Introduction The expanded use of Entrustable Professional Activities in medical education has led to a call to address concerns about implementation challenges and the validity of this framework for assessment. The use of well-trained, designated assessors (DAs) who not only provide feedback to learners but also participate in summative decision-making about learners' competency is one approach to address these issues. The lived experience of faculty who serve in this role within a program of assessment, including their beliefs and practices, has not been described in the literature. This study examines the experiences of designated assessors at a single institution, concentrating on their dual roles as formative assessors and summative decision-makers. Methods The experiences of designated assessors were explored using an interpretivist phenomenological approach. All DAs at one institution were invited to participate in the study. Interviews were recorded and transcribed verbatim. The interview guide was designed to investigate various aspects of the DA experience. An iterative process of content analysis, careful consideration of participants' statements, and memoing ultimately yielded three themes. Results Six of eight eligible participants were interviewed. Three themes were developed from in-depth interpretation, which inform the designated assessor's experience. These interpretations center on role enactment, community meaning-making, and the identification of struggling learners. Discussion Designated Assessors provided rich descriptions of their processes, shared experiences, and meaning they derive from these experiences. The DAs experience the unique assessor community they are building, the consequential nature of the assessments, and the high-quality assessment data they provide as valuable to learners and those who support them.

BACKGROUND:Medical students can experience a range of academic and non-academic struggles. Coaching is a valuable strategy to support learners, but coaches describe working with struggling learners as taxing. Transformative learning theory (TLT) provides insights into how educators grow from challenging experiences to build resilience. This study explores how coaches evolve as educators through supporting struggling students. METHODS:This qualitative study grounded in an interpretivist paradigm used interviews of longitudinal medical student coaches at two academic institutions. Interviews, using TLT as a sensitizing concept, explored coaches' experience coaching struggling learners. We performed thematic analysis. RESULTS:We interviewed 15 coaches. Coaches described supporting students through multi-faceted struggles which often surprised the coach. Three themes characterized coaches' experiences: personal responsibility, emotional response, and personal learning. Coaches shouldered high personal responsibility for learners' success. For some, this burden felt emotional, raised parental instincts and questions about maintaining boundaries with learners. Coaches evolved their coaching approach, challenged biases, and built skills. Coaches learned to better appreciate the learner point of view and employ resources to support students. DISCUSSION:Through navigating learner struggles, educators can gain self-efficacy, learn to understand learners' perspectives, and evolve their coaching approach to lessen their personal emotional burden through time.

BACKGROUND:Assessment of the Core Entrustable Professional Activities for Entering Residency requires direct observation through workplace-based assessments (WBAs). Single-institution studies have demonstrated mixed findings regarding the reliability of WBAs developed to measure student progression towards entrustment. Factors such as faculty development, rater engagement and scale selection have been suggested to improve reliability. The purpose of this investigation was to conduct a multi-institutional generalisability study to determine the influence of specific factors on reliability of WBAs. METHODS:The authors analysed WBA data obtained for clerkship-level students across seven institutions from 2018 to 2020. Institutions implemented a variety of strategies including selection of designated assessors, altered scales and different EPAs. Data were aggregated by these factors. Generalisability theory was then used to examine the internal structure validity evidence of the data. An unbalanced cross-classified random-effects model was used to decompose variance components. A phi coefficient of >0.7 was used as threshold for acceptable reliability. RESULTS:Data from 53 565 WBAs were analysed, and a total of 77 generalisability studies were performed. Most data came from EPAs 1 (n = 17 118, 32%) 2 (n = 10 237, 19.1%), and 6 (n = 6000, 18.5%). Low variance attributed to the learner (<10%) was found for most (59/77, 76%) analyses, resulting in a relatively large number of observations required for reasonable reliability (range = 3 to >560, median = 60). Factors such as DA, scale or EPA were not consistently associated with improved reliability. CONCLUSION:The results from this study describe relatively low reliability in the WBAs obtained across seven sites. Generalisability for these instruments may be less dependent on factors such as faculty development, rater engagement or scale selection. When used for formative feedback, data from these instruments may be useful. However, such instruments do not consistently provide reasonable reliability to justify their use in high-stakes summative entrustment decisions.

