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Background Sexual and reproductive health (SRH) is an important disease-specific concern for adolescent and young adult (AYA) women that is not consistently addressed in cystic fibrosis (CF) centers. This study identifies educational needs and preferences of interprofessional CF providers regarding SRH in AYA women with CF. Methods Interprofessional CF providers participated in an anonymous survey regarding general and CF-specific SRH knowledge and skills, factors for optimizing SRH care, and preferred approaches for SRH training. We calculated descriptive statistics for all respondents and stratified by provider type. Results A total of 523 providers completed the survey (39% physicians/advanced practice providers, 19% nurses, 20% social workers, and 22% other disciplines). Half reported comfort responding to female AYA SRH concerns; however, only one-third were comfortable asking appropriate questions and confident taking a sexual history. Only 29% were comfortable with their current CF-specific SRH knowledge. Respondents' preferred SRH topics for further training included: pregnancy/parenthood planning, sexual functioning, urinary incontinence, intimate partner violence, and taking a sexual history. Nearly two-thirds felt having connection to women's health specialists familiar with CF would facilitate SRH care. Approximately one-third desired SRH educational materials for providers to view at point-of-care or through online case-based learning; Conclusion Many interprofessional CF providers lack comfort and skills in addressing SRH with AYA women with CF. Provider training needs and approaches identified in this study can be used to develop tailored educational interventions to improve comprehensive CF care.

Background: Evaluation of applied ethical behavior and professionalism in pediatric and pediatric sub-specialty trainees remains challenging yet crucial, not only for learner growth and development, but for milestones evaluation and effective feedback. Objective: To develop and validate a pediatric ethics and professionalism assessment tool (Pedi-EPAT) that effectively and reliably assesses pediatric …

To pilot a short video-based resident-as-teacher training toolkit and assess its effect on resident teaching skills in clinical settings.A video-based resident-as-teacher training toolkit was previously developed by educational experts at Beth Israel Deaconess Medical Center, Harvard Medical School. Residents were recruited from two academic hospitals, watched two videos from the toolkit ("Clinical Teaching Skills" and "Effective Clinical Supervision"), and completed an accompanying self-study guide. A novel assessment instrument for evaluating the effect of the toolkit on teaching was created through a modified Delphi process. Before and after the intervention, residents were observed leading a clinical teaching encounter and scored using the 15-item assessment instrument. The primary outcome of interest was the change in number of skills exhibited, which was assessed using the Wilcoxon signed-rank test.Twenty-eight residents from two academic hospitals were enrolled, and 20 (71%) completed all phases of the study. More than one third of residents who volunteered to participate reported no prior formal teacher training. After completing two training modules, residents demonstrated a significant increase in the median number of teaching skills exhibited in a clinical teaching encounter, from 7.5 (interquartile range 6.5-9.5) to 10.0 (interquartile range 9.0-11.5; P.001). Of the 15 teaching skills assessed, there were significant improvements in asking for the learner's perspective (P=.01), providing feedback (P=.005), and encouraging questions (P=.046).Using a resident-as-teacher video-based toolkit was associated with improvements in teaching skills in residents from multiple specialties.

Background Dermatology residents routinely teach junior co-residents and medical students. Despite the importance of teaching skills for a successful academic career, no formal teaching instruction programs for dermatology residents have been described to our knowledge, and the extent of teaching opportunities for dermatology residents is unknown. Objective We sought to describe the range of teaching opportunities and instruction available to dermatology residents and to assess the need for additional teaching training from the perspective of dermatology residency program directors nationwide. Methods A questionnaire was administered to 113 US dermatology residency program directors or their designees. Descriptive statistics were used to analyze questionnaire item responses. Results The response rate was 55% (62/113). All program directors reported that their residents teach; 59% (33/56) reported offering trainees teaching instruction; 11% (7/62) of programs offered a short-term series of formal sessions on teaching; and 7% (4/62) offered ongoing, longitudinal training. Most program directors (74%, 40/54) believed that their residents would benefit from more teaching instruction. Limitations Response rate and responder bias are potential limitations. Conclusion Dermatology residents teach in a broad range of settings, over half receive some teaching instruction, and most dermatology residency program directors perceive a need for additional training for residents as teachers.

