Faculty Development and Supervision Flashcards

A program director receives a complaint that a supervising attending is delegating all patient presentations directly to interns without providing feedback, citing efficiency concerns. Under ACGME supervision requirements, which framework should the program director primarily invoke when addressing this behavior?

Answer: The supervision continuum framework, which mandates that faculty progression from direct to indirect supervision must align with demonstrated resident milestone achievement

ACGME supervision requirements establish a continuum from direct supervision (in-person, immediately available) to indirect supervision (available by phone) to oversight. Faculty must calibrate supervision level to individual resident milestone achievement — not blanket efficiency. The supervision continuum framework directly addresses the obligation to match supervisory intensity to documented resident competence, which this attending is bypassing.

During a faculty development needs assessment, you discover that 70% of your clinical faculty score below benchmark on giving feedback using the 'Ask-Tell-Ask' model, yet the same faculty rate themselves as highly effective feedback providers. This discrepancy is best explained by which educational psychology concept, and what intervention addresses it most directly?

Answer: The Dunning-Kruger effect; addressed by calibration exercises using video-recorded feedback encounters with structured peer review

The Dunning-Kruger effect describes the phenomenon where individuals with limited competence in a skill overestimate their ability, partly because they lack the metacognitive framework to recognize their own deficiencies. Calibration exercises — particularly viewing recorded feedback encounters and comparing them against expert-rated exemplars — force faculty to confront the gap between self-perception and performance, which is the most direct intervention.

A fellowship program is implementing competency-based medical education (CBME). The program coordinator is asked to help design a system where entrustment decisions are made prospectively and continuously rather than at fixed time points. Which data source combination best supports valid entrustment decisions in this model?

Answer: Longitudinal, workplace-based assessments from multiple observers across diverse clinical contexts combined with trainee self-assessment and direct observation tools

CBME entrustment decisions are most valid when grounded in multiple direct observations across varied contexts from multiple assessors over time — this triangulates performance and reduces rater bias. Workplace-based assessment tools (e.g., mini-CEX, DOPS, EPA-specific observation forms) combined with trainee self-reflection provide the granular, real-time, multi-source data CBME requires. Summative or single-source data (CCC ratings alone, exam scores) are insufficient for continuous, prospective entrustment.

A GME administrator is reviewing a faculty member's Teaching Effectiveness ratings from the past three years. Scores are consistently high from residents but the faculty member has never been observed directly by a peer or program director. The administrator flags this for remediation planning. Which principle of faculty assessment best supports this concern?

Answer: The single-source bias principle, indicating that trainee ratings alone cannot capture teaching behaviors requiring expert-level evaluation

Trainee evaluations of teaching are subject to multiple limitations: residents may rate highly based on charisma, clinical expertise displayed, or workload reduction rather than true pedagogical skill. Certain teaching behaviors — like use of learning theory frameworks, deliberate practice design, or appropriate feedback techniques — can only be assessed by trained peer observers. Single-source bias means relying solely on resident ratings creates a fundamentally incomplete picture, which is why direct observation and peer review are standard components of robust faculty assessment systems.

During a Clinical Competency Committee meeting, a member proposes placing a senior resident on a Performance Improvement Plan (PIP) based solely on a single rotation evaluation that scored 'Does Not Meet Expectations' in Patient Care. Another member argues that a PIP is premature. Which principle of remediation best supports delaying the PIP at this stage?

Answer: A single data point is insufficient to establish a pattern; remediation plans require triangulation across multiple assessments, time points, and ideally multiple rater types before formal action

Best practices in remediation — and legal defensibility — require that a pattern of deficiency be established before formal action. A single evaluation may reflect rater bias, an atypical clinical context, or situational factors unrelated to underlying competency. The CCC should triangulate: look for corroborating data across multiple rotations, raters, milestone levels, and ideally direct observations before initiating a PIP. This protects both the resident and the program from premature or unsubstantiated adverse action.

A program director wants to implement a structured faculty development curriculum focused on coaching rather than traditional teaching. Which theoretical model most directly underpins a shift from expert-directed instruction to a coaching paradigm in clinical medical education?

Answer: Self-Determination Theory (SDT), which posits that effective coaching fosters intrinsic motivation by supporting autonomy, competence, and relatedness rather than externally directing performance

Self-Determination Theory (Deci and Ryan) is the foundational framework most directly applied to coaching in medical education. Coaching explicitly targets the three SDT psychological needs: autonomy (the resident sets their own goals), competence (the coach helps the resident build self-efficacy through targeted feedback), and relatedness (the coaching relationship itself). Unlike traditional teaching, which is expert-directed and externally motivated, coaching activates intrinsic motivation — the mechanism SDT identifies as most durable for deep learning and behavioral change.