This novel application of the Objective Structured Teaching Exercise (OSTE) was done to enhance tutors’ skills as valued members of our integrated academic support program. The OSTE provided feedback to the tutors and enabled us to identify a need for enhanced tutor training in active learning strategies. The OSTE can be adapted for use in other health science educational programs to enhance their training programs and to assess tutor’s skills in preparation for their role.

Purpose: Leadership development programs often use institutional projects to activate learning. We explored how project work shaped leadership identity formation in senior women leaders from one academic health science center who enrolled in The Hedwig von Ameringen Executive Leadership in Academic Medicine (ELAM (R)) program. Materials and methods: We interviewed ELAM Fellows and conducted a qualitative analysis of transcripts. Our primary analysis focused on the influences of projects on Fellows and institutions. Leadership identity formation emerged as a distinct pattern, so this narrative content was separated for secondary analysis. All authors approved the final assignment of themes and codes. Results: Participants described a multi-dimensional process for developing a leadership identity. Themes encompassed participants' View of Self and One's Image as a Leader, Interpersonal Relationships, and Commitment to a Value-based Goal. These internal factors grounded external influences, such as interactions with colleagues and institutional leaders, and the world beyond the institution. Conclusions: We examined the process of leadership identity formation from the perspective of women leaders in academic health sciences who completed an institutional project during a leadership development program. Findings illustrate how internal and external forces, experienced in the context of project work, combine to influence leadership identity formation in women.

Problem The rapid expansion of entrustable professional activity (EPA) assessment programs has led to calls to ensure fidelity in implementation and integrity in meeting the goals of competency-based medical education. Initiated in July 2017, in advance of the articulated core components of EPA implementation, this article describes the structure and outcomes of the University of Virginia (UVA) EPA Program and provides support for the identified essential components. Approach The UVA EPA Program includes workplace assessments by residents/fellows, attending faculty, and master assessors (MAs), experienced clinicians who assess students across disciplines and clinical settings. All assessors participate in formal professional development and provide verbal and written comments to support their supervision ratings. The Entrustment Committee, composed of 12 MAs, uses a shared mental model and aggregates all assessor data to make a high-stakes summative entrustment decision about students' readiness to assume the role of an acting intern. Outcomes Since 2017, over 2,000 assessors have completed 56,969 EPA assessments for 1,479 students. Ninety-four percent of assessments have been done during the clerkship phase. Residents/fellows have completed a mean of 18 assessments, attending faculty a mean of 27, and MAs a mean of 882. Seventy-four percent of observed encounters involved patients with acute concerns with or without a co-morbid condition. Fifty percent of assessments occurred in inpatient and 32% in ambulatory settings. Eighty-seven percent of assessments contained narrative comments with more than 100 characters. Next Steps Planned next steps will include earlier identification of students who require individualized learning to promote the development of skills related to EPAs, expansion of the remediation program to enable more students to engage in a clinical performance mastery elective, and creation of targeted professional development for assessors to reinforce the tenets of the EPA program.

BACKGROUND:Use of EPA-based entrustment-supervision ratings to determine a learner's readiness to assume patient care responsibilities is expanding.OBJECTIVE:In this study, we investigate the correlation between narrative comments and supervision ratings assigned during ad hoc assessments of medical students' performance of EPA tasks.DESIGN:Data from assessments completed for students enrolled in the clerkship phase over 2 academic years were used to extract a stratified random sample of 100 narrative comments for review by an expert panel.PARTICIPANTS:A review panel, comprised of faculty with specific expertise related to their roles within the EPA program, provided a "gold standard" supervision rating using the comments provided by the original assessor.MAIN MEASURES:Interrater reliability (IRR) between members of review panel and correlation coefficients (CC) between expert ratings and supervision ratings from original assessors.KEY RESULTS:IRR among members of the expert panel ranged from .536 for comments associated with focused history taking to .833 for complete physical exam. CC (Kendall's correlation coefficient W) between panel members' assignment of supervision ratings and the ratings provided by the original assessors for history taking, physical examination, and oral presentation comments were .668, .697, and .735 respectively. The supervision ratings of the expert panel had the highest degree of correlation with ratings provided during assessments done by master assessors, faculty trained to assess students across clinical contexts. Correlation between supervision ratings provided with the narrative comments at the time of observation and supervision ratings assigned by the expert panel differed by clinical discipline, perhaps reflecting the value placed on, and perhaps the comfort level with, assessment of the task in a given specialty.CONCLUSIONS:To realize the full educational and catalytic effect of EPA assessments, assessors must apply established performance expectations and provide high-quality narrative comments aligned with the criteria.

