Purpose: As the medical community reels from the impact of the COVID-19 global pandemic, medical educators must reassess their own methods of evaluation and targeted support structures for resident learners. Current ACGME milestones offer broad guidelines that designate competencies for all trainees, regardless of subspecialty, but these parameters are known to be difficult to translate into observable behaviors, to not possess adequate validity, and may disproportionately marginalize atypical learners or fail to identify when high performers are struggling. With this in mind, the understanding of what is essential for resident trainees to master in order to become (and remain) competent, motivated physicians must shift.
Background: Threshold concepts are defined as core ways of thinking and practicing that are required for true mastery of a subject. While not native to medical education, these ideas capture the transformative way that learners should approach their own discipline and may assist educators in supporting professional development. Particularly in the field of obstetrics and gynecology, the identification of threshold concepts within residency training can help determine more holistic goals of graduate medical education
Methods: This was a qualitative study with a constructivist framework and based in grounded theory. Semi-structured interviews were conducted with eleven members of education teams at academic OBGYN residencies in New York City. Interviews were transcribed, coded, and analyzed in order to identify common themes until data saturation was reached.
Results: Six threshold concepts specific to OBGYN residency training were identified: recognition of clinical severity, anticipation and adjustment of surgical technique, ownership of responsibility to patient needs in a dynamic setting, empathic collaboration and team management, confidence in independent decision-making, and advanced emotional regulation.
Discussions: The potential benefits of this study are to spur educators to reframe how we evaluate learners in graduate medical education. While limited to perspectives from academic leadership in a major US city, the identification of threshold concepts for OBGYN trainees has applicability and generalizability to other training programs that seek to provide better support and mentorship to residents in this specialty.
Topics: CREOG & APGO Annual Meeting, 2022, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Assessment,
Olivia P. Myrick, MD, MHPE, NYU OBGYN Residency Program, NYU Langone Health
