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Implementing Milestones: Historical context, competency based medical education, and outcomes. August 6, 2013 Felix Ankel, MD. http://www.youtube.com/watch?v=Qy1dpLmJTrY&feature=related. All,

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Implementing Milestones: Historical context, competency based medical education, and outcomes


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    1. Implementing Milestones:Historical context, competency based medical education, and outcomes August 6, 2013 Felix Ankel, MD

    2. http://www.youtube.com/watch?v=Qy1dpLmJTrY&feature=related

    3. All, • We recently had a case where an intern, when asked by the nurse taking care of a patient with a NSTEMI, said it was okay for the patient to go to the bathroom off monitor. You guessed it; the patient subsequently was found in arrest in the bathroom. In our reactionary culture, some of our faculty are advocating for all decisions to go through the 3rd year resident and to make sure the intern doesn’t make decisions that adversly affect patient care. So, the questions for the collective: • Do you have a formal statement about what interns are allowed to do? • If not formally, do you have a process of what interns are allowed to do? • Are the nurses the “determiners” of who to go to?

    4. www.wordle.net

    5. Macrotrends Hierarachies Networks Individual Experts Wisdom of crowds Knowledge Competency Carrots and Sticks Autonomy, Mastery, Purpose Function Design Argument Story

    6. Milestones PC1: Emergency Stabilization PC2: Performance of Focused History & Physical Exam PC3: Diagnostic Studies PC4: Diagnosis PC5: Pharmacotherapy PC6: Observation and Reassessment PC7: Disposition PC8: Multi-tasking (Task-switching)

    7. Milestones PC9: General Approach to Procedures PC10: Airway Management PC11: Anesthesia and Acute Pain Management PC12: Other Procedures: Ultrasound (Diagnostic / Procedural) PC13: Other Procedures: Wound Management PC14: Other Procedures: Vascular Access

    8. Milestones • MK - Medical Knowledge • PROF1 - Professional values • PROF2 - Accountability • ICS1 - Patient Centered Communication • ICS2 - Team Management • PBLI - Practice Based Performance Improvement • SBP1 - Patient Safety • SBP2 - Systems-based Management • SBP3 - Technology

    9. Dreyfus model of skill acquisition

    10. Dreyfus model of skill acquisition

    11. Dreyfus model of skill acquisition

    12. Next Accreditation System 16

    13. Overall Milestone Project Goal Obtain outcome measures (i.e., milestones of competency development) to use as evidence of programs’ educational effectiveness 17

    14. Emergency Medicine Firsts • Developed and completed Milestones in 5 months • Approved by ABEM BOD 1/2012, and by RRC-EM 2/2012 • Based on Milestone progress, EM invited into NAS trial rollout July 2013 • Milestones are truly along a continuum of end of medical school to certification standards • Only specialty to take ABMS certification standards and apply to Milestones • Milestones are based on extensive survey data related to ABEM certification standards • Only specialty allowed to make revisions in program requirements • Only specialty to integrate the Milestones into proposed program requirement changes

    15. Uniformity of Milestone Reporting • 5 levels of proficiency • Novice, Beginner, Competent, Proficient, Expert • Level 4 - The ABEM certification standard • By definition where an individual should be at time of graduation • Level 5 - Attained after practice • Narrative anchors • Based on knowledge, skills and abilities (KSAs) • Balance between • Deconstruction (microtasks) • Integration (complex performance)

    16. What are the characteristics of a highly functioning CBME system?

    17. Carraccio C, Wolfshtal SD, Englander R, Ferentz K, Martin C. 2002. Shifting paradigms: from Flexner to competencies. Acad Med 77(5):361-367. p 362.

    18. Carraccio C, Wolfshtal SD, Englander R, Ferentz K, Martin C. 2002. Shifting paradigms: from Flexner to competencies. Acad Med 77(5):361-367. p 362.

    19. Carraccio C, Wolfshtal SD, Englander R, Ferentz K, Martin C. 2002. Shifting paradigms: from Flexner to competencies. Acad Med 77(5):361-367. p 362.

    20. Carraccio C, Wolfshtal SD, Englander R, Ferentz K, Martin C. 2002. Shifting paradigms: from Flexner to competencies. Acad Med 77(5):361-367. p 362.

    21. Microsystem success and assessment system correlates

    22. EM used as pilot specialty in NAS Began July, 2013 Integration of Milestones into EM Program Requirements A first! Development of assessment methodology Specialty-wide implementation of assessment methods? JMTF? Next Steps

    23. Next Accreditation System 50