In this chapter, we focus on functional mentoring, a form of dyadic mentoring in which a mentee partners with a mentor with specific expertise in order to address a particular mentoring need (Thorndyke et al., 2008). The focus of a functional mentoring relationship is often working on a project that may provide the opportunity for collaboration (Gusic, Milner, et al., 2010). While functional mentoring typically occurs between one mentor and one mentee, this dyadic team can exist within a constellation of an individual’s mentoring relationships (Aylor et al., 2016; Balmer et al., 2011; Christou et al., 2017; DeCastro et al., 2013). Functional mentoring is also a structure that aligns with the principles outlined by Kram and Higgins in their description of developmental networks in which personal and professional relationships evolve over time as the individual’s needs for support change (Higgins, 2001).

Background Entrustable professional activities (EPAs) have been introduced as a framework for teaching and assessment in competency-based educational programs. With growing use, has come a call to examine the validity of EPA assessments. We sought to explore the correlation of EPA assessments with other clinical performance measures to support use of supervision ratings in decisions about medical students' curricular progression. Methods Spearman rank coefficients were used to determine correlation of supervision ratings from EPA assessments with scores on clerkship evaluations and performance on an end-of-clerkship-year Objective Structured Clinical Examination (CPX). Results Both overall clinical evaluation items score (rho 0.40; n = 166) and CPX patient encounter domain score (rho 0.31; n = 149) showed significant correlation with students' overall mean EPA supervision rating during the clerkship year. There was significant correlation between mean supervision rating for EPA assessments of history, exam, note, and oral presentation skills with scores for these skills on clerkship evaluations; less so on the CPX. Conclusions Correlation of EPA supervision ratings with commonly used clinical performance measures offers support for their use in undergraduate medical education. Data supporting the validity of EPA assessments promotes stakeholders' acceptance of their use in summative decisions about students' readiness for increased patient care responsibility.

INTRODUCTION:The implementation of programs of assessment based on Entrustable Professional Activities (EPAs) offers an opportunity for students to obtain unique data to guide their ongoing learning and development. Although authors have explored factors that contribute to trust-based decisions, learners' use of assessors' decisions about the level of supervision they need has not been fully investigated.METHODS:In this study, we conducted semi-structured interviews of clerkship students who participated in the first year of our EPA program to determine how they interpret and use supervision ratings provided in EPA assessments. Content analysis was performed using concept-driven and open coding.RESULTS:Nine interviews were completed. Twenty-two codes derived from previous work describing factors involved in trust decisions and 12 novel codes were applied to the interview text. Analyses revealed that students focus on written and verbal feedback from assessors more so than on supervision ratings. Axial coding revealed a temporal organization that categorized how students considered the data from EPA assessments. While factors before, during, and after an assessment affected students' use of information, the relationship between the student and the assessor had impact throughout.CONCLUSIONS:Although students reported varying use of the supervision ratings, their perspectives about how assessors and students interact and/or partner before, during, and after assessments provide insights into the importance of an educational alliance in making a program of assessment meaningful and acceptable to learners.

Introduction: The Hedwig von Ameringen Executive Leadership in Academic Medicine program (ELAM) is a national professional development program for women that includes institutional action projects (IAPs). Although benefits of ELAM participation are well documented, the value of the IAPs has not been specifically evaluated. We explored the experience of ELAM Fellows and leaders from one institution to elucidate how institutional factors influence project implementation and outcomes. Methods: Fellows and deans participated in semistructured interviews. We analyzed the transcripts qualitatively to develop themes and describe factors that influenced IAP implementation and outcomes. We used the New World Kirkpatrick Model, an updated version of the widely used Kirkpatrick model of educational program evaluation, as a framework to elucidate how participants applied their leadership learning through project work, and to analyze early results of projects that indicated institutional impact. Results: Project work had bidirectional impact on the fellows in the program and on the institution itself. Project enablers included: focusing projects on institutional priorities, obtaining sustainable support, and navigating institutional complexity. Leading indicators of institutional outcomes included contributions to institutional leadership and culture, and mutual enhancement of the reputation of the fellow and of the institution. Discussion: By examining enablers and barriers for institutionally based projects conducted in a national leadership development program, we identified the drivers that facilitated application of leadership learning. Leading indicators of project outcomes reflected bidirectional impact on fellows and the institution, demonstrating outcomes at the highest levels of the New World Kirkpatrick Model.

