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[Auto-generated transcript. Edits may have been applied for clarity.]
Narrator: Welcome to the Competency Conversation Building Structure to support competency based Education,
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presented by the MUSC Center for the Advancement of Teaching and Learning and the team at the Learning Curve podcast.
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Welcome back to the Competency Conversation.
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Julia Liebenrood: Today we're joined by Leslie Morris, IT and online education manager for the Graduate Medical Office at the Medical University of South Carolina.
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Leslie brings a unique perspective at the intersection of technology, online learning,
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and graduate medical education, where she supports the design and delivery of digital learning experiences.
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And this conversation will explore how technology and innovation are helping to advance
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competency based education and support learners across clinical training environments.
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Leslie, we're so glad to have you. Leslie: Thank you. I'm happy to be here. All right.
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To get us started, when you hear the phrase competency based education. What does it mean to you in practice?
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So really in my role now, it's all competency based education.
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We are at the level where we're preparing residents and fellows for their actual practice.
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Um, so there's no gray area, right? It's can you perform this procedure or can you not?
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Um, the graduate milestones that they have are very clear and outlined.
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Well, and then we have more and more programs adopting and trustable, uh, professional activities which I know are popular among medical students.
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Our medical programs for students now, too. Um, so in my current role, it's it's daily, right?
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It's a daily practice. Um, before, though, it really wasn't right, because there is a lot of, you know, do I have to, um, you know, what?
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Do I have to learn this to be part?
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Or why is this part of my career? And it's hard to answer that question when it's not necessarily going to be part of their career, you know?
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So when I first started, I mean, this was years and years and years ago when I was in K-12 system I,
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when technology was coming out and was becoming more forefront, I started to ask the question, if you can Google it, why are you asking it in class?
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If they can Google an answer, why are you asking this? You know.
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And I got a lot of flak for that. But it's kind of the truth.
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Like, why are we even spending time on this, where you could spend time on much more quality education,
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which really does become competency based education? It's objective.
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Um, like I said, there's very rarely is there a gray area.
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Um, it just really makes a lot more sense to be observing someone.
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And then if you want to say, grading, grading someone with competencies rather than, you know, can you do it,
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can you not rather than good job or I didn't observe this or you know,
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how did you perform on this one exam that just has questions that are true false.
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A, b, c, d. It's not going to help you in practice.
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So it's kind of been refreshing actually in my new role to be immersed in competency based education because there's not really another choice.
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Yeah. So it's been great. Yeah. And I appreciate you sharing that.
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It's kind of like refreshed and invigorated. Your passion for education is what I'm getting from you.
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And we've heard that from our other folks that we've talked to is that it's like brought a new spark to education
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that they either didn't see coming or they were like hoping to have back that they may be used to have.
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Um, so I felt that in my own practice as well, that this was something that gave me a lot of hope.
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And I also got to see firsthand the benefits of this kind of approach.
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And it was like, once you see it, you really can't do it another way because you see how impactful it is,
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not only for the students, but for what they're going to do in the future. Um, and how we're setting them up for success.
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So you said that competency based education shows up a lot in your current role that you're working on this daily.
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So tell me a little bit about where you guys are in your kind of rollout of this, and maybe the projects that you're working on right now.
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So our accrediting body, um, the Acgme, they basically defined these milestones for residents and fellows.
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And there's kind of there's these buckets that, um, every resident and fellow has to, quote unquote, pass in order to graduate.
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Every program has better definitions within those buckets, I guess you could say,
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but they all have to at least meet their milestones in order for them to graduate on
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time and everything from professionalism to your medical knowledge to patient care.
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Each one is its own kind of bucket. And then they have sub competencies within.
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And so the sub competencies are really where we get to kind of the meat of observation and then evaluating residents of fellows.
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And so they have a couple of evaluations. One that we look at is their rotation evaluations.
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So at the end of our rotation when they finish um, clinic rotation, whatever it may be,
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the faculty members will fill out an evaluation based on how they performed, you know, during that month or during that period.