Introduction In a flipped classroom, students learn basic concepts before class, allowing them time during class to apply newly gained knowledge to problem sets and cases. Harvard Medical School (HMS) has introduced a form of flipped classroom, called case-based collaborative learning (CBCL), during preclinical curricula. Finding few published resources, the HMS Academy's Peer Observation of Teaching Interest Group developed a guide for observations and feedback to CBCL facilitators. Methods After conducting an extensive literature search, speaking to flipped classroom methodology experts, and observing 14 facilitators using CBCL methods, the interest group identified specific teaching behaviors that optimize student interaction and knowledge application. The group next engaged in several rounds of the modified Delphi method to develop the CBCL peer observation worksheet and compendium and then tested these materials' effectiveness in capturing CBCL teaching behaviors and providing feedback to CBCL faculty facilitators. Results Seventy-three percent of faculty rated the worksheet and compendium as extremely helpful or helpful in identifying new teaching techniques. Moreover, 90% found the CBCL peer observation and debriefing to be extremely helpful or helpful, and 90% were extremely likely or likely to incorporate peer suggestions in future teaching sessions. Discussion Medical schools have begun to embrace flipped classroom methods to eliminate passive, lecture-style instruction during the preclinical years of the MD curriculum. This tool identifies specific in-classroom approaches that engage students in active learning, guides peer observers in offering targeted feedback to faculty on teaching strategies, and presents consensus-based resources for use during CBCL faculty development and training.

Importance Optimal approaches to teaching bedside procedures are unknown. Objective To identify effective instructional approaches in procedural training. Data sources We searched PubMed, EMBASE, Web of Science and Cochrane Library through December 2014. Study selection We included research articles that addressed procedural training among physicians or physician trainees for 12 bedside procedures. Two independent reviewers screened 9312 citations and identified 344 articles for full-text review. Data extraction and synthesis Two independent reviewers extracted data from full-text articles. Main outcomes and measures We included measurements as classified by translational science outcomes T1 (testing settings), T2 (patient care practices) and T3 (patient/public health outcomes). Due to incomplete reporting, we post hoc classified study outcomes as ‘negative’ or ‘positive’ based on statistical significance. We performed meta-analyses of outcomes on the subset of studies sharing similar outcomes. Results We found 161 eligible studies (44 randomised controlled trials (RCTs), 34 non-RCTs and 83 uncontrolled trials). Simulation was the most frequently published educational mode (78%). Our post hoc classification showed that studies involving simulation, competency-based approaches and RCTs had higher frequencies of T2/T3 outcomes. Meta-analyses showed that simulation (risk ratio (RR) 1.54 vs 0.55 for studies with vs without simulation, p=0.013) and competency-based approaches (RR 3.17 vs 0.89, p

Objective To design and implement a teaching skills curriculum that addressed the needs of an ophthalmology residency training program, to assess the effect of the curriculum, and to present important lessons learned. Design A teaching skills curriculum was designed for the Harvard Medical School (HMS) Residency Training Program in Ophthalmology. Results of a needs assessment survey were used to guide curriculum objectives. Overall, 3 teaching workshops were conducted between October 2012 and March 2013 that addressed areas of need, including procedural teaching. A postcurriculum survey was used to assess the effect of the curriculum. Setting Massachusetts Eye and Ear Infirmary, a tertiary care institution in Boston, MA. Participants Overall, 24 residents in the HMS Residency Training Program in Ophthalmology were included. Results The needs assessment survey demonstrated that although most residents anticipated that teaching would be important in their future career, only one-third had prior formal training in teaching. All residents reported they found the teaching workshops to be either very or extremely useful. All residents reported they would like further training in teaching, with most residents requesting additional training in best procedural teaching practices for future sessions. Conclusions The pilot year of the resident-as-teacher curriculum for the HMS Residency Training Program in Ophthalmology demonstrated a need for this curriculum and was perceived as beneficial by the residents, who reported increased comfort in their teaching skills after attending the workshops.