Medical EducationVolume 55, Issue 11 p. 1311-1312 REALLY GOOD STUFF Coaching medical students to confront racism in the clinical setting Tiana Walker MSIV, Tiana Walker MSIV Medical StudentSearch for more papers by this authorLindsey B. Whalen MSIV, Lindsey B. Whalen MSIV Medical StudentSearch for more papers by this authorMarc J. Vetter MSIV, Marc J. Vetter MSIV Medical StudentSearch for more papers by this authorAndrew S. Parsons MD, MPH, Corresponding Author Andrew S. Parsons MD, MPH Assistant Professor [email protected] orcid.org/0000-0001-5631-9465 Correspondence Andrew S. Parsons, Department of Medicine and Public Health Sciences, Director of Foundations of Clinical Medicine, University of Virginia School of Medicine, 1215 Lee St., Charlottesville, VA 22908, USA. Email: [email protected]Search for more papers by this authorMegan J. Bray MD, Megan J. Bray MD Associate ProfessorSearch for more papers by this authorMaryellen E. Gusic MD, Maryellen E. Gusic MD Senior Advisor for Educational Affairs, Professor of Medical Education orcid.org/0000-0002-6519-223X Search for more papers by this author Tiana Walker MSIV, Tiana Walker MSIV Medical StudentSearch for more papers by this authorLindsey B. Whalen MSIV, Lindsey B. Whalen MSIV Medical StudentSearch for more papers by this authorMarc J. Vetter MSIV, Marc J. Vetter MSIV Medical StudentSearch for more papers by this authorAndrew S. Parsons MD, MPH, Corresponding Author Andrew S. Parsons MD, MPH Assistant Professor [email protected] orcid.org/0000-0001-5631-9465 Correspondence Andrew S. Parsons, Department of Medicine and Public Health Sciences, Director of Foundations of Clinical Medicine, University of Virginia School of Medicine, 1215 Lee St., Charlottesville, VA 22908, USA. Email: [email protected]Search for more papers by this authorMegan J. Bray MD, Megan J. Bray MD Associate ProfessorSearch for more papers by this authorMaryellen E. Gusic MD, Maryellen E. Gusic MD Senior Advisor for Educational Affairs, Professor of Medical Education orcid.org/0000-0002-6519-223X Search for more papers by this author First published: 02 September 2021 https://doi.org/10.1111/medu.14645Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume55, Issue11November 2021Pages 1311-1312 RelatedInformation

ContextSituativity theory posits that learning and the development of clinical reasoning skills are grounded in context. In case-based teaching, this context comes from recreating the clinical environment, through emulation, as with manikins, or description. In this study, we sought to understand the difference in student clinical reasoning abilities after facilitated patient case scenarios with or without a manikin.MethodsFourth-year medical students in an internship readiness course were randomized into patient case scenarios without manikin (control group) and with manikin (intervention group) for a chest pain session. The control and intervention groups had identical student-led case progression and faculty debriefing objectives. Clinical reasoning skills were assessed after the session using a 64-question script concordance test (SCT). The test was developed and piloted prior to administration. Hospitalist and emergency medicine faculty responses on the test items served as the expert standard for scoring.ResultsNinety-six students were randomized to case-based sessions with (n=48) or without (n=48) manikin. Ninety students completed the SCT (with manikin n=45, without manikin n=45). A statistically significant mean difference on test performance between the two groups was found (t=3.059, df=88, p=.003), with the manikin group achieving higher SCT scores.ConclusionUse of a manikin in simulated patient case discussion significantly improves students' clinical reasoning skills, as measured by SCT. These results suggest that using a manikin to simulate a patient scenario situates learning, thereby enhancing skill development.

