Validation of an Emergency Medicine Fellowship didactic teaching program against the ACGME milestones, a quality improvement project
Authors: Mohamed Seif, Ayman Hereiz , Ashid Kodumayil, Thirumoothy Suresh Kumar and Saleem Farook
Introduction
The 2-year Emergency Medicine Fellowship (EMF) program in Qatar goes beyond clinical competencies and aims to train the fellows into the development of their management, leadership, teaching and academic skills through a curriculum underpinned by the Accreditation Council for Graduation Medical Education (ACGME) milestones. This validated set of 23 educational milestones help to track the progress of the fellows against the curriculum. The EMF didactic program is organized for 5 hours every week and caters to the educational needs of the 48 fellows divided into junior and senior groups.
Methodology
We undertook a full review of the weekly didactic EMF teaching activities conducted throughout the academic year of 2016 -2017 and mapped these against the ACGME milestones. Whilst mapping against the full curriculum would be potentially time-consuming, mapping against the 23 milestones would be much quicker. Hence, we studied the didactic teaching program to determine the mode of delivery, the depth and frequency of coverage of each milestone.
Results:
A total of 125 classroom teaching activities were delivered throughout the academic year of 2016 -2017, conducted in the form of interactive lectures 28%(n=35), evidence based clinical topic reviews 19.2% (n=24), journal club 17.6% (n=22), simulation workshops 15.2% (n=19), simulation scenarios 9.6% (n=12), and flipped classrooms 9.6%(n=12). Of these activities, 68% (n= 85) were delivered by the faculty and 32% (n= 40) by the fellows under supervision.
Frequency analysis showed that some milestones were more likely to be covered in detail than others. For example, milestones on ‘focused history and examination’ was covered most often, followed by ‘emergency stabilization’ (n=29), ‘disposition’ (n=22), ‘diagnostic studies’ (n=20), ‘pharmacotherapy’ (n=18) and ‘system-based management’ (n=17). Other milestones that were less often visited were on ‘professional values’ (n=5), ‘wound management’ (n=4), ‘multi-tasking’, ‘anaesthesia’ and ‘technology’ (n=1).
Discussion:
Overall, the EMF didactic program clearly demonstrated the delivery of the 23 ACGME milestones. However, variance was noted; some milestones seemed to permeate the program while other specific milestones appeared to be dealt in a limited manner. As a result of the study, we have undertaken further revisions to the program to ensure certain milestones are visited more frequently in the next academic year. This project has also helped in identifying the milestones that are often challenging to be delivered in a classroom setting e.g. focused ultrasound, wound management and multitasking. These may be better achieved through workplace supervision in clinical areas, workplace-based projects and academic assignments such as quality improvement projects, morbidity and mortality meeting presentations and clinical research activities.
Conclusion:
The ACGME milestones appear to provide a comprehensive structure to measure the quality of an EMF didactic teaching program. A mapping exercise against the milestones may prove to be a short-cut quality improvement method for blueprinting the teaching activities against the curriculum.
