Launching the ACE

IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Australian & New Zealand Journal of Obstetrics & Gynaecology Pub Date : 2024-07-24 DOI:10.1111/ajo.13866
Katrina Calvert, Sarah Janssens, Ian Symonds
{"title":"Launching the ACE","authors":"Katrina Calvert,&nbsp;Sarah Janssens,&nbsp;Ian Symonds","doi":"10.1111/ajo.13866","DOIUrl":null,"url":null,"abstract":"<p>Much focus has been placed on optimising training in obstetrics and gynaecology, with redesign of accreditation standards, expansion of training sites, curriculum reviews and the ever-present dilemma around appropriate surgical numbers for trainee logbooks. However, the time has come to consider the role of the unsung heroes of the training experience – the trainers. At the 2023 Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Annual Scientific Meeting in Perth, a group of interested Fellows, Proceduralists, Trainees and College staff met to workshop what a RANZCOG Community of Practice for educators might look like. The discussion centred around the potential aims of such a group, its purpose, and of course – its name. Thus was born the RANZCOG Academy of Clinician Educators – the ACE. The ACE was formally launched by RANZCOG President Dr Gillian Gibson at the RANZCOG Symposium in the Sunshine Coast in July 2024, and will be hosting its opening webinar on the subject of ‘What makes a good medical teacher?’ on 22 August.</p><p>The aims of the ACE born out of that first meeting in Perth are fourfold: (1) to foster excellence in medical education; (2) to provide professional development opportunities for medical educators through RANZCOG; (3) to promote sharing of resources and collaboration between education providers and the College; and (4) to create networking and support opportunities for current medical educators and for those with an interest in the area (Fig. 1).</p><p>To foster excellence in education we need to know what that looks like: what are the essential competencies for a medical educator in our speciality? The literature identifies multiple competency domains, with good concordance between different authors on the subject.<span><sup>1-3</sup></span> The consensus is that excellence in medical education comprises skills or attributes in the following five areas: teaching and facilitating learning, designing and planning learning, assessment and feedback, educational research and scholarship, and educational leadership. If the ACE are to accept and promote those five competencies, we must first understand them, including understanding how they are applicable to clinician educators in our own speciality of obstetrics and gynaecology. Let us consider them in turn, starting with the most obvious competency area for an educator – that of teaching and facilitating learning.</p><p>How to define competency in teaching is surprisingly difficult within the medical field, as there seem to be opposing views on whether clinical expertise is more important than the non-clinical skills associated with teaching when it comes to medical education. In 2008, Sutkin <i>et al</i> published a literature review on the subject ‘What makes a good clinical teacher in medicine?’.<span><sup>4</sup></span> Sutkin identified 49 separate themes arising from analysis of the literature. The dominant theme was ‘Medical/clinical knowledge’ followed by ‘Clinical and technical skills/competence, clinical reasoning’. ‘Positive relationships with students and positive learning environment’ and ‘Communication skills’ were less dominant themes in Sutkin's literature review. Finn <i>et al</i> take a different stance, arguing that the non-cognitive traits of relationship skills, engagement with learners, and the creation of a safe but exciting interactive environment are the most important skills for a clinical teacher.<span><sup>5</sup></span> Singh <i>et al</i> bridged the gap between Sutkin and Finn, in their 2013 survey of clinical academics, finding that the top three most desirable characteristics of a medical educator were knowledge of subject, enthusiasm and communication skills.<span><sup>6</sup></span></p><p>If we can agree on the traits of an obstetrician and gynaecologist that make them a skilled educator, how will we know if our ACE members demonstrate those traits? Assessment of teaching traditionally relies on student or learner ratings, but these are known to be subject to bias and confounders. Junior medical staff appear to use surrogate markers of knowledge or expertise in their evaluation of surgical teachers, as illustrated in a 1991 paper by Tortolani <i>et al</i>.<span><sup>7</sup></span> Twenty-three general surgery residents evaluated 62 senior surgeons using a ten-item Likert scale rating. Senior doctors who performed more surgeries, attended more department meetings, and published more research reports were more likely to receive higher ratings as faculty, while seniors whose patients required longer hospital stays, or who had higher rates of complications from their surgeries were more likely to receive unfavourable ratings. The authors concluded ‘excellence in patient care and activity in teaching and research, although not necessarily related, characterise the superior surgical educator.’ There is some evidence that RANZCOG trainees also perceive a relationship between clinical and teaching expertise. In a 2009 survey, consultants who were supervising during operations dealing with complications were least likely to be rated as excellent teachers when compared to supervisors teaching during general obstetric, abdominal, vaginal or laparoscopic procedures.<span><sup>8</sup></span> An explanation for the relationship between perceptions of clinical and teaching expertise is the ‘halo effect’, whereby raters give higher scores to teachers with whom they have a good relationship, with high scores in one area positively impacting ratings in another.<span><sup>9</sup></span> One of the most successful ways to improve learner ratings (as per randomised controlled trial evidence), is to provide chocolate cookies to the learners.<span><sup>10</sup></span> Clearly more meaningful ways of evaluating teacher performance need to be found.</p><p>In faculty development terms, the solution to the problem of providing meaningful feedback on teaching performance possibly lies in the use of multiple rating tools by multiple raters, in addition to focused self-reflection for the improvement of teaching skills by junior educators.<span><sup>11</sup></span> Peer observation of teaching can be a powerful tool to aid reflection and guide faculty development.<span><sup>12</sup></span> In order to achieve the first goal of the ACE, fostering excellence in medical education, the ACE website therefore links users to faculty development tools that can be used by novice or experienced teachers. The tools can be used for learner ratings, as peer observation tools or as self-assessment tools in the setting of bedside clinical teaching, or in small group teaching sessions. They aim to provoke and support self-reflection and to aid in skill development in teaching.