Laura Culver Edgar¹
Raghdah Al Bualy², Fremen Chihchen Chou³ and James Kwan⁴
1 ACGME
2 Oman Medical Specialty Board
3 China Medical University Hospital
4 Tan Tock Seng Hospital

Abstract 

Clinician Educators are essential to all learners across the continuum of medical education. The scope and breadth of the field has grown exponentially over the last few decades across multiple domains, resulting in limited guidance for professional development for the practicing Clinician Educator. Representatives from undergraduate medical education, post graduate medical education, and continuing professional development developed a novel series of competencies and Milestones for the Clinician Educator, using the same professional developmentally based competency framework applied in all post graduate medical education programs in the United States. Whether new to the role or a seasoned educator, these Milestones provide a developmental pathway for professional development of a clinician educator. They also serve as a natural foundation for faculty development. 

The importance of the Clinician Educator role in delivery of medical education and patient care is well-recognized. There is, however, no formal mechanism to identify when a faculty member has the knowledge, skills, and attitudes (i.e., competencies) to be successful as an educator. The Milestones were developed as a response to this need. 

In this session, we will describe the Clinician Educator competencies, Milestones, and supplemental materials that support implementation. Participants will perform a self- assessment for three of the subcompetencies (assessment, feedback, and reflective practice) and discuss professional development activities and creation of a learning plan to help them achieve higher levels of proficiency on the Milestones. Next, the session will identify frameworks for personal professional development and offer a framework for faculty development with discussion on implementation strategies across the continuum of medical education. Finally, the session will enable participants to create their own “commitment to action”. 

Clinician educators and faculty development leaders from across the continuum of medical education 

Level of workshop
ALL 

Most clinician educators lack access to faculty development that supports professional development as an educator. The Clinician Educator Milestones will allow individual clinician educators to self-assess their abilities across 20 subcompetencies and make a learning plan for improvement. 

These Milestones can provide a framework for institutions, programs, and schools to support development and assessment of teaching, scholarship, and leadership, while providing opportunities for educators’ lifelong learning and growth. 

Heath JK, Murayi JO, Edgar L, Shah BJ. Training Generations of Clinician Educators: Applying the Novel Clinician Educator Milestones to Faculty Development. Gastroenterology. 2023 Mar;164(3):325-328.e1. doi: 10.1053/j.gastro.2022.12.003. 

Sherbino J, Frank JR, Snell L. Defining the key roles and competencies of the clinician- educator of the 21st century: a national mixed-methods study. Acad Med 2014;89(5):783-9. 

3. Clinician Educator Milestones: https://www.acgme.org/milestones/resources/clinician- educator-milestones/ 

Samantha Halman 
Kori LaDonna 

Purpose:
To be successful, academic physicians must not only care for patients and teach learners – they must also be excellent researchers, mentors, administrators, and leaders. Assessment and constructive feedback should drive professional development at all levels but efforts are largely focused on trainees. Self-doubt about the validity of achievements and career are not unique to learners. We explored academic physicians’ perspectives about the role evaluations and feedback play in their professional development, including how they obtain the constructive insights to foster growth across their various roles. 

Methods:
Informed by constructivist grounded theory, we interviewed fourteen physicians about their evaluation and feedback experiences. Data collection and analysis occurred iteratively; themes were identified using constant comparative analysis. 

Results:
All participants were generally dissatisfied with the feedback they currently receive, discarding most sources as useless for informing their professional development. Specifically, feedback generated via annual performance reviews or teaching evaluations were dismissed as “tick box check-ins” generating objective, numerical productivity metrics that primarily benefitted hospital/university administration, not their own development. Instead, most participants, including senior faculty leaders, were thirsty for more personalized guidance, seeking “advice” from informal sources about subjective performance aspects such as leadership style and work-life balance. This “advice” was perceived as meaningful, but distinct from feedback. 