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Um, and then every six months and every year we have these clinical competency Committee meetings where the entire faculty
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get together are a lot of faculty get together and they look at the milestones individually and they start asking like,
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how? How do they perform in their rotations?
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Did they meet these individual milestones and they actually fill out an additional evaluation six month and year with the actual evaluations,
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like based on the actual or based on the actual competencies?
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And so one thing, one goal that I have is I really would like to take these rotation evaluations.
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And one of the things I want to start doing is really helping them map those rotation evaluations to the actual competencies.
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There's a way to do this in our system that we have now, and I've seen a little bit of it,
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but I kind of want to kick it up a notch and take it up another level.
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The other thing I've noticed that looks really promising is these entrust professional activities.
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So I've seen more and more fellowships actually. So our fellowships are more defined right there.
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They're kind of more. Um, their skills are more honed into an exact, uh, area.
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And so what I've seen with those is they have EPAs,
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and I've seen their evaluations really honed in on the EPAs themselves, which is really neat to see.
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And so taking those and connecting them to the competencies, I think is kind of the next step there.
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But, um, I'm, I'm excited that it's heading in that way.
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Right. Um, I even have a couple of residencies that are pretty large that are actually adopting EPAs to more and more.
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Um, it's not new, but it's kind of new to some programs here and how those work and how to evaluate those and evaluate them.
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Well. Um, so I think another thing is kind of training faculty on the observation side of things.
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and kind of being making sure that you're objective, not subjective I think is another big piece.
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Mhm. Yeah. So what tool are you guys using.
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You said that the platform y'all are using. What is that that y'all are using within your program.
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So we have our electronic electronic residency management system is called Med Hub.
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And that's where our evaluations are housed right now. And so that is basically all of our evaluations come out of there.
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So all resident and fellow evaluations both rotations six month year.
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They're all there so that you can get a great picture with aggregate evaluation data of individual residents and fellows.
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The one thing that we want to really work on is, again, kind of helping our faculty, uh,
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really kind of answer those questions in a really objective way again, but also refrain from saying good job did well, right?
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Yeah. Those things. So because what we find is that a lot of the times,
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the comments actually really kind of help in those six month in year evaluation settings, those meetings.
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So it sounds like y'all are looking at the data alongside faculty and you're asking them to reflect,
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be objective, give clear, consistent, constructive feedback.
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When are these conversations happening? How often are you able to coach up our faculty?
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So it's not me. It's actually a program directors who do it. We oversee and will help in any way in the GMI office.
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I'm looking at evaluations now, actually kind of reviewing those, but it's our program directors who meet with the faculty members.
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And this is a requirement actually. So every six months, every year they have to.
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So it happens around they start around May end in June, uh, for those that are ending their year, ending their fellowship, graduating.
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So those types of things and kind of determine they really that group determines
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whether or not the resident or fellow is going to move on to the next year. Did they meet these competencies to move on to the next year?
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Um, and then the six month ones happen around start in November ish.
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Go through to about January. Yeah.
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And not only are we doing this for our accredited programs, but for the programs that are not accredited through Acgme,
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but have their own accreditation with another with another affiliate.
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And so we're looking at those two now. So we have educational oversight.
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It kind of has spread out a little bit over um, not just accredited but non non acgme programs as well.
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So yeah. And you said you're beginning to look at some of that data as you start to look at it.
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What kind of things are you noticing. So one thing is I think we need some.
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So one thing actually I've heard feedback, which has been fantastic.
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Feedback from faculty themselves is can we please not have a 20 question evaluation
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after a month rotation on the 15 residents I worked with in this rotation?
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Yes, we can help you with that. We can kind of get drilled down to the questions that actually mean something.
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Not that, you know, the questions that are 20, the evaluations that are 20 questions wrong don't mean something, but there is a better way, right?
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There is a better way to ask. So helping. That's one of the pieces of feedback I've heard from faculty.
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Um, the other is kind of the delivery option too.