Purpose: Critical thinking is central to the function of health care professionals. However, this topic is not explicitly taught or assessed within current programs, yet the need is greater than ever, in an era of information explosion, spiraling health care costs, and increased understanding about metacognition. To address the importance of teaching critical thinking in health professions education, the Shapiro Institute for Education and Research and the Josiah Macy Jr. Foundation jointly sponsored the Millennium Conference 2011 on Critical Thinking. Summary: Teams of physician and nurse educators were selected through an application process. Attendees proposed strategies for integrating principles of critical thinking more explicitly into health professions curricula. Working in interprofessional, multi-institutional groups, participants tackled questions about teaching, assessment, and faculty development. Deliberations were summarized into consensus statements. Conclusions: Educational leaders partic...

The authors share twelve practical tips on writing a case that engages learners in active learning and discussion. They first advise that, during the initial preparation of the case, authors should (1) identify the case goals and objectives, and (2) identify the level of the learners. When writing the case, authors should (3) use active and colorful language; (4) use patients' own descriptions rather than medical language; (5) allow the learners to interpret data themselves; (6) allow for natural discovery rather than presenting information chronologically; and (7) be realistic about interruptions in patient care. In addition, case authors should pay attention to methods that enhance discussion by (8) creating barriers to diagnostic or treatment options; (9) promoting questions and discussion over answers; (10) using cues to assure discussion flow and knowledge exploration; and (11) omitting details or inserting informational distractors. Finally, well-crafted questions are essential during the case presentation to engage learners in higher-order thinking; and to (12) stimulate curiosity and reflection.

Issue: Healthcare costs have spiraled out of control, yet students and residents may lack the knowledge and skills to provide high value care, which emphasizes the best possible care while reducing unnecessary costs. Evidence: Mainly national campaigns are aimed at physicians to reconsider their test ordering behaviors, identify overused diagnostics, and disseminate innovative practices. These efforts will fall short if principles of high value care are not incorporated across the spectrum of training for the next generation of physicians. Implications: Consensus findings of an invitational conference of 7 medical school teams consisting of academic leaders included strategies for institutions to meaningfully incorporate high value care into their medical school, residency, and faculty development curricula.

While current emphases on operative teaching focus on "virtual" education, residents and faculty engage most intimately in the operating room. The utilization of intraoperative teaching techniques, drawn from adult education principles, is understudied.A survey with both quantitative and qualitative elements was administered to surgical residents and their faculty. Thirty-eight analogous questions regarding teaching techniques, populating four general domains, were rated for frequency of application. Respondents were asked to rank best teaching practices and identify other effective educational approaches using open-ended questions.University-based general surgical residency (5 institutions).General surgical residents and their faculty.46 residents (77%) and 37 faculty (63%; mean 17 yrs experience) completed the survey. There was significant disagreement between residents and faculty in how frequently 32 of the 38 teaching techniques were applied (all p0.032). Faculty rated the technique "I set and communicate high standards" as the most frequently applied strategy, while residents rated "The faculty demonstrate technical consistency" the highest. The least employed approach, acknowledged by both groups, was "The faculty ask how they might improve their teaching." There were few differences between perceptions and preferences of junior vs. senior learners, and junior vs. senior faculty. Resident and faculty appreciation of most-effective teaching approaches was similar. Qualitative analysis of the open-ended questions yielded themes which resonate with both learners and teachers: communication processes, time pressures, optimization of the work/teaching environment, teacher engagement, patience/tolerance, autonomy, feedback, learner preparedness, and patient advocacy.The perceptions of residents and faculty regarding the frequency of using effective approaches for operative teaching are disparate. While faculty appear to value adult learning principles and perceive that they are employed regularly, residents have a discrepant viewpoint. However, themes that were identified by both residents and faculty through qualitative analysis provide the foundation for educational process improvements.