Conclusions:
Dissatisfaction with formal feedback and evaluation processes may result from a disconnect between the current prioritization of performance metrics and the holistic personal and professional growth that academic physicians want. Narrow conceptualizations of feedback may also interfere with perceived utility, perhaps explaining an on-going quest for constructive feedback despite already receiving meaningful “advice”. Rather than discarding formal feedback sources altogether, triangulating objective metrics with “advice” could generate the ‘holistic’ feedback grail physicians seek. 

References (maximum three) 

LaDonna K, Ginsburg S, Watling C. "Rising to the Level of Your Incompetence": What Physicians' Self-Assessment of Their Performance Reveals About the Imposter Syndrome in Medicine. Acad Med. 2018 May;93(5):763-768. 

Lockyer J, Armson H, Chesluk B, Dornan T, Holmboe E, Loney E, Mann K, Sargeant J. Feedback data sources that inform physician self-assessment. Med Teach. 2011;33(2):e113-20 

Mann K, van der Vleuten C, Eva K, Armson H, Chesluk B, Dornan T, Holmboe E, Lockyer J, Loney E, Sargeant J. Tensions in informed self-assessment: how the desire for feedback and reticence to collect and use it can conflict. Acad Med. 2011 Sep;86(9):1120-7 

Khemmawit Siriwong¹
Thitipat Pattanaprateeb¹, Ramon Sawetratanasatien¹ and Korakrit Imwattana¹
1 Faculty of Medicine Siriraj Hospital, Mahidol University 

Background:
Self-directed learning (SDL) is critical for promoting lifelong learning and is continuously integrated into newly developed medical school curricula in Thailand. Yet, the SDL effect on Thai medical students’ academic performance is under-assessed. This study aims to explore the relationship between SDL readiness and National Licensing Examination Step 1 (NLE1) score and to investigate the appropriateness of Fisher’s SDL readiness scale (SDLRS) for assessing medical students' engagement with SDL. 

Methods: 
This study was conducted on 4th and 5th-year medical students at the Faculty of Medicine Siriraj Hospital (n = 108). They were asked to complete a 40-item SDLRS questionnaire, covering three aspects: self-management skills, self-control skills, and learning eagerness. They also self-reported their NLE1 scores as a marker of academic competence. All SDLRS parameters were investigated for correlation with NLE1 scores using multiple linear regression. 

Results & Discussion:
Sixty students (55.6%, 95% CI: 45.7–65.1%) had SDLRS scores at least 150 and were classified as SDL-ready users. They were associated with higher NLE1 score (220.1 vs. 203.5; p = 0.005). Breakdown analyses showed that students most lacked self-management skills (average score 70.8%). These skills were the only aspect of SDL significantly associated with increased academic competence (p < 0.001). There was a moderate correlation between students’ self-perception and the questionnaire result (71.3% correlation, Cohen’s kappa = 0.41). 

Conclusion:
This study shows that SDL-ready users exhibit higher academic competence. It also demonstrates that SDL can be assessed and weak points identified using an appropriate tool. A full-scale assessment may not be necessary, as they were relatively aware of their performance. Thus, a more concise SDL readiness evaluation could benefit students by targeting their SDL usage weakness, which can be addressed to improve their academic competence. These insights can guide medical educators to enhance students' SDL readiness and academic outcomes. 

References (maximum three) 

1. Taylor TAH, Kemp K, Mi M, Lerchenfeldt S. Self-directed learning assessment practices in undergraduate health professions education: a systematic review. Med Educ Online. 2023;28(1):2189553. Available from: http://dx.doi.org/10.1080/10872981.2023.2189553 

2. Li S-TT, Tancredi DJ, Co JPT, West DC. Factors associated with successful self-directed learning using individualized learning plans during pediatric residency. Acad Pediatr. 2010;10(2):124–30. Available from: http://dx.doi.org/10.1016/j.acap.2009.12.007 

3. Kumar AP, Omprakash A, Mani PKC, Swaminathan N, Maheshkumar K, Maruthy KN, et al. Validation of Internal structure of Self-Directed Learning Readiness Scale among Indian Medical Students using factor analysis and the Structural equation Modelling Approach. BMC Med Educ. 2021;21(1):614. Available from: http://dx.doi.org/10.1186/s12909-021-03035-6 

