could be used as direct assessments.” (anesthesiology)Individual comments spoke to a wide variety of suggestions, such as the following:This survey was developed to collect general, voluntary feedback with only 2 focused questions for challenges and suggestions as an early look informing program evaluation for Milestones. While the data are not representative of any group or subgroup within GME, the broad and organic analysis shows that the GME community feels that the Milestones program should continue its focus on providing a transparent and concise assessment tool that does not overburden faculty, program directors, or the residents and fellows.2-5 The survey results also indicate the need to reiterate the validity of the Milestones assessments in the harmonized competencies as well as in patient care and medical knowledge.6,7 There is evidence supporting more emphasis on developing a concerted effort by faculty and CCCs to utilize the tools and resources that the Milestones program provides. Some survey respondents also expressed the need for Milestones to continue efforts for developing subcompetencies that could integrate with other specialty-specific assessment tools.The Milestones department has already researched and taken steps to provide GME faculty with access to resources, such as guidebooks (Milestones, CCCs, assessment, etc) and faculty development courses,8,9 and currently offers periodic courses to address faculty understanding and usage of the Milestones assessments. The department also has developed supplemental resources and has explained the rigor that goes into developing the validity and reliability of the tools.10 The data also spoke to the importance of keeping current and future resources visible, available, and accessible to the GME community.The ACGME Milestones team would like to thank those who took part in the survey and provided their valuable feedback. The resulting suggestions and conversations will give the Milestones department the foundations to better inform their upcoming evaluation research on the Milestones program. Over the next few years an intensive review of the Milestones will occur. This research will delve into the development process, content, and implementation within programs. Data will be collected through focus groups, interviews, content analyses, and targeted surveys. If you are interested in sharing your opinion, please send an email with your name, specialty, and/or subspecialty to MilestonesQA@acgme.org.

Rutgers Robert Wood Johnson Medical School.

Texas Tech University Health Sciences Center School of Medicine, Lubbock.

Introduction It is my intent in this article to apply recent theoretical developments in adult education to instructional development practice. More specifically, I will use the process of self-directed learning and the theory of transformative learning to reframe the roles that instructional developers adopt in working with faculty. Background Colleges and universities across North America as well as government departments responsible for higher education are increasingly paying attention to the quality of teaching [28]. This growing concern has led to renewed attention to faculty growth and development: how new faculty acquire their teaching skills [4], what higher education administrators can do to foster good teaching [31], the role of evaluation in enhancing effectiveness [12], and practical strategies for the instructional developer [39]. What is particularly encouraging are recent attempts to view instructional development from new perspectives that treat faculty as adult co-learners; for example, Zuber-Skerritt's [41] interest in collaborative research between developers and faculty; Amundsen, Gryspeerdt and Moxness's [1] work with faculty discussion groups; and Lunde and Hartung's [25] Cooperative Program for the Professional Renewal of Faculty. However, Levinson-Rose and Menges's [24] concern of a dozen years ago is still a concern of writers and researchers in faculty development. Upon reviewing the literature from the inception of faculty development programs in the late 1960s until 1980, Levinson-Rose and Menges concluded that most programs provided superficial experiences. They tended to focus on the teaching of specific techniques (constructing tests, preparing course outlines) in a prescriptive format and without consideration of the context of the faculty member's teaching or his or her prior knowledge and experience. The primary evidence of the effectiveness of such strategies was participants' ratings of their satisfaction with the session [24]. It became clear that one fundamental limitation of both practice and research in instructional development was the lack of a coherent and comprehensive theoretical foundation for the field. Institutions interested in the quality of teaching naturally enough followed the common model of establishing a center to support and enhance teaching. Such a center would then be staffed by developers (academic or staff positions) and support personnel. Generally, little formal training was available to such individuals [6]; therefore they relied on available guides and resources emphasizing practical techniques. Their research interests then focused on the evaluation of the effectiveness of their practice. This is not to say that promising theoretical work was not done, but it did tend to be somewhat fragmented, related to single aspects of the field. The intent here is not to provide a comprehensive review of these works; some illustrations should suffice to underline the point being made. Faculty development was linked with career development, drawing on stage theories [7], and with organizational development [21] models. Smith [35] and Smith and Schwartz [36] drew on Argyris and Schon's [2] action theory to devise strategies for helping faculty identify their assumptions about teaching. Brinko [6] used Vygotsky's [38] theory of cognitive development to describe communication between the instructional developer and the faculty member. Several researchers have used cognitive theory as a means of understanding faculty members' knowledge of their subject matter and of their instruction [29, 34]. Each of these aspects of instructional development are important, and the work being done to understand them by drawing on various theories can only be applauded. Yet one is still left with the sense that a more comprehensive theoretical framework would serve to enhance these efforts as well as the work of practitioners in the field. Rationale Faculty are adult learners. …

