Advances in the field of academic medicine

Recent papers by OHSU School of Medicine faculty and staff

June 14, 2015

Since fall 2015, 19 OHSU School of Medicine faculty, trainees and staff have co-written new papers published in Academic Medicine, the journal serving as a global forum for academic medicine to advance knowledge and discuss issues facing the community.

These co-authors join OHSU colleagues and other academic health center peers as contributors to a global knowledge base for best practices in health care education. This educational research is an important aspect of fulfilling OHSU's mission of educating the next generation of scientists and health care professionals.

The papers often represent a multi-institutional scientific collaboration; the entire team may not be listed here.

Below are synopses with OHSU authors noted; for full papers and complete author listings, please view the Ovid links below.

Have you or will you publish in Academic Medicine? Please abstracts.

Academic Medicine Jan 2016Creating a Cadre of Fellowship-Trained Medical Educators: A Qualitative Study of Faculty Development Program Leaders' Perspectives and Advice.

OHSU co-author: Lalena M. Yarris, M.D., MCR, associate professor of emergency medicine
Publication date: January 2016

PURPOSE: Well-trained educators fill essential roles across the medical education continuum. Some medical schools offer programs for existing faculty to enhance teaching and scholarship. No standard postgraduate training model exists for residency graduates to attain competency as faculty members before their first academic appointment. The objective of this study is to inform the development of postgraduate medical education fellowships by exploring perceptions of educational leaders who direct well-established faculty development programs.

CONCLUSIONS: Medical education fellowships cultivate leaders and communities of trained educators but require participants to balance faculty responsibilities with professional development. Advice of current directors can inform the development of postgraduate programs modeled after accredited clinical specialty fellowships. Programs with the support of strategic partners, financial stability, and well-defined goals may allow new faculty to begin their careers with existing competency in medical education skills.


Academic Medicine Feb 2016

The Creation of Standard-Setting Videos to Support Faculty Observations of Learner Performance and Entrustment Decisions.
OHSU co-author: A.J. Starmer, M.D., volunteer affiliate professor of pediatrics
Publication date: February 2016

Purpose: Entrustable professional activities (EPAs) provide a framework to standardize medical education outcomes and advance competency-based assessment. Direct observation of performance plays a central role in entrustment decisions;however, data obtained from these observations are often insufficient to draw valid high-stakes conclusions. One approach to enhancing the reliability and validity of these assessments is to create videos that establish performance standards to train faculty observers. Little is known about how to create videos that can serve as standards for assessment of EPAs.The authors report their experience developing videos that represent five levels of performance for an EPA for patient handoffs. The authors describe a process that begins with mapping the EPA to the critical competencies needed to make an entrustment decision. Each competency is then defined by five milestones (behavioral descriptors of performance at five advancing levels). Integration of the milestones at each level across competencies enabled the creation of clinical vignettes that were converted into video scripts and ultimately videos. Each video represented a performance standard from novice to expert. The process included multiple assessments by experts to guide iterative improvements, provide evidence of content validity, and ensure that the authors successfully translated behavioral descriptions and vignettes into videos that represented the intended performance level for a learner. The steps outlined are generalizable to other EPAs, serving as a guide for others to develop videos to train faculty. This process provides the level of content validity evidence necessary to support using videos as standards for high-stakes entrustment decisions.


Academic Medicine March 2016Building a Framework of Entrustable Professional Activities, Supported by Competencies and Milestones, to Bridge the Educational Continuum.

OHSU co-author: Joseph Gilhooly, M.D., adjunct professor of pediatrics
Publication date: March 2016

ABSTRACT: The transition to competency-based medical education (CBME) and adoption of the foundational domains of competence by the Accreditation Council for Graduate Medical Education, Association of American Medical Colleges (AAMC), and American Board of Medical Specialties' certification and maintenance of certification (MOC) programs provided an unprecedented opportunity for the pediatrics community to create a model of learning and assessment across the continuum. Two frameworks for assessment in CBME have been promoted: (1) entrustable professional activities (EPAs) and (2) milestones that define a developmental trajectory for individual competencies. EPAs are observable and measureable units of work that can be mapped to competencies and milestones critical to performing them safely and effectively. The pediatrics community integrated the two frameworks to create a potential pathway of learning and assessment across the continuum from undergraduate medical education (UME) to graduate medical education (GME) and from GME to practice. The authors briefly describe the evolution of the Pediatrics Milestone Project and the process for identifying EPAs for the specialty and subspecialties of pediatrics. The method of integrating EPAs with competencies and milestones through a mapping process is discussed, and an example is provided. The authors illustrate the alignment of the AAMC's Core EPAs for Entering Residency with the general pediatrics EPAs and, in turn, the alignment of the latter with the subspecialty EPAs, thus helping build the bridge between UME and GME. The authors propose how assessment in GME, based on EPAs and milestones, can guide MOC to complete the bridge across the education continuum.


A Model for Catalyzing Educational and Clinical Transformation in Primary Care: Outcomes From a Partnership Among Family Medicine, Internal Medicine, and Pediatrics.

OHSU co-authors: M. Patrice Eiff, M.D., professor of family medicine; Rose Harding; Eve Dexter, M.S.; Miguel Marino, Ph.D., assistant professor of family medicine; Patricia A. Carney, Ph.D., professor of family medicine
Publication date: March 2016

PURPOSE: To report findings from a national effort initiated by three primary care certifying boards to catalyze change in primary care training.