Nicole Kain^1,2
Nigel Ashworth^1,2, Nancy Hernandez-Ceron¹, Iryna Hurava¹, Ed Jess¹ and Parisa Hamayeli- Mehrabani¹
1 College of Physicians & Surgeons of Alberta
2 University of Alberta

1. Background
The College of Physicians & Surgeons of Alberta (CPSA) is the Medical Regulatory Authority (MRA) in the province of Alberta, Canada, and is mandated by law to assess the continuing competence of all physicians in that region. Identifying potentially poorly performing physicians improves quality of health care, which ensures patient safety. 

2. Summary of work
CPSA’s Research & Evaluation Unit (REVU) created a composite risk score to use as a screening tool to identify poorly performing physicians. Multivariate models of predictors of complaints, and high risk prescribing were created for physicians’ outcomes. From these, a theoretical composite ‘risk’ score for each physician in Alberta (the “REVU score”) was created. Using the REVU score, we identified potentially high-risk physicians. Along with randomly-selected physicians we then undertook a prospective cohort study to test whether the REVU score can improve the ability to select poorer performing physicians. 

3. Results
Individualized assessments were performed of 94 physicians. In the randomly-selected group 6.4% (3/47) failed the assessment compared to 55.3% (26/47) in the ‘high’ risk selected group. The risk of failure was 8.7 times higher in the selected group (using the REVU score) compared to random. 

4. Discussion
The REVU score helps identify poorer performing physicians. As demonstrated by individualized assessments, high risk physicians are approximately 9 times more likely to fail than randomly-selected physicians. 

5. Conclusions 
The REVU score is a viable screening tool to identify potentially poor performance. It provides an opportunity to identify physicians at higher risk of failing their individualized assessments, making the selection and the assessment process itself more efficient. 

6. Take-home messages / implications for further research or practice 
MRAs have better alternatives than random selection, and can use a REVU score or similar to best utilize limited resources when conducting competence assessments. 

References (maximum three) 
no references 

Ngoc-Thanh-Van Nguyen¹
Sy Van Hoang¹, Thi-Thanh-Huong Ta¹ and Hoa Ngoc Chau¹
1 University of Medicine and Pharmacy at Ho Chi Minh city

Continuing professional development (CPD) is required for maintaining practice after registration. Two critical issues exist in CPD assessments. First, evaluation focuses on summative rather than formative assessment. Second, theoretical MCQs fail to evaluate the learner's capacity to effectively applying these updates in improving patients' outcome. Therefore, we designed a pilot study, aiming to (1) deliver formative assessments to facilitate participants with heterogenous background to achieve the homogeneous requirements, and to (2) strengthen participants' ability to apply updated knowledge in practice by solving common real-world cases. 

From May to October 2022, we conducted a hierarchical CPD program on “Diagnosis and Treatment of Left Ventricular Hypertrophy in Hypertension”, starting from lectures on detection, diagnosis, treatment and ending in small group practice. During the practice session, no lectures were delivered. Instead, learners were divided into small group of 20 and solved 12 challenging scenarios together using the acquired knowledge. Each learner was required to interact with other team members during problem solving, and self-reflect before receiving feedback from tutors. These activities served as multiple formative assessments before the final summative MCQ. At least 70% of summative MCQ should be correct to receive CPD certificate. 

Our program addressed 2 common issues in CPD assessments. First, using a hierarchical model, we provided all necessary knowledge, from basic to advanced levels, with multiple formative assessments along the way, so that learners from different background could meet the similar passing requirement in summative assessment (100% pass rate). Second, practical cases represent common barriers during practice, so participants would have multiple exposures, reflections and thus be better prepared in applying learned knowledge into practice (100% reported feeling more confidence in clinical application). 

Our pioneering CPD design was the first in Vietnam that included multiple formative assessments, facilitating learners to better applying knowledge to improve patient care. 