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We have some cleanup to do on that, and I feel like so right now we can automate evaluations.
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Not sure that's the best when you want to collect the most accurate data.
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So we're looking at the delivery of those as well.
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Um, then with the data specifically you know, are they meeting where they need to be?
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And really, we use it for any kind of resident who may be struggling in an area.
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We take a deeper dive to where we can in our office to look at where they are.
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Our Dio doctor tally, she has access to all of them as well.
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Um, so she can help anybody who may be struggling in an area or help that program director.
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So it's important that we have not just accurate data, but also data that's going to really tell the story of the resident themselves.
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And that's what I really want to start kind of instilling in our programs.
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Um, are those questions that are going to not just be accurate but also really help drive, you know,
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whether or not they can truly graduate from their residency or their fellowship and how they did.
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Um, and the faculty can answer with confidence how they did.
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That's my goal. Yeah. So going to take us back a little bit.
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So you mentioned at the beginning of this that why are we asking questions to folks that can Google students, young students at Google.
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So in today's age, why are we giving them prompts or assignments that they can just use AI for?
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So I would love to hear a little bit more about how you see AI intersecting within competency based education and kind of,
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you know, what your mind goes to when we think about those two things in conjunction.
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Absolutely. So, um, one of the things that I've done in the past is I've been one of the like a co facilitator for our Clinicians as Educators course,
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which has been awesome, enlightening, has been fantastic. And we and thank you for helping us with that, by the way.
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Um, I love that project. Yeah. It was that was awesome.
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So one of the things we did this year is we asked them for specifically for scenarios, for a feedback situation.
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And, um. Basically when I got there.
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All of their projects back or all of their feedback questions back.
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And the reason why we do that is because part of competency based education is a lot of scenarios,
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a lot of like, let me learn from this situation kind of thing.
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So we had them fill out or we had them write up,
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basically a feedback scenario of an attending and a resident of an upper level fellow and a resident, like how would this feedback situation go?
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Something bad happen, something good happened on my rotation. Let's discuss it.
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Let's, you know, let's get to the bottom of what happened. Keep it open.
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Um, you know, make sure that it's a kind environment and all.
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What was funny is that a lot of them had the same doctor, and it was doctor Patel was the attending,
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and the resident was maybe Richard or something like that.
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And I was like, how did all of these people have the same name? Well, then I put in my own into copilot.
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Sure enough, it gave me Doctor Patel as the attending, and it gave me a resident name.
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And I was like, that is so interesting that it was the same throughout, but it was not it wasn't bad quality.
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And you could what we did with that, it wasn't like we were expecting them to spend the most time writing out these scenarios.
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That's not the focus. The focus was bring it to class because we're going to pull yours potentially, and you're going to act it out.
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We're going to have two people act it out. Two different people that you don't know.
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Act out the scenario and talk about what went well, what didn't.
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So it was more or less kind of putting the putting the responsibility more on
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what we were doing in class rather than what we were doing outside of class,
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and I just thought it was interesting that they used it was clear that they used AI, which is fine.
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You know, to us we're fine with that. It's just what you do with it, you know, is where is where the importance lies.
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Yeah, absolutely. And as a musk as a whole, we are starting to see more AI questions come up.
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Use within the courses. So what does AI look like within your programs.
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And are you guys trying to instill some of those AI, um, goals, competencies frameworks into the work that y'all are doing?
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So 100% is about stewardship, I think at our level.
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Um, and what I mean by that is just promoting good stewardship, right?
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Um, we do not have a we have drafts of guidelines that we have for programs.
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But again, we vary so greatly in our program.
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So, you know, we have everything from surgery to pathology, right?
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And they do not learn the same way. I mentioned different competencies or sub competencies within each one.
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And so they vary on how they would be using AI as well.
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But there's a few overarching kind of guidelines that we want to address.
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Right. So number one, obviously, even though we're protected you through our copilot license through a bar with Microsoft, I get that we're protected.
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It's still a good practice not to put patient information in there, right.