CONCLUSIONS: Results suggest that improvements in faculty perceptions of confidence and skills occurred and that the creation of interdisciplinary learning communities catalyzed transformation. Lengthening the intervention period, engaging other professions involved in training the primary care workforce, and a more discriminating evaluation design are needed to scale this model nationally.


Academic Medicine April 2016A Novel Specialty-Specific, Collaborative Faculty Development Opportunity in Education Research: Program Evaluation at Five Years.

OHSU co-author: Lalena M. Yarris, M.D., MCR, associate professor of emergency medicine
Publication date: April 2016

PURPOSE: For the busy clinician-educator, accessing opportunities that develop the skills and knowledge necessary to perform education research can be problematic. The Medical Education Research Certification at Council of Emergency Medicine Residency Directors (MERC at CORD) Scholars' Program is a potential alternative. The current study evaluates the program's outcomes after five years.

CONCLUSIONS: Kirkpatrick-level outcomes 1, 2, 3, and perhaps 4 demonstrate that the MERC at CORD program is successful in its intended purpose.


Health Systems Science Curricula in Undergraduate Medical Education: Identifying and Defining a Potential Curricular Framework.

OHSU co-author: Patrick Brunett, M.D., clinical professor of emergency medicine
Publication date: April 2016

PURPOSE: The authors performed a review of 30 Accelerating Change in Medical Education full grant submissions and an analysis of the health systems science (HSS)-related curricula at the 11 grant recipient schools to develop a potential comprehensive HSS curricular framework with domains and subcategories.

CONCLUSIONS: This broad framework aims to build on the traditional definition of systems-based practice and highlight the need for medical and other health professions schools to better align education programs with the anticipated needs of the systems in which students will practice. HSS will require a critical investigation into existing curricula to determine the most efficient methods for integration with the basic and clinical sciences.


Academic Medicine May 2016Tools to Assess Behavioral and Social Science Competencies in Medical Education: A Systematic Review.

OHSU co-author: Patricia A. Carney, Ph.D., professor of family medicine; Ryan T. Palmer, Ed.D., assistant professor of family medicine; Marissa Fuqua Miller; Erin K. Thayer; Frances E. Biagioli, M.D., professor of family medicine; William J. Hatt
Publication date: May 2016

PURPOSE: Behavioral and social science (BSS) competencies are needed to provide quality health care, but psychometrically validated measures to assess these competencies are difficult to find. Moreover, they have not been mapped to existing frameworks, like those from the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME). This systematic review aimed to identify and evaluate the quality of assessment tools used to measure BSS competencies.

CONCLUSIONS: These findings serve as a valuable resource for medical educators and researchers. More rigorous measurement validation and testing and more robust study designs are needed to understand how educational strategies contribute to BSS competency development.


Role Modeling and Regional Health Care Intensity: U.S. Medical Student Attitudes Toward and Experiences With Cost-Conscious Care.

OHSU co-author:
Patricia A. Carney, Ph.D., professor of family medicine
Publication date: May 2016

PURPOSE: To examine medical student attitudes toward cost-conscious care and whether regional health care intensity is associated with reported exposure to physician role-modeling behaviors related to cost-conscious care.

CONCLUSIONS: Medical students endorse barriers to cost-conscious care and encounter conflicting role-modeling behaviors, which are related to regional health care intensity. Enhancing role modeling in the learning environment may help prepare future physicians to address health care costs.


Quality of Care Provided by Board-Certified Versus Non-Board-Certified Psychiatrists and Neurologists.

OHSU co-author: Bentson H. McFarland, M.D., Ph.D., emeritus professor of psychiatry
Publication date: May 2016

PURPOSE: To examine associations between board certification of psychiatrists and neurologists and quality-of-care measures, using multilevel models controlling for physician and patient characteristics, and to assess feasibility of linking physician information with patient records to construct quality measures from electronic claims data.

CONCLUSIONS: The authors demonstrated the feasibility of linking physician information with patient records to construct quality measures from electronic claims data, but there may be only minimal differences in the quality of care between BC and nBC psychiatrists and neurologists, or there may be a difference that could not be measured with the quality measures used.


Gender Differences in Publication Productivity, Academic Rank, and Career Duration Among U.S. Academic Gastroenterology Faculty.

OHSU co-author: Sarah J. Diamond, M.D., assistant professor of medicine; Charles R. Thomas, Jr., M.D., professor of radiation medicine; Sima Desai, M.D., associate professor of medicine; Brintha K. Enestvedt, M.D., MBA, assistant professor of medicine
Publication date: May 2016

PURPOSE: Female representation in academic medicine is increasing without proportional increases in female representation at senior ranks. The purpose of this study is to describe the gender representation in academic gastroenterology (GI) and compare publication productivity, academic rank, and career duration between male and female gastroenterologists.

CONCLUSIONS: A gender gap exists in the number and proportion of women in academic GI;however, after correcting for career duration, productivity measures that consider quantity and impact are similar for male and female faculty. Women holding senior faculty positions are equally productive as their male counterparts. Early and continued career mentorship will likely lead to continued increases in the rise of women in academic rank.