Faculty Bibliography

OBJECTIVE:To perform a qualitative content analysis of learning and assessment strategies that pediatric subinterns describe in Individualized Learning Plans (ILPs) and to explore barriers and facilitators to their learning. METHODS:We analyzed ILPs from medical students enrolled in pediatric subinternships at 10 US medical schools that utilized a standardized curriculum and were recruited to reflect diversity in geographic location, funding, and enrollment. Students used an ILP to record 3 or more selected learning objectives, rationale for selection, and reflection on learning and assessment strategies. Investigators used the constant comparative method to perform a content analysis of the ILPs, grouping codes into themes, and verifying relationships between codes within themes. RESULTS:Two hundred and four ILPs that included student reflections on 850 learning objectives were analyzed. Content was analyzed in 5 categories: rationale for selecting objectives, learning strategies, assessment strategies, challenges to learning, and facilitators of learning. Students showed strong commitment to individualized, self-directed learning, developed a wide range of creative learning strategies, and relied heavily on self-reflection to assess their progress. The learning environment both helped and hindered students' ability to make and assess progress on their selected learning objectives. CONCLUSIONS:Through ILP-guided reflection and a formal curriculum, students can choose well-justified learning objectives and demonstrate resourcefulness and independence in developing self-directed learning and assessment strategies. The strategies that students identified in this study provide a menu of learning and assessment options for subinterns. Identified challenges and facilitators of learning provide guidance for educators who seek to enhance the clinical learning environment.

INTRODUCTION/BACKGROUND:There are limited data on the status of faculty development (FD) in the United States. Through a national survey of pediatric educators, we explored the frequency and topics of FD on teaching skills offered at US medical schools, as well as the strategies' schools use to encourage and track participation. METHODS:Five piloted questions were included in the 2017 Annual Council on Medical Student Education in Pediatrics Survey. We used descriptive statistics. RESULTS:Ninety-seven (66%) of the 148 surveyed US medical schools responded to at least one FD question. Ninety-eight percent of respondents reported being offered FD on teaching, with 97% of those respondents reporting that FD occurred at least annually. A variety of FD topics were reported, with feedback and precepting being most common. Incentives included continuing medical education (CME credit) (39%) and being relieved of clinical duties (23%). However, 29% reported little support for FD. Only 20% of schools reported their department tracked FD participation outside the department. DISCUSSION/CONCLUSIONS:Our data suggest that the majority of medical schools offer FD on teaching skills at least yearly, with a variety of topics. Institutions utilize a variety of incentives for participation. However, a significant minority of respondents reported little support for FD. Further, departments rarely track faculty FD participation.

OBJECTIVE:To validate an approach to measuring professional identity formation (PIF), we explore if the Professional Identity Essay (PIE), a stage score measure of medical professional identity (PI), predicts clinical communication skills. METHODS:Students completed the PIE during medical school orientation and a 3-case Objective Structured Clinical Exam (OSCE) where standardized patients reliably assessed communication skills in 5 domains. Using mediation analyses, relationships between PIE stage scores and communication skills were explored. RESULTS:For the 351 (89%) consenting students, controlling for individual characteristics, there were increases in patient counseling (6.5%, p<0.01), information gathering (4.3%, p = 0.01), organization and management (4.1%, p = 0.02), patient assessment (3.6%, p = 0.04), and relationship development (3.5%, p = 0.03) skills for every half stage increase in PIE score. The communication skills of lower socio-economic status (SES) students are indirectly impacted by their slightly higher PIE stage scores. CONCLUSION/CONCLUSIONS:Higher PIE stage scores are associated with higher communication skills and lower SES. PRACTICE IMPLICATIONS/CONCLUSIONS:PIE predicts critical clinical skills and identifies how SES and other characteristics indirectly impact future clinical performance, providing validity evidence for using PIE as a tool in longitudinal formative academic coaching, program and curriculum evaluation, and research.