Clinicians who teach are essential for the health workforce but require faculty development to improve their educational skills. Curricula for faculty development programs are often based on expert frameworks without consideration of the learning priorities as defined by clinical supervisors themselves. We sought to inform these curricula by highlighting clinical supervisors own requirements through answering the research question: what do clinical supervisors identify as relative strengths and areas for improvement in their teaching practice? This mixed methods study employed a modified version of the Maastricht Clinical Teaching Questionnaire (mMCTQ) which included free-text reflections. Descriptive statistics were calculated and content analysis was conducted on textual comments. 481 (49%) of 978 clinical supervisors submitted their mMCTQs and associated reflections for the research study. Clinical supervisors self-identified relatively strong capability with interpersonal skills or attributes and indicated least capability with assisting learners to explore strengths, weaknesses and learning goals. The qualitative category 'establishing relationships' was the most reported strength with 224 responses. The qualitative category 'feedback' was the most reported area for improvement, with 151 responses. Key areas for curricular focus include: improving feedback practices; stimulating reflective and agentic learning; and managing the logistics of a clinical education environment. Clinical supervisors' self-identified needs provide a foundation for designing engaging and relevant faculty development programs.

Valuing the Education Mission: Implementing an Educational Value Units System

Learning how to “teach one”: A needs assessment of the state of faculty development within the Consortium of the American College of Surgeons Accredited Education Institutes