</p><p>Designing and planning learning is an endeavour that occurs at local, state, and national levels, with curriculum development an ongoing area of focus for the College in 2024 and 2025. The current focus for curriculum development is on advanced training, including the formation of a new training pathway for rural specialists. Multiple opportunities exist to get involved with curriculum development, including via the College website where feedback on the 4th edition of the FRANZCOG Curriculum can be given via email as a ‘live’ process.<span><sup>13</sup></span> The encouragement of active feedback and participation in curriculum planning allows all Fellows and trainees to participate in, and thereby learn more about, this critical area of medical education. The inclusion of curriculum design into the mandatory units of the Education Advanced Training Module is in acknowledgement of the importance of this as a foundational skill for a clinical educator.</p><p>The third medical education competency area, assessment and feedback, comprises a critical element of the practice of a clinician educator, with adequate feedback provision a clear enabler of clinical competency development for RANZCOG trainees.<span><sup>14</sup></span> The problem with feedback in medicine is that it has the potential to be rejected, or even to be harmful to the performance of the recipient if delivered in a way which is unsafe, threatens self-esteem or lacks credibility.<span><sup>15</sup></span> Our system of three- and six-monthly feedback provision can lead to a major erosion of credibility as feedback is commonly given separately to the event, and by an individual acting through hearsay and second-hand information rather than as a result of personal, near-contemporaneous observation.<span><sup>15</sup></span> Giving on-the-spot feedback is more likely to be credible but is challenging to do safely in our fast-paced clinical environments. Indeed, as newly minted Fellows, even our sub-speciality trained junior consultants may lack confidence in feedback provision and balancing of teaching with clinical commitments.<span><sup>16</sup></span> The ACE website includes links to online resources which members can use to improve skills in feedback provision. The implementation of mini-Clinical Evaluation Exercise assessments is likely to provide opportunities for supervisors to hone feedback skills which may be transferrable to other areas of our education practice as we start to embed feedback into our daily practice with trainees.</p><p>While even the most skilled clinical educator might be competent with teaching, educational design, assessment, and feedback, what of educational research skills? Nuthalapaty <i>et al</i> provide an excellent introduction to research practice and methodology in their 2012 article, ‘To the point: a primer on medical education research’.<span><sup>17</sup></span> Educational research frameworks are similar to those used in clinical research. Most concepts, such as the use of the PICO (patient/population, intervention, comparison and outcomes) framework to design and interrogate a research question, or the use of a standardised rubric in journal club discussions, can be transferred painlessly into medical education research. The ACE website provides just such a journal club rubric, and it is hoped that users will find that their familiarity with the medical education literature will rapidly grow alongside their ambition to add to it. Using these resources will also encourage networking and connecting to peers with an interest in medical education – another major goal of the ACE.</p><p>Lastly, but not of least importance, the fifth competency area of leadership in education is required for RANZCOG to achieve a sustainable future in the provision of training. In their 2022 article Ruge, Pedroarena-Leal, and Trenado mount a passionate and powerful argument based in ‘dignity neuroscience’ for the importance of good leadership, stating that ‘<i>It is not affordable to waste the dignity and talent, skill and insight, knowledge and valuable lifetime of one person’</i> through the consequences of poor leadership and bad decision-making in medical education.<span><sup>18</sup></span> Faculty development programs in leadership in medical education have been shown to promote gains in leadership skills and positive changes in leadership behaviour.<span><sup>19</sup></span> Such a program can be accessed via the Academic Leaders Institute, the link to which can be found on the ACE website.<span><sup>20</sup></span> The Academic Leaders Institute defines visionary leadership in medical education as including the ability to ‘embrace a possibility mentality’, to ‘anticipate the future of the discipline’ and to ‘reflect the culture of service leadership with heart for and willingness to serve’ – lofty ideals indeed and ones to which the members of the ACE can certainly aspire.</p><p>The aims of the ACE are clearly broad, its scope undeniably ambitious. But to whom should we entrust the vaulting ambitions of our speciality, if not its educators? For too long we have accepted that teaching has been a second thought, coming far behind clinical care on our daily priority list. It is time that we celebrated our clinician educators as the most important asset we have, investing as they do in the future of our profession. The ACE will take a central role in coordinating activities, curating resources, fostering collaboration, and raising the bar for all of us in this vital endeavour. You are all already doing amazing work in teaching, training, and supporting learners every day. Welcome to the ACE, you are already a member.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"64 4","pages":"305-307"},"PeriodicalIF":1.4000,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13866","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Australian & New Zealand Journal of Obstetrics & Gynaecology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ajo.13866","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Much focus has been placed on optimising training in obstetrics and gynaecology, with redesign of accreditation standards, expansion of training sites, curriculum reviews and the ever-present dilemma around appropriate surgical numbers for trainee logbooks. However, the time has come to consider the role of the unsung heroes of the training experience – the trainers. At the 2023 Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Annual Scientific Meeting in Perth, a group of interested Fellows, Proceduralists, Trainees and College staff met to workshop what a RANZCOG Community of Practice for educators might look like. The discussion centred around the potential aims of such a group, its purpose, and of course – its name. Thus was born the RANZCOG Academy of Clinician Educators – the ACE. The ACE was formally launched by RANZCOG President Dr Gillian Gibson at the RANZCOG Symposium in the Sunshine Coast in July 2024, and will be hosting its opening webinar on the subject of ‘What makes a good medical teacher?’ on 22 August.