BACKGROUND: NYU uses the same 14-item checklist for assessing medical student communication skills across our curriculum, which includes highquality Objective Structured Clinical Skills Exams throughout the first three years of medical school: a 3-station Introductory Clinical Experience OSCE (ICE), a 3-station end-of-clinical skills OSCE (Practice of Medicine; POM); and an 8-station, high- stakes OSCE (Comprehensive Clinical Skills Exam; CCSE) after core clerkship. We describe how skills change throughout school and explore how patterns vary by cohort (class) in ways that could be explained by admissions criteria, measurement quality, and/or curriculum changes.
METHOD(S): Three domains are assessed: Info gathering (6 items), relationship development (5 items); and patient education & counseling (3 items). Checklist items use a 3-point scale (not done, partly, well done) with behavioral anchors. Internal consistency (Cronbach's alpha) exceeds .75 for all subdomains and across all years. Domains are supported by Confirmatory Factor Analysis. Mean average % well done was calculated across cases and individuals for each subdomain in an OSCE and compared over the OSCEs and between 8 classes of medical school students entering from 2009 to 2016 (graduating 2013 to 2020) (n=1569).
RESULT(S): Cohorts showed similar patterns communication skills trajectories - improvement over time. Despite changes in admissions criteria and processes, cohorts did not differ in terms of demographics, undergraduate GPA, or MCAT scores. Variability in scores decreased in all cohorts over time while communication improved. Patient education & counseling was significantly and substantially lower than other domains. In terms of cohort effects, communication scores for the entering class of 2013 at the start of medical school (ICE OSCE) were significantly higher than the previous 4. At the end of MS2, scores were similar for cohorts for info gathering and relationship development domains (and high, mean range=77-87% well done) but patient education & counseling varied: Improvement from the 1st to 3rd cohort and then decline for the last 5 cohorts. Within the CCSE (8-station pass/fail, MS3), communication scores increased steadily across entering classes, especially from cohort 4 on. These changes over time and between cohorts were mapped onto a priori descriptions of curricular, measurement and admission changes.
CONCLUSION(S): Our cohort data showed interesting and complex patterns. This study reinforces some limitations of linking curriculum to performance (e.g., no direct measures of the curriculum in terms of content, process and intensity over time, limited data on what makes cohorts different, variable measurement over time, and being unable to control for broader trends likely to influence both cohort and time effects) while also demonstrating the promise of longitudinal perspectives on the development of core competencies. LEARNING OBJECTIVE #1: Understand cohort performance in relation to curricular trends. LEARNING OBJECTIVE #2: Describe variation in performance

BACKGROUND: The transition from medical school to residency is characterized by an abrupt transition of learning needs and goals. Coaching is a promising intervention to support individual learning and growth trajectories of learners. It is uncommon for medical school faculty to have undergone training as coaches. We explored our faculty's perceptions and skills after instituting a new coaching program.
METHOD(S): Faculty advisors (N=12) and GME (N=16) participated in a coaching development program and in community of practice meetings where challenging coaching scenarios were shared. GME faculty also participated in a Group Objective Structured Clinical Exam (GOSCE) to practice and receive feedback on their skills. Peer-faculty observers and resident raters used behaviorally grounded checklists to assess faculty performance. We conducted 2 focus groups: 1) UME advisors engaged in longitudinal coaching (n=9) and 2) GME faculty participating in the coaching development program (n=8) to better understand how faculty make sense of and put into practice these new coaching roles and skills.
RESULT(S): Simple thematic coding showed that both groups emphasized the blurring of the many roles they serve when interacting with trainees and struggled with recognizing both which hat to wear (role to adopt) and which skills to call upon in specific situations. UME advisors who have dedicated advising/coaching roles reported assuming multiple roles at different times with their same students. Many of the GME coaches serve as Associate Program Directors, and described adopting a coaching frame of reference (mentality) and requiring external reinforcement for coaching skills. Some reported realizing after the fact that coaching would have been a valuable approach. Faculty newer to their role felt more successful in engaging in coaching mindset and coaching. Faculty were curious about how trainees would feel about this approach and anticipated that some would appreciate this more than others. 12 faculty participated in a three station Coaching GOSCE. Both resident raters and faculty peer raters suggested faculty coaches were able to establish trust and engage in authentic listening. Coaches negotiated the tension between empathetic listening with supporting goal-setting. Residents provided slightly lower ratings than peer observers on coaches' ability to ask questions and assume a coachee- focused agenda.
CONCLUSION(S): Medical educators may benefit from obtaining coaching skills, but deliberate training in how these skills complement, and differ, from existing skills requires both didactic and experiential learning. Cultivating a community of practice and offering opportunities for deliberate practice, observation and feedback is essential for medical educators to achieve mastery as coaches. LEARNING OBJECTIVE #1: Identify and perform appropriate learning activities to guide personal and professional development (PBL) LEARNING OBJECTIVE #2: Understand and apply core longitudinal coaching skills (Professionalism)