In the Next Accreditation System, resident performance and progression assessed through educational Milestones will be used as 1 of a number of quality indicators to evaluate the educational effectiveness of residency programs. The Anesthesiology Milestones will be used to measure the success of individual anesthesiology residents in achieving expected goals of training, and the effectiveness of the residency program will in part be evaluated based on aggregated Milestone performance data.The members of the Anesthesiology Milestone Working Group were selected by the Residency Review Committee (RRC) for Anesthesiology, with input from the American Board of Anesthesiology (ABA), the Society for Education in Anesthesia, and program directors. The working group included 9 physician anesthesiologists, the executive director of the Anesthesiology RRC, and an Accreditation Council for Graduate Medical Education (ACGME) consultant. Four of the physician members were representatives from the Anesthesiology RRC (1 also served as the designated institutional official of a university-based medical center), 2 were former directors of the ABA, 2 were anesthesiology program directors, and 1 was an anesthesiology resident in the final year of training. An anesthesiologist who did not participate in the development of the Anesthesiology Milestones was appointed to the multidisciplinary expert panel that developed cross-specialty Milestones for interpersonal and communication skills, practice-based learning and improvement, professionalism, and systems-based practice suggested for use by all specialties. Working group members were provided access to Milestone documents developed by several specialties that were a part of the initial stage in Milestone development. These models were used as templates to approach the task of developing anesthesiology-specific Milestones.The Anesthesiology Milestone Working Group held its first face-to-face meeting in February 2012, at which the ACGME consultant, who had experience working with prior Milestone working groups, provided an overview of the approach ACGME envisioned for the development of specialty-specific Milestones and shared lessons learned from Milestone development in the Phase 1 specialties. Based on the ACGME's recommendation that each Milestone should contain 5 levels of assessment (corresponding to the range from beginner to expert), initial discussions focused on determining if Milestone levels could be correlated with levels of residency training (clinical base year, clinical anesthesia years 1–3, and graduation). After recognizing that in their final form the levels would be independent of strictly time-based markers, the group made the decision that each Milestone level would represent expectations at the end of a point on the educational continuum. As a part of that continuum Level 1 Milestones were set as the expectations at the end of clinical base training. Level 2 Milestones were set to represent training expectations at the end of foundational (nonsubspecialty) clinical anesthesia training. Level 3 Milestones were set to represent the expectations for a resident at the midpoint of training after having been exposed to all subspecialty areas within anesthesiology. Level 4 Milestones were set to represent the expectations for a physician ready to practice anesthesiology independently without supervision. Level 5 Milestones were set to represent advanced characteristics of independently practicing physicians and were considered aspirational goals (a few of which might be achieved by a subgroup of exceptional residents during their training).After completion of the first draft of the Anesthesiology Milestones, the committee solicited feedback from members of the Association of Anesthesiology Core Program Directors (AACPD) and the Society for Education in Anesthesiology during their 2012 annual meetings. At the AACPD meeting feedback was provided formally through an audience response system that allowed program directors to respond to questions of relevance, importance, and measurability of each Milestone. Following these meetings, the working group edited the Milestones based upon the feedback received. This revised draft was then distributed to all program directors who were asked to provide constructive feedback through an electronic survey tool allowing confidential, individualized feedback from the program directors to the working group. The feedback was reviewed by the committee and used to make additional modifications to the Anesthesiology Milestones.The working group developed Milestones for each of the 6 ACGME competencies over the course of multiple face-to-face meetings and teleconferences. The patient care and medical knowledge Milestones, which are unique to each specialty, were developed first, and generic Milestones developed by a multispecialty panel were used as a starting point for the development of Milestones for the competencies of interpersonal and communications skills, problem-based learning and improvement, professionalism, and systems-based practice.The working group recognized the potential increase in workload that Milestone evaluation will place on program directors and Clinical Competency Committees (CCCs), and refined the number of Milestones to ensure appropriate assessment of competencies at each level of training, while not making the Milestones so granular that the evaluation process would be too burdensome. In the final version, the number of Milestones was reduced to 25. The working group believed this number provided an appropriate balance between comprehensiveness and practicality. The distribution of the Anesthesiology Milestones across the 6 competencies is shown in the table in this Introduction.While the working group sought input from the anesthesiology educational community to ensure that the Milestones were appropriate for assessing anesthesiology resident progression, the working group also recognized that the value of the proposed Milestones would benefit from an initial assessment using a pilot study in selected programs. A representative group of 20 anesthesiology programs has been selected to participate in the pilot study. The pilot will use the CCC in each program to assess the residents using the current Milestones. An evaluation tool has been developed for the program directors to provide the working group with feedback on each Milestone. The working group anticipates that the current version of the Anesthesiology Milestones will require modification over time as the specialty gains experience with this evaluation process. Once the final version of the Milestones is incorporated into training program evaluation, the RRC and other stakeholders will need to monitor and modify the Milestones based on experience so that they provide meaningful assessment of the residents, allowing anesthesiology training programs to foster excellence and optimize the educational experience for each trainee.The goal of the working group's effort was to produce Milestones that will provide program directors and CCC members with a progressive resident assessment tool that more readily identifies areas of strength and areas in need of improvement for each trainee. As Milestone data is accumulated in a department, the performance of an individual resident can be readily compared to peers and the course of progress of individual residents and residency levels in all 6 competencies domains can be evaluated. In addition, the program will have information about resident performance across the entire residency complement that will allow it to identify areas in which to focus educational efforts.The Next Accreditation System requires that accredited programs appoint CCCs to monitor residents' progress. The CCC is not new to anesthesiology training programs; the ABA has required submission of CCC reports for more than 25 years. The working group recognized that the Milestones represent a different and important approach to assessment of resident performance and progression. Although CCCs have been instrumental in assessing residents in anesthesiology programs, incorporation of Milestones into the assessment process will require modifications of the assessment process, faculty development to understand the Milestones and their implications and changes in the assessment, and communication with residents regarding performance.Based on the addition of Milestones in the assessment process, anesthesiology programs may have to modify the composition of the CCCs to ensure representation of all subspecialties and faculty involved in all levels of training. The ideal size of the CCC will likely vary by program based on the number of residents and faculty in the program. Regardless of the size of the CCC, faculty development will be the cornerstone in the transition to Milestones as a method for assessing clinical performance and progression through training. The working group recognized that as CCCs gain experience with incorporating Milestone assessments into their decisions, modifications of assessment strategies may be required. In addition, some Milestones may be difficult to assess in the traditional clinical environment because of the changing clinical environment and case distribution. Not all residents will be presented with the same clinical case experiences; therefore, a resident may not have an opportunity within the clinical environment to demonstrate some of the characteristics encompassed within the Milestones. The use of simulation, standardized patients, and other nonclinical assessments will likely grow in importance as methods for evaluating resident performance in some areas. The Milestone process will be helpful in assessing resident progression during training and the need for remediation when a resident is not progressing through a Milestone. At the same time, the Milestone process may be helpful in evaluating the effectiveness of and role for these alternative training methods in identifying areas of weakness.The adoption of Milestones in resident assessment will advance the journey toward competency-based graduate medical education that began with the Outcomes Project. Yet with this advance comes additional challenges. Once well-defined Milestones are fully integrated into residency education, it will be necessary to reconcile competency-based end points of training with the variable rate at which Level 4 Milestones will be reached by individual residents. Resolving this dilemma will provide opportunities for innovation in future training paradigms.