This review presents a systematic approach to curriculum development, divided into five steps: 1) perform a needs assessment, 2) define the goals and learning objectives, 3) identify resources, 4) develop educational strategies and implement the curriculum, and 5) evaluate and modify the curriculum. Although the curriculum developmental stages are presented in five ordered steps, curriculum development is actually a dynamic, interactive process, in which development of one step naturally affects other steps. Learners are central to this process, and with each step, the instructor needs to be mindful of the learners' needs and prior experiences, using a variety of educational strategies to reach trainees with different learning styles.

Research in medical education is stymied by a variety of methodological, logistical, and institutional challenges. Multicenter collaboration may advance the current state of medical education research by increasing subject sample size, harnessing the power of collective expertise, and garnering visibility for issues of national importance.We convened the "Millennium Conference 2007: A Collaborative Approach to Educational Research" in May 2007 to consider the role of national initiatives in addressing challenges in educational research. We selected 9 medical schools through a competitive application process to participate as school teams. We led participants through structured discussions about the challenges of educational research and the opportunities offered through national collaboratives. School teams also met to refine their current local educational research initiatives.A group of committed stakeholders met to consider a national educational research agenda. The recommendations from this conference proceed from consensus reached by the participants.

Faculty development is essential to fostering excellence in medical education and desired learning outcomes. Little is known, however, about the personal and professional impact of faculty development programs on participants, learners, and institutions. We explored the perspectives of medical education fellowship graduates on their skills, self-perceptions, participation in learning communities, and reflective practice. We also explored the results of the implementation of a scholarly medical education project.The study was a qualitative analysis of semistructured interviews with 40 faculty from multiple disciplines who, between 1999 and 2005, had completed a yearlong fellowship in medical education.Through qualitative analysis, we identified 11 themes. Study participants described postfellowship changes in knowledge, self-perceptions, and behaviors and institutional changes that resulted from education projects. With a foundation of principles and skills, the Fellows' confidence and identity as educators were strengthened by their sense of self-efficacy, others' perceptions of their credibility, and support from a community of peers and mentors. This change affected the graduates' professional career trajectories.Common themes in this and other studies suggest that enhancement of knowledge about medical education and teaching skills, protected time, a supportive learning environment, relationships with peers and mentors, validation of educational expertise by others, community building and networking, and emphasis on self-reflection and awareness are essential elements of faculty fellowships in medical education. This analysis suggests that these elements foster the evolution of identity, confidence, and self-efficacy among fellowship graduates. This personal development promotes the professional development of the medical educator.

The authors present 10 strategies, plus challenges and opportunities, that have informed three well-established, yearlong medical education fellowships (defined as single cohorts of medical teaching faculty who participate in extended faculty development activities) during the period 1998 to 2008. These strategies include (1) defining an operating philosophy, values, and goals, (2) establishing a curriculum that reflects the roles and responsibilities of fellows and faculty, (3) employing a basic approach to adult learning, (4) striving to achieve a balance between stated objectives and openness of discussion, (5) creating optimum learning opportunities for the fellows to acquire and practice skills delineated in the curriculum, (6) fostering interdisciplinary communication, team development, and the creation of a learning community, (7) developing mindfulness and critical self-reflection, (8) systematically reviewing each session, (9) evaluating fellowship outcomes, and (10) planning for the future. This in-depth look presents both curricular content and process, providing a useful starting point from which those who develop and conduct educational faculty development activities at medical schools and academic medical centers may fashion and implement a local curriculum.