Problem: Development of a novel, competency-based program of assessment requires creation of a plan to measure the processes that enable successful implementation. The principles of implementation science outline the importance of considering key drivers that support and sustain transformative change within an educational program. The introduction of Entrustable Professional Activities (EPAs) as a framework for assessment has underscored the need to create a structured plan to prepare assessors to engage in a new paradigm of assessment. Although approaches to rater training for workplace-based assessments have been described, specific strategies to prepare assessors to apply standards related to the level of supervision a student needs have not been documented. Intervention: We describe our systematic approach to prepare assessors, faculty and postgraduate trainees, to complete EPA assessments for medical students during the clerkship phase of our curriculum. This institution-wide program is designed to build assessors’ skills in direct observation of learners during authentic patient encounters. Assessors apply new knowledge and practice skills in using established performance expectations to determine the level of supervision a learner needs to perform clinical tasks. Assessors also learn to provide feedback and narrative comments to coach students and promote their ongoing clinical development. Data visualizations for assessors facilitate reinforcement of the tenets learned during training. Collaborative learning and peer feedback during faculty development sessions promote the formation of a community of practice among assessors. Context: Faculty development for assessors was implemented in advance of implementation of the EPA program. Assessors in the program include residents/fellows who work closely with students, faculty with discipline-specific expertise and a group of experienced clinicians who were selected to serve as experts in competency-based EPA assessments, the Master Assessors. Training focused on creating a shared understanding about the application of criteria used to evaluate student performance. EPA assessments based on the AAMC’s Core Entrustable Professional Activities for Entering Residency, were completed in nine core clerkships. EPA assessments included a supervision rating based on a modified scale for use in undergraduate medical education. Impact: Data from EPA assessments completed during the first year of the program were analyzed to evaluate the effectiveness of the faculty development activities implemented to prepare assessors to consistently apply standards for assessment. A systematic approach to training and attention to critical drivers that enabled institution-wide implementation, led to consistency in the supervision rating for students’ first EPA assessment completed by any type of assessor, ratings by assessors done within a specific clinical context, and ratings assigned by a group of specific assessors across clinical settings. Lessons learned: A systematic approach to faculty development with a willingness to be flexible and reach potential participants using existing infrastructure, can facilitate assessors’ engagement in a new culture of assessment. Interaction among participants during training sessions not only promotes learning but also contributes to community building. A leadership group responsible to oversee faculty development can ensure that the needs of stakeholders are addressed and that a change in assessment culture is sustained.

OBJECTIVES: Surgical simulation has been used to facilitate the acquisition of vascular surgery skills. However, high cost and limited availability may restrict the use of this educational resource. We report how instruction using a low-cost, pulsatile, carotid endarterectomy (CEA) bench-top surgical simulation model can be used to enhance learners' procedure-specific knowledge, comfort, and confidence in performing the steps of a CEA procedure DESIGN: A single instructor engaged each participant in a one-on-one instructional session during which the instructor demonstrated, and then the participants performed, the steps of a CEA. Participants completed a pre- and postintervention assessment of knowledge and attitudes about preforming a CEA and use of simulation as a learning tool. Postintervention, participants rated the impact of the simulation model on their learning. A Related T-test and Wilcoxin signed Rank Test were used to compare pre- and postintervention results. SETTINGS: University of Virginia Health System, Charlot-tesville, Virginia. PARTICIPANTS: Seventeen postgraduate trainees. RESULTS: A significant difference was observed in pre-and postknowledge scores (48% vs 91% correct, p < 0.01). Trainee confidence (1.65 vs 2.88, p < 0.01) and comfort (1.59 vs 2.82, p < 0.01) with doing the procedure also increased significantly. Sixteen (94%) responded that use of the simulator was extremely or very important as a tool for learning. All 17 trainees (100%) reported that the simulation experience was either essential or very useful in helping them learn how to perform a CEA. Sixty-five percent responded that they were extremely likely to apply the skills learned during the intervention the next time they performed a CEA. CONCLUSIONS: A low-cost, pulsatile CEA simulation model used as an educational tool increased procedure-specific knowledge, comfort, and confidence among trainees. Learner's increased confidence and affirmation that they are likely to apply the learned skills in a clinical setting support the use of this educational approach to impact trainee behaviors. (C) 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The goal of designing innovative curricula and programs in medical education is to create interventions that will change the attitudes, knowledge, skills, and behaviors of learners in order to prepare them to contribute to the health of patients and communities they serve. Systematic evaluation allows curriculum/program developers to optimize their curriculum/program and ensure that the goals of the curriculum/program are met. While curriculum/program evaluation is distinct from educational research, when approached in a rigorous manner, curriculum/program evaluation can be published as educational scholarship. The goal of our paper is to equip readers with tools to apply a scholarly approach to curriculum/program evaluation to produce findings that will advance the field. We start by defining curricula, educational programs, learner assessment, and evaluation. We then briefly describe examples of best practice models for curriculum/program development that incorporate the critical step of planning for evaluation. Building on published work, we distinguish the use of best practice models and conceptual frameworks to inform curriculum/program development and evaluation. More specifically, we outline steps to plan an evaluation that demonstrates WHAT was effective, describes HOW the curriculum/program contributed to the outcomes achieved, and points to WHY the curriculum/program led to the outcomes observed. We conclude with key considerations for publishing findings of an evaluation, including what to include in each section of a manuscript.