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So that's one kind of major thing that we want to address.
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Um, things like make sure you back up what you, what AI has told you, you know, is this truth.
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Does this make the most sense? Is this valid? And how can you validate it?
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And then I thought it was interesting, but our Dio said previously, she said, you know,
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what's interesting about that is you could be working with somebody and they also give you an answer.
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They're not AI. They're not using AI. But maybe a faculty member could be another fellow.
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Could be anybody gives you an answer. Are they also validated?
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Are you validating your answer with them? And I thought that's kind of interesting. Are you validating every answer that you receive?
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But I feel like with AI, because AI is still in the learning stage itself,
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especially our large language models, that we should be actually validating that.
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So that's another kind of stewardship practice that we want to get into. Um, or good stewardship practice.
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So we are starting these guidelines.
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We're also starting an AI, uh, committee for specifically for GMI because residents and fellows are kind of their own.
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We are our own little selves over there, kind of separate from students.
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Right. You've learned that to unique body. We really are.
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Yes. Yeah. So we have, we're going to have kind of a because it it kind of bridges.
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Right. So it's not just AI learning and an education and in you know, taking courses and that kind of thing.
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It's also in the clinic. Right. So we kind of have to bridge the two.
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Um because they're learning happens in clinical environments.
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So we're looking at those type of guidelines, the AI committee that we're going to have, we'll look at those guidelines,
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kind of write them out for program directors, making sure that they're broad enough so that they can,
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uh, so that they're applicable to all programs, but also giving the programs a little bit of choice in there and how they deal with,
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um, you know, the education of AI in their own program.
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Um, the access is another big thing right now. So, uh, our new brand new PG one start the 1st of July.
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So just in a little over a week And can they have access to Dax?
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Copilot day one right. Hot topic right now among a lot of our faculty.
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So it's kind of things like that that we want to help guide them but not give them a set.
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You have to do this. We just want to provide the best guidance we possibly can.
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And then in terms of education, our goal right now. So we've we kind of reach two out of our three goals.
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So the first one was we connected everybody and actually made it a mandatory this year for everybody to watch the MSCI module.
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That's in our day. So everybody in coming has watched that.
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So they understand really the understand kind of um I would say the principles here of AI right.
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So they've all watched that. The second step is we wanted to provide some kind of literacy.
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So cattle helped with that greatly. And connecting us with the deck.
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Um, so we have. We have. We're in the review stage of that right now.
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We have it right. But we have a couple of our residents fellows looking at it.
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Um, just kind of logging in to see, you know, if it's, um, if it's kind of applies to that level.
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And then part three is what our main focus is going to be this year.
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Um, we will have our curriculum committee really dive in and do an AI curriculum, but more, um, based on competencies than anything else.
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So we're going to get to that competency level with AI and actually using it, uh, in clinical situations, in the learning environment kind of thing.
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So that is kind of our last and final goal and put together a curriculum for our program directors to use,
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um, so that they can kind of so that they don't feel kind of island.
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Right. They're not like alone in this, that we we are there to support them and,
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and give them something that's quality, uh, so they can use it with their own residents of bellows.
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My one concern about that is I feel like there could potentially be a little bit of a gap.
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Um, meaning I wonder if our residents and fellows who are coming out.
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What does your medical school teach you?
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What did your undergrad teach you? Was it a thing? My guess is kind of no, since everybody's learning this or maybe different there.
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So I do think, uh, providing the AI at Musk module was really important to tell them these are our principles here and these are expectations here.
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So that's why we thought that step one was so important. We're trying to bridge that gap a little bit.
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And I can imagine that because you guys have students coming to you filtered through a bunch of different, you know, universities prior.
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They're all coming in with these different experiences, different expectations.
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But that's kind of the beauty with competency based education is because you have these very streamlined expectations laid out for folks,
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and you can see where all of your students or your residents or your fellows fall on that continuum and say, okay, they need to work on this aspect.