Musculoskeletal problems including both rheumatologic and orthopaedic pathologies are the primary reason for physician office visits across the United States, with approximately 92.1 million encounters reported annually, according to the 2004 National Ambulatory Medical Care Survey1. Despite the impact that musculoskeletal diseases have on society and the wide range of medical practitioners who treat these conditions, there is compelling evidence that undergraduate medical curricula do not adequately prepare physicians in musculoskeletal medicine2-5. In 2005, the Association of American Medical Colleges (AAMC) issued a Medical School Objectives Project Report on musculoskeletal medicine highlighting the need for medical schools to improve the education of future physicians in this area6. The report outlined educational guidelines to establish a more coherent undergraduate musculoskeletal curriculum. We conducted a study at our medical school during the 2005-2006 academic year that substantiated the need for improving the musculoskeletal curriculum. Students lacked cognitive mastery, demonstrated low clinical confidence, and were dissatisfied with the amount of time spent learning musculoskeletal medicine. Findings of the study suggested the need to improve the integration of musculoskeletal medicine into the curriculum3. Data from the 2005 Step-1 United States Medical Licensing Examination at our institution also revealed that performance on the musculoskeletal section was the lowest of all the subsections. Thus, both national as well as institutional concerns prompted us to lobby for, develop, and begin implementation of a four-year integrated musculoskeletal curriculum. We focused our initial reform endeavors on the preclinical (first and second-year) curriculum. The process of curriculum reform and development differs among various medical schools. As such, the purpose of this study was to provide a framework that may assist educators in achieving the adoption of an integrated musculoskeletal curriculum into the preclinical curriculum at their own school. We offer …

Although faculty development programs in medical education have increased over the past two decades, there is a lack of rigorous program evaluation. The aim of this study was to determine quantifiable outcomes of Harvard Medical School's (HMS's) Fellowship in Medical Education and evaluate attainment of its goals.In 2005 and 2009 the authors collected curricula vitae (CVs) and conducted within-subject analysis of 42 fellowship graduates and also conducted comparison analysis between 12 academic year 2005 fellows and 12 faculty who did not participate in the program. The authors identified 10 metrics of academic advancement. CV analysis for the 42 graduates started 2 years prior to fellowship enrollment and continued for 2-year intervals until June 2009 (10 years of data collection). CV analysis for the comparison group was from 2003 to 2009. The authors also analyzed association between gender and academic outcomes.Fellowship graduates demonstrated significant changes in 4 of 10 academic metrics by the end of the fellowship year: academic promotion, educational leadership, education committees, and education funding. Two metrics-educational leadership and committees-showed increased outcomes two years post fellowship, with a positive trend for promotions. Fellowship graduates significantly outpaced the comparison group in 6 of 10 metrics. Women did significantly more committee work, secured more education funding, and were promoted more often than men.Findings indicate that the HMS Fellowship in Medical Education meets programmatic goals and produces positive, measurable academic outcomes. Standardized evaluation metrics of longitudinal faculty development programs would aid cross-institutional comparisons.

There is a growing appreciation of the need for educational faculty development within medical education. The authors describe the establishment and subsequent expansion of one such fellowship in medical education that arose from the cooperative efforts of Harvard Medical School, Beth Israel Deaconess Medical Center, and Mount Auburn Hospital. Three resultant fellowships are outlined that share the common goals of enhancing the skills of the faculty as educators, providing an opportunity to conduct scholarly educational research, supporting the fellows as change agents, and fostering the creation of a supportive community dedicated to enhancing the field of medical education. Curricular structure and content are outlined as well as current approaches to curricular and programmatic evaluation. The fellowships have been well received and are widely perceived as transformative for the faculty, many of whom have assumed increased roles of organizational and educational leadership. Lastly, future directions for these fellowships are presented.