References (maximum three) 

Wallace S, et al. Assessing and enhancing quality through outcomes-based continuing professional development (CPD): a review of current practice. Vet Rec. 2016 Nov 19; 179(20): 515–520.doi: 10.1136/vr.103862 

Russell DSOUZA¹
Dr. Princy Louis Palatty², Mary Mathew³ and Krishna Mohan Surapaneni⁴
1 International Chair/ UNESCO Chair in Bioethics
2 Amrita School of Medicine, Amrita Institute of Medical Sciences
3 Kasturba Medical College
4 Panimalar Medical College Hospital & Research Institute 

Medical ethics education is complex and requires a degree of moral reasoning. A strong foundation of bioethics principles is warranted. Imbibing the principles, applying them in real- time situations and deciding the best possible outcome weighs heavily upon the physician practising it. Teaching bioethics to undergraduates involves unfolding many layers of concepts through innovative teaching methods. It involves exploring various concepts of philosophy, ethics, and health law. Conventionally students' ethical learning was related to the role modelling of teaching faculty offering nonspecific learning that was considered to be the hidden curriculum. The evolving bioethics curriculum attempts to remodel teaching-learning methodologies. All educational courses rely on an effective and reliable mode of assessment. Thus, the rational solution to overcome this challenge is a multimodal assessment approach with documentation over the continuum. Assessment of bioethics competencies in students has challenged the affective domain. The crux of the problem lies in assessing the internalization of ethical principles related to the affective domain. For medical students who took part in the bioethics education curriculum, a designed logbook was used as an instrument for formative assessments of bioethics competencies achieved from the bioethics education in the continuum. A study was implemented to evaluate the reliability of this instrument in assessing bioethics competencies in medical students who took part in the bioethics curriculum of the medical education program. One hundred fifty students from first- and second-year batches and 100 from third- and fourth-year batches were included for interim evaluation. The evaluation of the logbook as an effective assessment tool was evaluated for validity, reliability, feasibility, and reproducibility. The use of Miller’s pyramid of the levels of attitudinal changes and Krathwohl’s affective domain of learning were used for the evaluation. 

References (maximum three) 

Schüttpelz-Brauns K, Narciss E, Schneyinck C, Böhme K, Brüstle P, Mau-Holzmann U, Lammerding-Koeppel M, Obertacke U. Twelve tips for successfully implementing logbooks in clinical training. Med Teach. 2016 Jun;38(6):564-9. doi: 10.3109/0142159X.2015.1132830. Epub 2016 Feb 3. PMID: 26841068; PMCID: PMC4926785. 

Banta, T. W. (2003). Introduction: Why portfolios? Porfolio assessment: Uses, cases, scoring, and impact. San Francisco, CA: Jossey-Bass. 

Paulson, P. R., &amp; Paulson F. L. (1991, March). Portfolios: Stories of knowing. Paper presented at the 54th annual meeting of the Claremont Reading Conference (No. ED377209). 

Mary Mathew¹
Russell DSOUZA², Dr. Princy Louis Palatty³ and Krishna Mohan Surapaneni⁴
1 Kasturba Medical College
2 International Chair/ UNESCO Chair in Bioethics
3 Amrita School of Medicine, Amrita Institute of Medical Sciences
4 Panimalar Medical College Hospital & Research Institute 

Bioethics encompasses various disciplines like ethics, medicine, research, and law. It serves as a moral compass for physicians, researchers, and lawmakers. A deep understanding of bioethics principles is mandatory for the effective functioning and delivery of healthcare services. Bioethics training begins from the commencement of any professional healthcare course. The current age records immense technological advances. Using technology to monitor and assess the progress of bioethics education-related competencies being achieved. The electronic portfolio (e-portfolio) is a collection of the student's work, highlighting a student’s learning progress. It is a demonstration of their achievement and evidence of the body of their bioethics education during the period of study. This includes text-based essays, recordings of demonstrations, presentations, and interviews. Assessment of bioethics is a challenge due to the multiple domains of competencies that are to be assessed. In the ePortfolio, the students select their representative work, reflect, and introspect on what they have internalized and, in the process, arrive at conclusions that they have derived from their bioethics education interwoven with experience. The purpose of an e-portfolio is to evaluate and monitor the effectiveness of bioethics education and the student’s achievement, which can be tracked, and their progress evaluated. This enables maintaining a progress graph of each student, which can be assessed. 150 students, each from first, and second-year batches of medical undergraduates took part in the evaluation using e-portfolio as an assessment tool in bioethics education. This presentation will discuss the evaluation of the e-portfolio used for formative assessment of bioethics competencies gained in the affective, cognitive and psychomotor domains. The results offered evidence of their performance, highlighting their progress towards attaining the learning objectives. 

