Lia Logio, MD, professor of medicine and director of the residency program at Weill Cornell Medicine and New York-Presbyterian Hospital, said whether the milestone process is optimal has yet to be determined. 

“We don’t know yet,” Dr Logio said in an interview. “The value of [milestones] is to define very specific components of good doctoring.  If you are trying to be a doctor it gives you a framework. For the learner, they are a good idea. For the accreditation process, I am not sure. The language is standard, but the way we get to the rating is very uniquely defined by each program.”

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Improving the Use of Oral Case Presentations

There are other steps that are also now being proposed to improve training. Scholars are suggesting that oral case presentation in medical education could be used to assess clinical competence and teach clinical reasoning.

Even though oral case presentations are widely used, they could be used more effectively as tools for structured teaching and assessment, according to the authors of a Viewpoint in JAMA.2  Part of the problem is that oral case presentations in medical education lack standardization.

“Medical educators can achieve greater effectiveness in using case presentations for teaching by doing 3 things: first by telling trainees more clearly what expectations they have for presentation format and content; second, they should use probing questions to check for understanding; and third they should model how they think through a case to help trainees understand their clinical reasoning,” said viewpoint author Rodrigo Cavalcanti, MD, associate professor of internal medicine at the University of Toronto in Canada.

He would like to see more formative evaluation based on oral case presentations in which the assessment of the trainee’s performance is designed to help improve performance, similar to what a sports coach might do.

“When watching someone play, coaches focus on giving tips on how to perform the task better. Presentations happen on a daily basis in every teaching hospital for almost every trainee,” Dr Cavalcanti told Endocrinology Advisor.

Co-author Lindsay Melvin, MD, also from the University of Toronto, said the main barriers have to do with time constraints for the clinical teacher. Teaching clinicians are under pressure to be efficient and are faced with competing demands of providing care.

“Improvements need to start by acknowledging these two important tasks and recognizing the value of each of them. Clinical care is paramount. Teaching also needs to be rewarded for its contributions to the new generation of physicians.” Dr. Melvin said in an interview. 

What About Teaching High-Value Care?

Two medical ethics scholars are urging careful consideration of how the concept of high-value care should be integrated in medical education.3 

In another Viewpoint published in JAMA, the authors noted that if primacy of patient welfare is to truly remain fundamental to the profession, then there needs to be a commitment to this principle. Further, it should be the most critical ethical value instilled in cultivating professional identity, according to the authors.3

This article originally appeared on Endocrinology Advisor