Musculoskeletal complaints are a common reason for primary care visits; however, many essential physical examination, diagnostic and treatment skills are not adequately taught. The objectives of the study were to create and implement a comprehensive clinical skills teaching model, and to evaluate its effects on residents' knowledge and diagnostic skills. A comparison of cohorts who participated and did not participate in a musculoskeletal curriculum was undertaken. Second and third year medical residents participated in comprehensive curricula to teach and evaluate musculoskeletal skills. Sixty-seven attended the first of three lectures on the painful shoulder; 61 attended all three lectures and completed pre- and post-self assessment forms and tests. Three months later 26 of these residents and 10 controls participated in an OSCE examination. Thirty-nine medical residents attended the first of three lectures on the painful knee; 32 attended all three lectures and completed pre- and post-self assessment forms and tests. Seven of these residents and eight controls participated in an OSCE examination three months later. Both the shoulder and knee curricula were associated with a significant improvement in test scores (p < 0.0001), in self-assessment of physical examination, diagnostic and procedural skills (p < 0.0001), and in OSCE results (p < 0.005). It was concluded that the skills required for the diagnosis and treatment of common musculoskeletal complaints can be effectively taught and assessed using inexpensive and simple methods.

Few medical school electives include longitudinal patient care across clinical specialties and environments. Systemic lupus erythematosus represents a disease process with complex pathophysiology for students to learn from providers across medical fields, including dermatology, rheumatology, nephrology, and cardiology, in both pediatric and adult patients. Diagnosis, understanding, and management of lupus also rely heavily on basic science and clinical immunology, providing a link to the preclinical curriculum. In 2009, Harvard Medical School introduced a one-month elective course "Understanding Lupus: A Multidisciplinary Approach to Systemic Disease," designed to provide students with both outpatient and inpatient care experiences in dermatology, rheumatology, and multidisciplinary clinics at Brigham and Women's Hospital and Boston Children's Hospital. Core components of the elective include a continuity experience that allows students to attend one patient's multiple specialist visits; didactics from dermatology, rheumatology, and immunology covering evidence-based medicine and basic sciences; and clinical immunology laboratory exposure to teach serologic and auto-antibody testing methods. The authors provide lessons learned in the development of this interdisciplinary, multi-institution elective rotation, which may serve as a model at other medical schools for incorporating basic sciences into the clinical curriculum and using multidisciplinary care and varied educational settings.

Objective Although cataract surgery is one of the most commonly performed surgeries in the country, it is a microsurgical procedure that is difficult to learn and to teach. This study aims to assess the effectiveness of a new method for introducing postgraduate year (PGY)-3 ophthalmology residents to cataract surgery. Setting Hospital-based ophthalmology residency program. Design Retrospective cohort study. Participants PGY-3 and PGY-4 residents of the Harvard Medical School Ophthalmology Residency from graduating years 2010 to 2012. Results In July 2009, a new method of teaching PGY-3 ophthalmology residents cataract surgery was introduced, which was termed "the stepwise introduction to cataract surgery." This curriculum aimed to train residents to perform steps of cataract surgery by deliberately practicing each of the steps of surgery under a structured curriculum with faculty feedback. Assessment methods included surveys administered to the PGY-4 residents who graduated before the implementation of these measures ( n = 7), the residents who participated in the first and second years of the new curriculum ( n = 16), faculty who teach PGY-4 residents cataract surgery ( n = 8), and review of resident Accreditation Council for Graduate Medical Education surgical logs. Resident survey response rate was 100%. Residents who participated in the new curriculum performed more of each step of cataract surgery in the operating room, spent more time practicing each step of cataract surgery on a cataract surgery simulator during the PGY-3 year, and performed more primary cataract surgeries during the PGY-3 year than those who did not. Faculty survey response rate was 63%. Faculty noted an increase in resident preparedness following implementation of the new curriculum. There was no statistical difference between the precurriculum and postcurriculum groups in the percentage turnover of cataracts for the first 2 cataract surgery rotations of the PGY-4 year of training. Conclusions The introduction of cataract surgery to PGY-3 residents in an organized, stepwise manner improved resident preparedness for the PGY-4 year of residency. This surgical teaching method can be easily applied to other surgical specialties.