BACKGROUND: A core responsibility of medical educators is to foster a strong sense of medical professional identity (PI). Few studies specifically examine the qualities that constitute the PI of physicians recognized for exemplary professionalism. We describe those qualities based on an assessment of PI to inform educational efforts and support learners' development of PI.
METHOD(S): We used Colby and Damon's criteria for selection of moral exemplars (1992) to invite nominations of exemplary faculty physicians at NYUGSOM from faculty and trainees. Participants completed the Professional Identity Essay (PIE), a 9-question reflective writing measure based on a wellknown model of adult development that explores meaning making on PI (Bebeau & Lewis, 2004; Kegan, 1982, 1994). Two raters with extensive training and experience in adult developmental theory rated PIE responses for stage or transition phase. PI stages include independent operator, teamoriented idealist, self-defining, and self-transforming. These stages reflect increasing complexity and internalization of PI. We also gathered information on specialty, years in practice, gender, and race/ethnicity.
RESULT(S): Two hundred and twelve faculty were nominated; 35 were invited to participate (based on number of nominations, diversity of ages, backgrounds and career stage), and 21 completed scorable PIEs. They were from 13 specialties; mean career length was 21.5 years (range 6-45), and 35% were female. All but 2 were Caucasian. PIE scores ranged from 3 to 4.5 (Table 1), demonstrating differing and increasingly complex and internalized ways faculty understand their PI, and that not all nominated exemplars share a singular view of professionalism.
CONCLUSION(S): Physicians nominated as exemplars of professionalism embody a range of professional identities and professionalism world-views. Our study provides rich descriptions of multiple pathways to strengthening a physician's professionalidentities, of critical importance to faculty and physician development in a milieu of challenges to recruitment and retention of physicians. This approach can also inform educators' efforts to support PI development in learners and support the development of learning communities that foster a growth mindset. LEARNING OBJECTIVE #1: Recognize importance of strong role models for MPI. LEARNING OBJECTIVE #2: Describe the varying levels of MPI in a cohort of exemplar physicians

BACKGROUND: Internalizing a strong medical professional identity (PI) is a critical part of medical education. Recent studies of medical students have documented that students' PI, measured by the Professional Identity Essay (PIE), a reflective writing assessment of PI based on Kegan's theory of adult development and Bebeau's developmental model of PI, vary and are impacted by education. Little is known about the PI of exemplary professional physicians. We sought to: 1) describe the PI of physicians who exemplify the highest principles of the medical profession, and 2) evaluate NYU faculty identified as professional exemplars by peers to provide data and demonstrate clear role models for learners METHODS: We elicited nominations for professional exemplar physicians from NYU faculty, chief residents, and 4th-year students, using the definition of professionalism developed by Colby and Damon (1992). Participants were recruited after receiving at least 3 nominations; select participants who received 1 or 2 nominations were also recruited to diversify the participants in terms of specialty, years of practice, gender and race.We also used snowball techniques to get nominations fromstudy participants. After consenting, faculty received the 11-question PIE. We analyzed demographic data of nominated faculty and completed a content analysis of the PIE.
RESULT(S): 206 individual faculty were nominated at least one time by 70 community members. 32 individuals were recruited to the study; to date 22 have completed the PIE. The 206 nominees/22 participants represent: 34/12 specialties, average years in practice 17.6/23.8, range of years in practice 62 for nominees/44 for participants. We identified 3 primary themes through the content analysis: (1) Response to Expectations, "Everything. The profession demands everything.As much as this profession takes fromme, it is dwarfed by what I have received in return." (2) Response to Failure: "I fail to live up to expectations every day. Some days thismotivatesme, other days I disappoint myself." (3) Learning from Others: "I view teaching as integral to medical professionalism." There was a range of developmental levels in the responses with some focusing more on external rather than internal motivations: "I can say that the [malpractice] process for me was very threatening, emotionally consuming and had the potential to alter professional behavior in the wrong way."
CONCLUSION(S): Nominated faculty represented a diverse group with respect to PI. Many participants demonstrated great professionalism and a sense of internal PI in responses to the PIE questions, while others focused onmore externalmotivations to drive their professional behaviors. Further analysis is needed to define the qualities of a true exemplary professional. The range of responses of the exemplars can both serve as role models for learners and provide multiple pathways for learners and faculty to strengthen their own professional identities

