The 2006 Straatsma Award Lecture: The (R)Evolution in Medical Education
8 2008, Volume 1, Number 1 In this article I am hoping to demonstrate that medical education is undergoing either a revolution or evolution at present. The American Heritage Dictionary defines revolution as: a sudden or momentous change in a situation and evolution as a gradual process in which something changes into a different and usually more complex or better form. Surprisingly to me, I have to credit the Accreditation Council for Graduate Medical Education (ACGME) and their outcomes project as the catalyst that has changed medical education in the United States. They defined six core competencies that every resident must achieve: 1. Patient Care (medical and surgical); 2. Medical Knowledge; 3. Practice-Based Learning and Improvement; 4. Interpersonal and Communication Skills; 5. Professionalism; and 6. Systems-Based Practice. The ACGME's outcome project is designed to assess competence in these areas. Our old education system emphasized minimum num-bers to graduate. The resident must do at least 45 cata-ract cases, 1000 refractions, 300 hours of lecture, etc. This system does not measure competence! So, out with the old, in with the new competency based system. In this system we must measure and produce evidence of competence. Thus, the competency based model meas-ures whether a program is actually educating the resi-dent. The ACGME requires that we have valid and reliable measures to assess residents' competence in the six core competencies. Validity may be loosely defined as we are measuring what we think we are measuring and reli-ability, in a sense, is how reproducible the measure-ments are. Prior to the competencies, most programs evaluated residents by faculty rating scales and the Oph-thalmic Knowledge Assessment Program (OKAP). The OKAP has been shown to be valid and reliable but only measures one aspect of competence: medical knowl-edge. Faculty rating scales have not been shown to be valid or reliable. Thus, new methods of assessing resi-dent competence were needed. The American Board of Ophthalmology (ABO) formed a Competency Task Force charged with developing such assessment tools. I was the Chair of the patient care section, and we devel-oped the Ophthalmic Clinical Evaluation Exercise (OCEX) patterned after the American Board of Internal Medicine's Clinical Evaluation Exercise [1]. This is a one-page rating checklist designed to be used by an at-tending physician as they directly observe a resident-patient interaction. The completed OCEX form is re-viewed with the resident immediately after the interac-tion to provide timely formative feedback. We have shown the OCEX to have validity and interrater reliabil-ity [2]. Subsequently, the On-Call Assessment Tool (OCAT) was designed and shown to have content valid-ity [3]. It became apparent that to develop valid and reliable assessment tools collaboration is necessary. Any one ophthalmology program simply does not have enough residents to generate numbers required for favorable statistical analysis. The Program Director's Medical Education Research Group (PDMERG) was formed to: 1) enhance program director collaboration, 2) conduct and publish medical education research, 3) increase quality of resident education and assessment, and 4) improve the program directors' academic reputation. Currently more than one-third of the U.S. program di-rectors are members of PDMERG. Our first research The 2006 Straatsma Award Lecture: The (R)Evolution in Medical Education Karl C. Golnik, MD, MEd 1* 1 Program Director, Professor of Ophthalmology and Neurosurgery, The University of Cincinnati, The Cincinnati Eye Institute, Cincinnati, OH * Corresponding Author & e-mail: kgolnik@fuse.net Accepted for publication August 1, 2007 2008; 1:8-10 Available on the web at http://www.academic-ophthalmology.com The author(s) have no personal financial interest in any of the prod-ucts or technologies cited herein. Â 2008