The aims of the ACE born out of that first meeting in Perth are fourfold: (1) to foster excellence in medical education; (2) to provide professional development opportunities for medical educators through RANZCOG; (3) to promote sharing of resources and collaboration between education providers and the College; and (4) to create networking and support opportunities for current medical educators and for those with an interest in the area (Fig. 1).

To foster excellence in education we need to know what that looks like: what are the essential competencies for a medical educator in our speciality? The literature identifies multiple competency domains, with good concordance between different authors on the subject.1-3 The consensus is that excellence in medical education comprises skills or attributes in the following five areas: teaching and facilitating learning, designing and planning learning, assessment and feedback, educational research and scholarship, and educational leadership. If the ACE are to accept and promote those five competencies, we must first understand them, including understanding how they are applicable to clinician educators in our own speciality of obstetrics and gynaecology. Let us consider them in turn, starting with the most obvious competency area for an educator – that of teaching and facilitating learning.

How to define competency in teaching is surprisingly difficult within the medical field, as there seem to be opposing views on whether clinical expertise is more important than the non-clinical skills associated with teaching when it comes to medical education. In 2008, Sutkin et al published a literature review on the subject ‘What makes a good clinical teacher in medicine?’.4 Sutkin identified 49 separate themes arising from analysis of the literature. The dominant theme was ‘Medical/clinical knowledge’ followed by ‘Clinical and technical skills/competence, clinical reasoning’. ‘Positive relationships with students and positive learning environment’ and ‘Communication skills’ were less dominant themes in Sutkin's literature review. Finn et al take a different stance, arguing that the non-cognitive traits of relationship skills, engagement with learners, and the creation of a safe but exciting interactive environment are the most important skills for a clinical teacher.5 Singh et al bridged the gap between Sutkin and Finn, in their 2013 survey of clinical academics, finding that the top three most desirable characteristics of a medical educator were knowledge of subject, enthusiasm and communication skills.6