Medical Educational Program Highlights The Next Generation (Next Gen) curriculum at the University of Virginia School of Medicine (UVA SOM) is grounded in the Twelve Competencies Required of a Contemporary Physician1 and was implemented in 2010 in alignment with these goals: Assure all graduates demonstrate mastery of the competencies required of a contemporary physician Integrate content around organ systems Integrate clinical and basic science within each educational experience and across all phases of the curriculum Incorporate experiential and active learning activities Provide frequent developmental activities for clinical skills Unique features of the current program include: Integrated program of assessment incorporating competency-based metrics such as the Entrustable Professional Activities (EPAs) program: A longitudinal, integrated system of learning and assessment. Students are directly observed by residents, fellows, faculty, and master assessors in authentic patient encounters within the workplace. Students receive immediate feedback to support their continued development. Data are aggregated and analyzed for summative decision-making by the Entrustment Committee to grant graduated autonomy as students’ skills develop. EPA assessments supplement information from other clinical evaluations. Cohesive student support system: College deans and learning communities: Four student affairs deans each lead a learning community of students and faculty coaches and intentionally engage and support learners as they navigate the curriculum as a cohort. Faculty coaches aid students in analyzing and interpreting data from clinical performance evaluations, OSCEs, and EPA assessments to cocreate individualized student learning plans. The college deans work closely with coaches to identify resources to aid students in addressing issues that affect their clinical performance. Master assessors are faculty selected and trained to be expert assessors provide immediate feedback to students during real-time assessments of authentic clinical tasks (EPAs). They are empowered to feed forward information about a student to the students’ faculty coach and college dean. Coaches address clinical performance issues, and college deans identify resources to address nonacademic issues affecting students’ performance. Master assessors additionally provide summative feedback as members of the Entrustment Committee. Alpha Omega Alpha (AOA) Peer Mentoring Program: AOA Honor Society student volunteers offer mentoring and academic support for coursework across the curriculum, provide strategies to prepare for national licensing exams, and share advice about how to navigate one’s role as a student member of clinical teams. Experiential learning designed to promote professional identity formation: The Patient Student Partnership (PSP) program is a longitudinal program that pairs students with a patient at matriculation. The intent is not only to give students a framework for acquiring medical knowledge but also to provide an opportunity to serve as a patient advocate while learning about socio-economic systems that affect patient health and access and utilization of health care. Enhanced student participation in the clerkship phase curriculum review process: Student Medical Education Committee representatives meet with clerkship directors quarterly to provide ongoing student feedback and participate in the annual review done by the Curriculum Committee. Curriculum Curriculum description The Next Gen curriculum is organized into 3 phases: The preclerkship phase is 18 months in length, is system-based, integrates foundational science and clinical medicine, and uses active learning strategies. In parallel, students complete a Foundations of Clinical Medicine (FCM) course that focuses on the development of clinical skills and diagnostic reasoning and allows students to apply learning to patient experiences, both in simulated and inpatient settings, and through the PSP and reflection on experiential learning in the Social Issues in Medicine (SIM) course. The clerkship phase is 1 year in length and includes discipline-specific clinical rotations completed in 12-week blocks with one’s learning community. The postclerkship phase is 46 weeks long and includes 10 weeks of required courses, allowing for individualization of each student’s learning and preparation for residency training. See Supplemental Digital Appendix 1—Curriculum Map—at https://links.lww.com/ACADMED/A855. Curriculum changes since 2010 In addition to the highlights described above, other recent innovations have been implemented. Curricular interventions to ease students’ transitions across the phases of the curriculum: Classrooms to clinics: End of preclerkship phase course in which students use biomedical knowledge and apply their clinical skills and diagnostic reasoning to undifferentiated patient cases. Learning occurs in laboratory, classroom, and simulated settings. Transitions course: Initial course in the clerkship phase focused on learning (knowledge, skills, behaviors) that students require to assume their role as a new member of the patient care team. DxRx: Just before the postclerkship phase, this course emphasizes systems-based practice, health disparities, population health, health policy, and advocacy. Intern Readiness course: Post-Match, discipline-specific course that focuses on the skills necessary for residency, interpersonal communication, and interprofessional collaborative practice. Clerkship and postclerkship curriculum reform: With the opening of our regional campus in northern Virginia in 2021, we are embarking upon curriculum redesign. The size of our medical school class will not change. Guiding principles for this redesign include: Create core clinical learning experiences for learners to meet our program objectives and to develop competence for future practice Individualize learning to foster continued development and to prepare learners for the next stage of training Organize clinical learning experiences developmentally to ensure that learners are engaging in authentic roles in increasing complex environments as they demonstrate competence Align change with accreditation standards and emerging best practices in clinical education Sustain structures that support learners’ sense of community and developing professional identity Continue to integrate clinical and basic science across all phases of the curriculum Development of a new learning management system (VMED) Assessment Our program objectives were initially developed using the AAMC Medical School Objectives Project, are aligned with the ACGME domains of competence, and map to the Physician Competency Reference Set. See Supplemental Digital Appendix 2—Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A855. Recent additions to our assessment program include: Our EPA program Implementation of criterion-based standard setting for OSCEs Structured process for pre- and posttest review of multiple-choice question (MCQ) examinations used in the preclerkship curriculum Tagging of questions used in MCQ examinations in the preclerkship curriculum to learning objectives