Patient care is improved when health-care providers work collaboratively as teams. However, many institutions have not fully embraced these concepts and are not providing sufficient opportunities for their current health-care professional trainees. For institutions to properly educate health-care providers to be practice ready in interprofessional collaboration (IPC) teams upon graduation, faculty training programs are critical. Faculty development efforts in interprofessional education (IPE) must be strategic in their design and implementation, include a dedicated and experienced leadership team, and have adequate financial support. In this paper, the authors describe a faculty development program designed to promote IPE among multiple health-care professions. A three-session interdisciplinary faculty development series was developed, incorporating peer coaching, mentorship, self-directed learning, assignments, and lecture-based presentations as principle learning activities. The major learning objectives of this series were to (1) understand the roles and responsibilities of interdisciplinary team members, (2) identify challenges of an interprofessional approach to patient-centered care, and (3) apply collaborative approaches to the health-care needs of the patient. Strategies to promote active learning opportunities were planned for all three sessions, designed to encourage participants to learn with, about, and from each other to improve health outcomes. Upon completion of the series, participants expressed positive changes in perception of IPE and shared learning but remained divided in opinion of the practicality of working in health-care teams. The authors conclude that designing and implementing an interprofessional faculty development program takes time and is an ever-evolving process, requiring shared vision, commitment, flexibility, and sustained administrative support.

Women's health education is an emerging interdisciplinary field that has recently received national attention. The American Board of Internal Medicine and the American Academy of Family Practice recently have published competencies in women's health for their residents, with increased attention to gynecological and mental health issues. Increasing women's health in the curricula of internal medicine (IM) and family practice (FP) residents will certainly require faculty development among IM and FP teaching faculty. We report a multiinstitution needs assessment among IM and FP teaching faculty for continuing medical education (CME) in multidisciplinary women's health topics. The survey (n = 100) asked whether faculty desired CME in 30 women's health topics. It also requested rates of referral to specialists for breast and menstrual problems and performance of tests commonly carried out in the care of women (e.g., endometrial biopsy, colposcopy, skin biopsy, and sigmoidoscopy) as measures of possible need for CME. Of the 69 respondents, 37% were IM physicians and 63% were FP physicians. Among the 30 women's health topics listed, breast cancer treatment alternatives, infertility for primary care providers, cervical dysplasia, medical treatment in pregnancy, vulvar disease, indications for pelvic ultrasound/endometrial biopsy, and menstrual disorders were of highest interest. The ranking of desirability of topics by IM and FP faculty correlated by .54 (Spearman rank, df = 28, p < 0.01). Analysis of variance revealed a significantly higher interest overall by IM than FP physicians, 58% vs. 42% (F = 4.1, df = 1, 50, p < 0.05). None of the IM teaching faculty performed endometrial biopsy or colposcopy compared with 57% of FP physicians, and only 12.5% of internists performed skin biopsy and sigmoidoscopy compared with 70% of FP physicians (F = 33, df = 1, 38, p < 0.001). We conclude that faculty development in women's health would benefit resident training in IM and FP, and topics of interest are identifiable. The correlation in interests between the IM and FP teaching faculty might make joint programs successful, although gynecological skills and knowledge clearly are needed more by IM teaching faculty. Obstetrics and gynecology (OB/GYN) faculty could be instrumental in improving women's health education among their IM and FP colleagues.

Objective: To explore students’ perceptions of how they utilize their self-directed learning skills to identify their own learning deficiencies. Methodology: This exploratory qualitative study, conducted from September 2022 to May 2023 used Kolb's Experiential Learning as a theoretical framework. Ten individual interviews of dental students were conducted at Baqai Dental College. The interviews were recorded using Audacity and transcribed, and the data were then explored using Braun and Clarke's Thematic Analysis. Results: This study reveals four themes about the perceptions of dental students on utilizing their self-directed learning skills. The four themes include learning by discovery, motivation and accountability, perceived challenges and benefits, and integration of knowledge, suggesting how students apply their self-directed learning to address their learning gaps and how facilitators can redirect students' potential to lifelong learning. Conclusion: This study has provided an understanding of how students use their self-directed learning abilities to identify their learning deficiencies. Integrating structured self-directed learning, personal development plans, and CPD opportunities into curricula, along with faculty development and technological support, can enhance student autonomy and skill development. Future studies should compare educational settings to identify best practices for optimizing learning outcomes.