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Maybe their prior university didn't prepare them as much in this area, and that's like from the AI side.
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But I also feel like it's probably could help you guys within the content side of things too,
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because as more and more programs go to competency based education,
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I would venture to think that your students that are coming in as your residents and fellows are going to be more prepared,
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hopefully, because they've had these real world.
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You've talked about them, the EPAs, they've had experience in these, you know, situations,
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clinical practice, whatever it might be for their programs that they're coming in with a little bit of,
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um, a leg up because hopefully, you know,
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they're coming in with a stronger background because of the work that maybe their prior institution has done with them through CBE.
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That's what we're hoping. I mean, ultimately when they graduate here, we're saying that they can be your doctor.
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That's a lot of responsibility, right? So I think that's another reason why our accrediting body, the IG,
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has done extensive research in these different competencies and sub competencies to make sure that when they graduate,
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we can confidently say they can do these and perform these tasks at level.
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Yeah. When you bring the medical profession into it, is is, you know, in some situations it's life or death.
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And so we have to make sure that we can confidently put them into those situations to, um, you know, out into the world to help people.
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That's what we want to do. Um, throughout y'all's work and all of the things that you guys have done.
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Have there been any unexpected wins or anything that you're extremely proud of that you guys have done over in your office?
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Yeah, I mean, so the Clinicians as Educators course was specifically for, um, it went out to everyone, but I don't know.
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But it kind of it was tough because it was all in person.
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Um, not a lot of people can make it. Right. So they weren't able to kind of, um, join the course even though they may have wanted to.
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It was also a two year commitment, right? So it was there was a lot involved.
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And that is hard for a lot of folks, um, especially when residencies and fellowships,
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they are some finish in seven years, some finish in one, some finish in three.
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So our goal for that was we really wanted to make sure that everybody had an opportunity.
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So when the education committee took it on the first year, we had, I think 28 pretty sure, uh, were our graduates that year.
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And this past year we had 49. So that was a major increase, which was fantastic.
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We have a lot of interest in it. We have a lot of folks who really want to take that education pathway, which is fantastic.
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Um, and so we want to continue to grow that as much as we possibly can. So I would say that's definitely a win there.
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Um, I think that what we're developing, curriculum wise is also a huge win, starting with feedback.
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That's a major win to a lot of the other kind of, um, curriculum pieces that we've added.
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So one was, um, health care disparities. We have a great didactic talk from one of our faculty members who it's now broadcast to GM.
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They they can have access to it if they want to. They can review it and share it with their faculty.
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So I think that our education committee has made a lot of strides in kind of what we've always wanted to do,
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but just didn't have the staff, didn't have the time, didn't have the commitment where we were able to commit to it.
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We now are. That's probably the biggest one, is that we can commit to it now and really get our promises, you know,
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achieved, I think, and I think it's going to better our faculty and residents fellows in the long run.
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Yeah, absolutely. Completely agree. All right. Our last question for today wrap us up.
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What does building competence together mean to you.
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Building competence together I think is that feedback again with the resident fellow and faculty all the way up to our office to I mean,
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tell us, um, feedback is something that we all need to kind of be aware of.
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Right. And so you can't get better unless you unless you have really good feedback from someone, you can't better yourself.
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Um, I think it's working together and a coaching Kind of situation more so than it is.
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I'm the teacher. You will learn from me, right?
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Um, we instill that especially in our kind of upper level residents and fellows, that you are really a coach to our incoming.
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Right? More of a coach to students helping them through that coaching process rather than like you will do what I say kind of thing.
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Um, so I think it's really the one on one, um, and being able to do that in a safe environment to, um,
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knowing that you can go to our faculty members and knowing that you can have an open discussion with them and that there's not that retaliation,
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that's huge as well. So being comfortable to have those conversations.
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Um, and that's what we're trying to instill is that coaching, but also in a safe environment for folks.
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Well, I really appreciate your time today. Thank you so much for joining us. And, um, we'll see you next time.
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Absolutely. Thanks so much.