related to courses and threads (longitudinal thematic content, e.g., anatomy, ethics, patient safety) Redesign of summative student clinical evaluation forms using competency-based, behavioral anchors Pedagogy The courses within the preclerkship phase of our curriculum are delivered using a variety of pedagogies. The goal is that over 80% of learning activities are active, including case-based learning, weekly patient presentations/panels, team-based learning, in-class problem sets, and clinical anatomy and imaging labs. In FCM, students participate in small-group discussions and simulated exercises using high-fidelity simulation and standardized patients. Students also have a service learning requirement in their SIM course. The majority of teaching in the clerkship and postclerkship phases occurs in a clinical setting as students participate in patient care as members of an interprofessional team. Across all phases, students engage in self-directed learning activities. Clinical experiences Students complete the majority of their clinical education at UVA Health System. Students can also complete clinical rotations at our clinical affiliates: Salem VA Medical Center, INOVA Fairfax Medical Campus, and Bon Secours Health System. All students participate in 2 community-based required rotations during their clerkship year. Students engage with patients in clinical settings beginning in the fall of their first year in FCM and PSP (longitudinal exposure). Students have the opportunity to participate in electives at all of our affiliate sites, to arrange experiences at other LCME-accredited institutions, or to participate in approved global health rotations. Current challenges to implementing clinical experiences at sites associated with other health entities include establishing efficient processes for ensuring faculty certification, student credentialing, and creating affiliation agreements that meet each system’s requirements. Curricular Governance The Curriculum Committee as established and codified in the School of Medicine bylaws and comprises elected and appointed members. It has the authority to set educational objectives; establish educational requirements; establish and approve content; ensure content integration, coordination, and coherence; allocate curriculum time; specify teaching methods; select and oversee course and clerkship directors; and evaluate educational outcomes. See Figure 1—Curriculum governance.Figure 1: Curriculum governance.Education Staff The Office of Medical Education (OME) is the unit within the Office of Educational Affairs that provides administrative oversight and centralized support for undergraduate medical education. Members include: Decanal staff Faculty with expertise in student assessment and program evaluation Faculty administrative leaders for preclerkship courses: one who is also director of curriculum integration and development, and one who is the director of academic advancement A faculty director of anatomy and staff who support anatomy teaching Faculty who oversee FCM and PSP Faculty and staff who operate the clinical skills and medical simulation centers An instructional designer An educational technology unit that includes a director, instructional technologists, and staff who support systems for curriculum management and provide IT support for classrooms and instructional tools used in teaching Instructional support professionals Administrative staff OME also provides financial support for clerkship coordinators who are members of clinical departmental administrative staff. See Figure 2—Organizational chart.Figure 2: Organizational chart.OME also serves as an academic home within the SOM. Faculty with administrative roles in undergraduate medical education in addition to teaching faculty at clinical affiliate sites hold appointments on the instructional track within OME. Faculty Development and Support in Education Professional development for educators is organized by OME in collaboration with the Academy of Distinguished Educators (ADE) and the UVA SOM Office of Faculty Affairs and Faculty Development. Professional development sessions are offered through a series of highly interactive workshops, medical education grand rounds, and a monthly journal club. Faculty who participate in 10 workshops over a 2-year period receive a Certificate of Commitment to Faculty Development in Medical Education that can be included in their teaching portfolio. Although faculty on all tracks contribute to each of the 3 missions of the SOM, faculty whose area of excellence is education are appointed to 1 of 3 tracks. Faculty on the clinician–educator track, a tenure eligible designation, spend at least 80% time devoted to patient care and/or medical education. The award of tenure is granted with evidence of excellence in both domains. There are also 2 tenure ineligible designations, clinical faculty and instructional faculty. Clinical faculty must demonstrate excellence in either patient care or education. Educational accomplishments are demonstrated through excellence in training, teaching, and advising learners or colleagues; election to honorary educational societies and receipt of teaching awards; and invited presentations and participation in educational professional development. Published scholarship is required for clinician–educators and for promotion to professor in the clinical and instructional faculty tracks. Scholarship includes peer-reviewed publications, textbooks or chapters, and dissemination of teaching materials. Instructional faculty spend the majority of their time in teaching or service. For this track, excellence in education can be demonstrated through activities done in support of the educational mission. The ADE was founded in 2003 to recognize, reward, and promote excellence in education. Members of the medical school faculty are selected through an application process. In addition to funding to support medical education innovation and research, the ADE sponsors the annual Medical Education Week that includes an invited keynote speaker, a poster session, and oral presentations of educational projects done by learners and members of the UVA health science education community. The institution is currently restructuring the ADE to build an inclusive membership and serve learners and teachers across the biomedical community. The SOM recently created the Center for Educational Research and Scholarly Innovation. This center will serve as an organizing unit and provide individual and programmatic support for members of the SOM community to apply a scholarly approach in their work as educators across the domains of teaching, curriculum development, learner assessment, advising/mentoring, and educational leadership and administration. The center will support the development and dissemination of educational scholarship through professional development programming, coaching/mentoring, community building, and infrastructure support. Regional Medical Campuses In 2021, our first cohort of students (36) will begin their clerkship and postclerkship phases of the curriculum at the UVA SOM INOVA Campus in Fairfax, Virginia.