References (maximum three) 

Banta, T. W. (2003). Introduction: Why portfolios? Porfolio assessment: Uses, cases, scoring, and impact. San Francisco, CA: Jossey-Bass. 

Paulson, P. R., & Paulson F. L. (1991, March). Portfolios: Stories of knowing. Paper presented at the 54th annual meeting of the Claremont Reading Conference (No. ED377209). 

Baghbani R, Rakhshan M, Zarifsanaiey N, Nemati R, Daneshi S. Comparison of the effectiveness of the electronic portfolio and online discussion forum methods in teaching professional belonging and ethical behaviors to nursing students: a randomized controlled trial. BMC Med Educ. 2022 Aug 15;22(1):618. doi: 10.1186/s12909-022-03677-0. PMID: 35965313; PMCID: PMC9376119. 

Catherine Hale¹
1 University of Warwick

Phronesis or practical wisdom is a concept of making ethically wise decisions informed by accumulated collective wisdom gained through previous practice dilemmas and decisions. This paper responds to a call from medical practice to be provided with the means to apply phronesis to their decision-making and appropriately assess that ability. In responding to this call, research collected narratives of doctors’ in answer to the question: What does it means for doctors to make ethically wise decisions for patients and their communities and how is it possible to assess this? 

This is the first empirical study of self-assessment and reflection of wise decision making by Drs, a UK AHRC funded three-year project. 131 Drs/medical students were interviewed, and in-depth analyses of their self-assessment and reflection conducted to understand the virtues underpinning medical wisdom. The interviewees were at different career stages and we used a semi-structured, qualitative methodology. Interviews took up to 45 minutes and were them transcribed and analysed using both manual coding and NVivo. 

From this the fifteen virtue continua appear to underpin the professional ethical decision- making systems that Drs use to make wise decisions and also to self-assess, utilise dialogical learning and reflect upon ethical decisions made. The research reveals that experience alone does not make doctors wise, it is the process of self-assessment, reflection, and peer dialogue with experience or simulated experience that leads to higher level decision making. 

The fifteen virtue continua that emerged are conveyed in a seven-part film series and app- available on phronesis website. This paper provides evidence that phronesis can be cultivated through reflection and self and peer assessment as well as dialogue based on a three-year evaluation of this unique research. 

References (maximum three) 

Conroy M, Malik A, Hale C, et al (2021) Using practical wisdom to facilitate ethical decision- making: a major empirical study of phronesis in the decision narratives of doctors BMC Medical Ethics 22, Article number 16 (2021) DOI: https://doi.org/10.1186/s12910-021-00581- y 

Malik A, Weir C, Conroy M, Hale C & Turner C (2020) Phronesis and the Medical Community Follow-on Impact and Engagement Project. AHRC Final Report and UoB publication 51 pages 

https://www.birmingham.ac.uk/Documents/college-social-sciences/social- policy/phronesis/impact-assessment-phronesis.pdf 

Conroy M, Malik A, Weir C, Hale C, et al (2018) Phronesis in Medical Decision Making: Medical Leadership, Virtue Ethics and Practical Wisdom. AHRC Final Report and UoB publication 180 pages 

https://www.birmingham.ac.uk/Documents/college-social-sciences/social- policy/phronesis/phronesis-in-medical-decision-making.pdf 

Hale C (2018) The Phronesis Foundation Teaching Resources- Tutor Notes and Student Guide: Teaching Materials for Ethical Wise Decisions in Medicine- Available to subscribing institutions, companies and individuals at https://www.thephronesisfoundation.com/