If we can agree on the traits of an obstetrician and gynaecologist that make them a skilled educator, how will we know if our ACE members demonstrate those traits? Assessment of teaching traditionally relies on student or learner ratings, but these are known to be subject to bias and confounders. Junior medical staff appear to use surrogate markers of knowledge or expertise in their evaluation of surgical teachers, as illustrated in a 1991 paper by Tortolani et al.7 Twenty-three general surgery residents evaluated 62 senior surgeons using a ten-item Likert scale rating. Senior doctors who performed more surgeries, attended more department meetings, and published more research reports were more likely to receive higher ratings as faculty, while seniors whose patients required longer hospital stays, or who had higher rates of complications from their surgeries were more likely to receive unfavourable ratings. The authors concluded ‘excellence in patient care and activity in teaching and research, although not necessarily related, characterise the superior surgical educator.’ There is some evidence that RANZCOG trainees also perceive a relationship between clinical and teaching expertise. In a 2009 survey, consultants who were supervising during operations dealing with complications were least likely to be rated as excellent teachers when compared to supervisors teaching during general obstetric, abdominal, vaginal or laparoscopic procedures.8 An explanation for the relationship between perceptions of clinical and teaching expertise is the ‘halo effect’, whereby raters give higher scores to teachers with whom they have a good relationship, with high scores in one area positively impacting ratings in another.9 One of the most successful ways to improve learner ratings (as per randomised controlled trial evidence), is to provide chocolate cookies to the learners.10 Clearly more meaningful ways of evaluating teacher performance need to be found.

In faculty development terms, the solution to the problem of providing meaningful feedback on teaching performance possibly lies in the use of multiple rating tools by multiple raters, in addition to focused self-reflection for the improvement of teaching skills by junior educators.11 Peer observation of teaching can be a powerful tool to aid reflection and guide faculty development.12 In order to achieve the first goal of the ACE, fostering excellence in medical education, the ACE website therefore links users to faculty development tools that can be used by novice or experienced teachers. The tools can be used for learner ratings, as peer observation tools or as self-assessment tools in the setting of bedside clinical teaching, or in small group teaching sessions. They aim to provoke and support self-reflection and to aid in skill development in teaching.

Designing and planning learning is an endeavour that occurs at local, state, and national levels, with curriculum development an ongoing area of focus for the College in 2024 and 2025. The current focus for curriculum development is on advanced training, including the formation of a new training pathway for rural specialists. Multiple opportunities exist to get involved with curriculum development, including via the College website where feedback on the 4th edition of the FRANZCOG Curriculum can be given via email as a ‘live’ process.13 The encouragement of active feedback and participation in curriculum planning allows all Fellows and trainees to participate in, and thereby learn more about, this critical area of medical education. The inclusion of curriculum design into the mandatory units of the Education Advanced Training Module is in acknowledgement of the importance of this as a foundational skill for a clinical educator.

The third medical education competency area, assessment and feedback, comprises a critical element of the practice of a clinician educator, with adequate feedback provision a clear enabler of clinical competency development for RANZCOG trainees.14 The problem with feedback in medicine is that it has the potential to be rejected, or even to be harmful to the performance of the recipient if delivered in a way which is unsafe, threatens self-esteem or lacks credibility.15 Our system of three- and six-monthly feedback provision can lead to a major erosion of credibility as feedback is commonly given separately to the event, and by an individual acting through hearsay and second-hand information rather than as a result of personal, near-contemporaneous observation.15 Giving on-the-spot feedback is more likely to be credible but is challenging to do safely in our fast-paced clinical environments. Indeed, as newly minted Fellows, even our sub-speciality trained junior consultants may lack confidence in feedback provision and balancing of teaching with clinical commitments.16 The ACE website includes links to online resources which members can use to improve skills in feedback provision. The implementation of mini-Clinical Evaluation Exercise assessments is likely to provide opportunities for supervisors to hone feedback skills which may be transferrable to other areas of our education practice as we start to embed feedback into our daily practice with trainees.

While even the most skilled clinical educator might be competent with teaching, educational design, assessment, and feedback, what of educational research skills? Nuthalapaty et al provide an excellent introduction to research practice and methodology in their 2012 article, ‘To the point: a primer on medical education research’.17 Educational research frameworks are similar to those used in clinical research. Most concepts, such as the use of the PICO (patient/population, intervention, comparison and outcomes) framework to design and interrogate a research question, or the use of a standardised rubric in journal club discussions, can be transferred painlessly into medical education research. The ACE website provides just such a journal club rubric, and it is hoped that users will find that their familiarity with the medical education literature will rapidly grow alongside their ambition to add to it. Using these resources will also encourage networking and connecting to peers with an interest in medical education – another major goal of the ACE.

