1. The Medical School Accreditation Process and The Surgery Resident's Role in Teaching Medical Students Larry Tan, MD Director, Surgery Undergraduate Deparment of Surgery University of Manitoba March 2010

2. Objectives Medical school accreditation process Description of Education Directive 24 How ED-24 applies to residents who act as teachers How ED-24 is implemented in the Department of Surgery. Resident's role in teaching medical students in the clerkship rotation and in formal teaching sessions Feedback on resident teaching from the medical students Note – blue text are hyperlinks ED-24

3. Medical School Accreditation

4. Liaison Committee on Medical Education is the accrediting body for all North American medical schools Liaison Committee on Medical Education LCME determines whether medical schools meet established standards for structure, resources and education delivery. Educational Objectives are outlined in ED-01 to ED-47 Educational Objectives ED-24 is an objective found to be poorly implemented in accreditation of other North American medical schools ED-24

5. LCME Accreditation Actions Possible outcomes of accreditation are: Possible outcomes of accreditation Grant accreditation status (full, preliminary or provisional) or deny accredition – for new schools Continue accreditation status, with or without specifying terms Continue accreditation, with warning of probation Continue accreditation, with probation Withdraw accreditation ED-24

6. University of Manitoba Accreditation Schedule Previous accreditation – 2004 – full approval, with areas of partial non-compliance, including ED-24 Upcoming accreditation LCME secretariat visit – March 1-2, 2010 Mock accreditation (voluntary) – November 2010 Database submission to LCME – January 2011 LCME accreditation visit – April 2011 Accreditation report – June 2011 ED-24

7. Accreditation Probation Probation for Probation One or more areas of noncompliance that must be corrected in 12-24 months Previously identified areas of noncompliance that have not been corrected Medical schools placed on probation must inform the public within 24 hours, e.g. Dalhousie University 2009Dalhousie University 2009 Failure of probation can lead to withdrawal of accreditation University of Manitoba was in partial non-compliance with ED-24 in 2004. ED-24

8. What Is ED-24? An Educational Directive that governs oversight of teaching interactions between residents and medical students. Residents must know the objectives for the medical students they are teaching. Residents must be given training in how to teach. In cases where performance is weak, residents must be given remedial training. Students should provide feedback on residents who teach them. Residents should receive feedback on their teaching performance from faculty and students ED-24

9. Minimal expectation #1 Residents and other instructors who do not hold faculty ranks (such as graduate students and postdoctoral fellows) should receive a written copy of the course/clerkship objectives and clear guidance from the course/clerkship director about their roles in teaching and evaluating medical students. From www.lcme.orgwww.lcme.org ED-24

10. Minimal Expectation #2 The institution and/or relevant departments provide resources such as workshops/written materials to enhance the teaching and evaluation skills of residents and other non-faculty instructors. From www.lcme.orgwww.lcme.org ED-24

11. Other Expectations There should be central monitoring of the level of resident/other instructor participation in activities to enhance their teaching/evaluation skills. The LCME encourages formal assessment of the teaching and evaluation skills of residents and other non-faculty instructors, with opportunities provided for remediation if their performance is inadequate. From www.lcme.orgwww.lcme.org ED-24

12. Implementation of ED-24 ED-24 implementation is a shared responsibility of: Faculty Undergraduate Medical Education office Faculty Postgraduate Medical Education office Department of Surgery Undergraduate program The surgical residency and fellowship programs The surgery residents and fellows ED-24

13. ED-24 - Implementation In the Department of Surgery, ED-24 must be implemented across: 24 clerkship rotations at seven sites six Royal College primary residency programs two Royal College fellowship programs and ~ 10 other fellowship programs. ED-24

14. The Surgery Resident's Role in Teaching Medical Students

15. CanMEDS Scholar Role Physicians...facilitate the learning of...students... Describe principles of learning relevant to medical education Collaboratively identify the learning needs and desired learning outcomes of others Select effective teaching strategies and content to facilitate others' training Demonstrate an effective lecture or presentation Assess and reflect on a teaching encounter Provide effective feedback Describe the principles of ethics with respect to teaching ED-24 From http://rcpsc.medical.orghttp://rcpsc.medical.org

16. Three Types of Teaching Responsibilities Service- or rotation-based teaching Ex. supervising a clerk rotating on your service Formal teaching sessions assigned by service or residency program Ex. presenting at service rounds or grand rounds to an audience that includes medical students Formal teaching sessions assigned by Department of Surgery Education Office Ex. teaching knot-tying or the breast examination to medical students

17. Service- or Rotation-Based Teaching Patient-centered, ward-based, often informal Daily opportunity for teaching Clerkship objectives are available for each rotation – residents must read these objectives Residents must know their own objectives in the CanMEDS scholar domainCanMEDS scholar ED-24

18. Written Copy of the Course/Clerkship Objectives Latest versions of the clerkship rotation descriptions are found on the undergraduate webpage for the Department of Surgeryundergraduate webpage Residents must read the clerkship objectives and rotation information for the general surgery and selective rotations in which they supervise medical studentsgeneral surgery selective Feedback and corrections are welcome – please email surgundergrad@hsc.mb.ca surgundergrad@hsc.mb.ca ED-24

19. Teaching Assigned by Service or Residency Program Formal, scheduled sessions Occur weekly or monthly Residents should provide objectives for academic presentations e.g. objective page on a powerpoint presentation Objectives can be developed in conjunction with the residents' preceptors Please keep the students' educational goals in mind. ED-24

20. Teaching Assigned by Department of Surgery Education Office At present, very few teaching sessions assigned to residents, pending development of comprehensive objectives and teaching scripts for each session In the future, the objectives and the teaching material for all teaching sessions will be available through OPAL, allowing more resident participationOPAL ED-24

21. Evaluation of Medical Students MITERs are discussed at mid-point of rotation – formative feedback FITERs are completed by the attending staff at the end of the rotation – summative feedback Residents provide feedback on student performance FITERs are divided into cognitive domains similar to CanMeds Resident feedback is incorporated into the FITER Copy of Surgery Clerkship FITER and MITER available on Department of Surgery Undergraduate Education webpage Copy of Surgery Clerkship FITER and MITER ED-24

22. Educational Resources New resident orientation TIPS program Surgery Foundations Seminar Series One-minute preceptor Giving effective feedback Faculty development workshops Public-speaking workshop for PGY3s OPAL (Online Portal for Advanced Learning) training and workshopsOPAL (Online Portal for Advanced Learning) ED-24

23. Feedback on Resident Teaching Performance Comprehensive online mechanism under development by Faculty of Medicine, implemented via OPALOPAL Most residency and fellowship programs have a mechanism for providing feedback on resident teaching performance (e.g. paper-based forms, T-Res, WebEval, One45). The students on service should also provide feedback. Feedback should be collected and reported every 6-12 months to allow anonymity for the student responders. ED-24

24. Summary ED-24 Implementation of ED-24 will require cooperation and coordination among the students, residents, program directors, teaching staff, the Department of Surgery and the Faculty of Medicine Please review the clerkship objectives and evaluation forms for your rotation, available through the surgery clerskhip webpage www.umanitoba.ca/faculties/medicine/units/surgery/education/undergrad/rotation/index.html Feedback and comments - surgundergrad@hsc.mb.casurgundergrad@hsc.mb.ca