Coaching is a critical tool to guide student development of clinical competency and formation of professional identity in medicine, two inextricably linked concepts. Because progress toward clinical competence is linked to thinking, acting and feeling like a physician, a coach's knowledge about a learner's development of clinical skills is essential to promoting the learner's professional identity formation. A longitudinal coaching program provides a foundation for the formation of coach-learner relationships built on trust. Trusting relationships can moderate the risk and vulnerability inherent in a hierarchical medical education system and allow coaching conversations to focus on the promotion of self-regulated learning and fostering skills for life-long learning. Herein, we describe a comprehensive, longitudinal clinical coaching program for medical students designed to support learners' professional identify formation and effectively promote their emerging competence.

In the move toward competency-based medical education, leaders have called for standardization of learning outcomes and individualization of the learning process. Significant progress has been made in establishing defined expectations for the knowledge, skills, attitudes, and behaviors required for successful transition to residency training, but individualization of educational processes to assist learners in reaching these competencies has been predominantly conceptual to date. The traditional time-based structure of medical education has posed a challenge to individualization within the curriculum and has led to more attention on innovations that facilitate transition from medical school to residency. However, a shift of focus to the clerkship-to-postclerkship transition point in the undergraduate curriculum provides an opportunity to determine how longitudinal competency-based assessments can be used to facilitate intentional and individualized structuring of the long-debated fourth year. This Perspective demonstrates how 2 institutions-the University of Virginia School of Medicine and the University of Michigan Medical School-are using competency assessments and applying standardized outcomes in decisions about individualization of the postclerkship learning process. One institution assesses Core Entrustable Professional Activities for Entering Residency, whereas the other has incorporated Accreditation Council for Graduate Medical Education core competencies and student career interests to determine degrees of flexibility in the postclerkship phase. Individualization in addition to continued assessment of performance presents an opportunity for intentional use of curriculum time to develop each student to be competently prepared for the transition to residency.