Lastly, but not of least importance, the fifth competency area of leadership in education is required for RANZCOG to achieve a sustainable future in the provision of training. In their 2022 article Ruge, Pedroarena-Leal, and Trenado mount a passionate and powerful argument based in ‘dignity neuroscience’ for the importance of good leadership, stating that ‘It is not affordable to waste the dignity and talent, skill and insight, knowledge and valuable lifetime of one person’ through the consequences of poor leadership and bad decision-making in medical education.18 Faculty development programs in leadership in medical education have been shown to promote gains in leadership skills and positive changes in leadership behaviour.19 Such a program can be accessed via the Academic Leaders Institute, the link to which can be found on the ACE website.20 The Academic Leaders Institute defines visionary leadership in medical education as including the ability to ‘embrace a possibility mentality’, to ‘anticipate the future of the discipline’ and to ‘reflect the culture of service leadership with heart for and willingness to serve’ – lofty ideals indeed and ones to which the members of the ACE can certainly aspire.

The aims of the ACE are clearly broad, its scope undeniably ambitious. But to whom should we entrust the vaulting ambitions of our speciality, if not its educators? For too long we have accepted that teaching has been a second thought, coming far behind clinical care on our daily priority list. It is time that we celebrated our clinician educators as the most important asset we have, investing as they do in the future of our profession. The ACE will take a central role in coordinating activities, curating resources, fostering collaboration, and raising the bar for all of us in this vital endeavour. You are all already doing amazing work in teaching, training, and supporting learners every day. Welcome to the ACE, you are already a member.

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启动 ACE。
随着评审标准的重新制定、培训基地的扩大、课程的审查以及始终存在的关于学员日志中适当手术数量的难题,妇产科培训的优化已成为关注的焦点。然而,现在到了考虑培训经历中的无名英雄--培训师的作用的时候了。在珀斯举行的2023年澳大利亚和新西兰皇家妇产科医学院(RANZCOG)年度科学会议上,一群感兴趣的研究员、手术医师、受训人员和学院工作人员聚集在一起,讨论RANZCOG教育工作者实践社区的发展前景。讨论主要围绕这样一个团体的潜在目标、宗旨,当然还有它的名称。于是,新西兰皇家妇产科学会临床教育工作者学院(ACE)应运而生。2024 年 7 月,在阳光海岸举行的兰新理事会研讨会上,兰新理事会主席吉莉安-吉布森(Gillian Gibson)博士正式宣布成立 ACE,并将于 8 月 22 日举办主题为 "如何成为一名优秀的医学教师?在珀斯举行的首次会议上,ACE 提出了四项目标:(1) 促进卓越医学教育;(2) 通过新西兰皇家医学院为医学教育工作者提供专业发展机会;(3) 促进教育机构与学院之间的资源共享与合作;(4) 为当前的医学教育工作者以及对该领域感兴趣的人员创造交流和支持机会(图 1)。1-3 目前的共识是,卓越医学教育包括以下五个方面的技能或特质:教学和促进学习、设计和规划学习、评估和反馈、教育研究和学术研究以及教育领导力。如果 ACE 要接受并推广这五种能力,我们必须首先了解它们,包括了解它们如何适用于我们妇产科专业的临床教育工作者。在医学领域,如何定义教学能力出乎意料地困难,因为在医学教育中,临床专业知识是否比与教学相关的非临床技能更重要,似乎存在相反的观点。2008 年,Sutkin 等人发表了一篇关于 "怎样才能成为一名优秀的医学临床教师 "的文献综述。最主要的主题是 "医学/临床知识",其次是 "临床和技术技能/能力、临床推理"。在 Sutkin 的文献综述中,"与学生的积极关系和积极的学习环境 "和 "沟通技巧 "是不太主要的主题。Finn 等人采取了不同的立场,认为关系技巧、与学习者的互动以及创造安全而又令人兴奋的互动环境等非认知特质是临床教师最重要的技能。辛格等人在 2013 年对临床学者进行的调查中发现,医学教育者最理想的三大特征是学科知识、热情和沟通技巧。6 如果我们能就妇产科医生成为熟练教育者的特征达成一致,那么我们如何知道我们的 ACE 成员是否展现了这些特征?对教学的评估传统上依赖于学生或学员的评分,但众所周知,这些评分存在偏差和混杂因素。正如 Tortolani 等人在 1991 年发表的一篇论文7 中所述,初级医务人员在评价外科教师时似乎会使用知识或专业技能的替代标记。做过更多手术、参加过更多科室会议、发表过更多研究报告的资深医生更有可能获得较高的教师评分,而病人需要更长时间住院或手术并发症发生率较高的资深医生则更有可能获得较差的评分。作者总结道:"卓越的病人护理和教学科研活动虽然没有必然联系,但却是优秀外科教育者的特征。有证据表明,新西兰皇家妇产科学院的学员也认为临床和教学专长之间存在关系。
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来源期刊
CiteScore
3.40
自引率
11.80%
发文量
165
审稿时长
4-8 weeks
期刊介绍: The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.
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