Background: To bolster medical student wellbeing and combat burnout, the NYU School of Medicine (NYUSOM) implemented a longitudinal resiliency curriculum coupled with a wellbeing self-assessment tool. We qualitatively studied the impact of this curriculum on knowledge, self-awareness, and behaviors related to wellbeing and resiliency.
Method(s): The MD AWARE curriculum was launched in August 2017 for the NYUSOM class of 2020. Six sessions were implemented at critical junctions of their training. Each session includes a short lecture, followed by a small group activity led by trained facilitators. At the start of each session, students complete an anonymous online self-assessment adapted from three validated assessment tools measuring different aspects of wellbeing and burnout. Students immediately receive scores with explanations and benchmarks of each and then debrief in their small group. After each MD AWARE session, students completed a retrospective pre/post evaluation survey. Focus Groups (FG) were held in December 2017 (after Sessions 1& 2) to gain richer insight into the impact of the curriculum and self-assessment tool. A purposeful sampling strategy with maximal variation was employed to recruit participants; 10 students participated in each FG. Qualitative data was gathered through the surveys and the FG. The FG were recorded and transcribed. Each FG had 2 project staff members and post-session debriefing. Member-checking was also used. Responses were subsequently coded and analyzed by two experienced faculty members (a third colleague assisted in theme triangulation). An iterative data analysis strategy was applied. Throughout the analysis, an audit trail, frequent memo writing and a reflexivity journal was maintained.
Result(s): Themes: Community Building: Connecting with another student it was helpful for my wellbeing Skill and Knowledge Acquisition and Application: The main sort of takeaway is you need to be aware of (Burnout) and if you need help there are resources Importance of Faculty Development: I think that a prep session between those who designed the curriculum and those who facilitate the small-groups could go a long way towards creating the environment I imagine was originally intended Value of Refection: The score didn't add much It was more about the act of answering the questions than the number that came out of it NYU Administration Values Medical Student Wellbeing: Just the fact that NYU has this program and is making it part of orientation already speaks volumes about its priorities: that we matter
Conclusion(s): Thematic analysis of the impact of MD AWARE indicated that it provides concrete information on resources available to the students. Additionally, the students value both protected time with their peers and for self-refection. Lastly, although care must to be taken in selecting faculty to facilitate the small groups, the mere existence of the longitudinal curriculum signaled that the NYUSOM administration values medical student wellbeing

Introduction/UNASSIGNED:There is an increasing call for developing validity evidence in medical education assessment. The literature lacks a practical resource regarding an actual development process. Our workshop teaches how to apply principles of validity evidence to existing assessment instruments and how to develop new instruments that will yield valid data. Methods/UNASSIGNED:The literature, consensus findings of curricula and content experts, and principles of adult learning guided the content and methodology of the workshop. The workshop underwent stringent peer review prior to presentation at one international and three national academic conferences. In the interactive workshop, selected domains of validity evidence were taught with sequential cycles of didactics, demonstration, and deliberate practice with facilitated feedback. An exercise guide steered participants through a stepwise approach. Using Likert-scale items and open-response questions, an evaluation form rated the workshop's effectiveness, captured details of how learners reached the objectives, and determined participants' plans for future work. Results/UNASSIGNED:The workshop demonstrated generalizability with successful implementation in diverse settings. Sixty-five learners, the majority being clinician-educators, completed evaluations. Learners rated the workshop favorably for each prompt. Qualitative comments corroborated the workshop's effectiveness. The active application and facilitated feedback components allowed learners to reflect in real time as to how they were meeting a particular objective. Discussion/UNASSIGNED:This feasible and practical educational intervention fills a literature gap by showing the medical educator how to apply validity evidence to both existing and in-development assessment instruments. Thus, it holds the potential to significantly impact learner and, subsequently, patient outcomes.