The current, so-called "Millennial" generation of learners is frequently characterized as having deep understanding of, and appreciation for, technology and social connectedness. This generation of learners has also been molded by a unique set of cultural influences that are essential for medical educators to consider in all aspects of their teaching, including curriculum design, student assessment, and interactions between faculty and learners. The following tips outline an approach to facilitating learning of our current generation of medical trainees. The method is based on the available literature and the authors' experiences with Millennial Learners in medical training. The 12 tips provide detailed approaches and specific strategies for understanding and engaging Millennial Learners and enhancing their learning. With an increased understanding of the characteristics of the current generation of medical trainees, faculty will be better able to facilitate learning and optimize interactions with Millennial Learners.

The 2003 Institute of Medicine's report "Health Professions Education: A Bridge to Quality" argued for the education of health professionals in patient safety. In response to this call, a number of organizations and institutions have developed frameworks and curricula that provide the educational foundation essential for learning about patient safety. However, there is limited guidance on strategies for implementation of training programs in patient safety.We convened the "Millennium Conference 2009: Patient Safety--Implications for Teaching in the 21st Century" to develop concrete approaches to teach patient safety in undergraduate and graduate medical education. We selected 9 medical schools through a competitive application process to participate as school teams. We led attendees through structured discussions on three topics: (a) promoting a culture of patient safety, (b) implementing patient safety content into preexisting curricula, and (c) providing faculty development. School teams also met to refine their current local initiatives in patient safety teaching.A group of committed stakeholders gathered to collectively consider strategies for the integration of patient safety education into undergraduate and graduate medical education. The recommendations from this conference proceed from consensus reached by the participants.

Despite mandates from accreditation bodies for programs to ensure procedural competence, standardized measures do not exist to assess residents' skills in performing central venous catheter (CVC) insertion. The objective of the present study was to develop an instrument to assess residents in subclavian (SC) CVC insertion, to set performance standards, and to validate the tool using performance data.In 2007, the authors convened experts to create an assessment tool for CVC insertion using a modified Delphi method. They applied the Angoff method to a second set of experts to determine minimum passing scores (MPSs) for both the borderline trainee and the competent trainee. Two faculty evaluators then used the checklist to assess residents performing CVCs on simulators.The authors created and experts confirmed a 24-item checklist. Using the Angoff method, the MPS required completion of 10 major and 2 minor criteria for a trainee to show borderline proficiency with CVC insertion under supervision. This MPS was correlated with a global rating of 2 on a 5-point scale. The MPS for competence was 17 major and 5 minor criteria. None of the residents deemed competent on a global rating scale achieved the MPS for competence.The authors were able to create and validate a consensus-driven procedural assessment tool with data-driven standards for basic proficiency and competence that faculty can use to assess residents as they perform CVC insertion.

Introduction The Accreditation Council for Graduate Medical Education defines systems-based practice as a residents' understanding of the health care system and their ability to efficiently and effectively utilize resources within this system. We developed this module to train medical residents in the delivery of optimal care to patients by helping them navigate the complex maze of health care resources and to make transitions of care more seamless. Methods We created an interactive, web-based 30-minute module based on the story of an older patient who presents to an emergency room with focal weakness after a recent hospital stay. The key curricular components of this training module are: (1) the basic elements of Medicare and Medicaid, (2) the various levels of post-acute hospital care for older patients, and (3) the role of provider-to-provider and provider-to-patient communication in patient transitions of care, including the critical elements of an effective discharge summary. The vignette has been tailored to be applicable to multidisciplinary trainees. Interactive questions are embedded within the case to emphasize key teaching points while continuing to engage the learners. Results We piloted this web-based module on trainees of the Harvard Geriatric Medicine Fellowship. Among the 10 fellows who participated, there was an average increase in score between pre- and posttests of 10.6% (from 79% to 90%). The module was well-received by the trainees, and we anticipate a greater improvement in performance among trainees who have never been trained in geriatric medicine. Discussion Systems-based practice is difficult to teach. By creating and piloting this web-based module we hope to offer residency directors an effective and entertaining interactive tool which may be used in either a didactic or an individual setting. Geriatric medicine offers an ideal forum for such teaching.