Promoting the Development of Core Competencies during Early Medical Education: Implementation of a Teaching Assistant Program in Anatomy Course

Brown MT¹, Fenderson BA² and Zhang G²*

¹Medical Student Class 2018, Sidney Kimmel Medical College, Thomas Jefferson University, USA

²Department of Pathology, Anatomy and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, USA

*Corresponding author: Guiyun Zhang, Department of Pathology, Anatomy and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, 1020 Locust Street, Room 263G Jefferson Alumni Hall, Philadelphia, PA 19107, USA

Received: September 13, 2017; Accepted: November 22, 2017; Published: November 29, 2017

Abstract

Competency-based curricula that emphasize personal and professional development have been widely implemented in medical schools. To strengthen competency training during the early years of medical education, we established an anatomy Teaching Assistant (TA) program for raising second-year medical students. The medical student TAs assumed a leadership role in a dissectionbased anatomy course for Physician Assistant (PA) students. They worked in the dissection laboratory demonstrating dissection techniques, confirming anatomic structures, and engaging PA students in dialog to facilitate a comprehensive understanding of anatomy. Two questionnaires were conducted at the end of the course: a �TA Self-Reflection Survey� completed by the medical students and a �TA Evaluation Survey� completed by the PA students. Both questionnaires addressed the development of TA core competencies during the course. The survey data indicated that medical student TAs acquired a greater base of knowledge for practice and enhanced interpersonal communication and life-long learning skills, such as the confidence to admit and correct mistakes. The data also indicated that the medical student TAs learned and demonstrated many attributes of professionalism, including commitment to excellence, respect and compassion for learners, timeliness, and inter-professional collaboration. The TAs agreed that they learned essential skills and behaviors that would benefit future patient care. Our findings indicate that anatomy TA programs provide a valuable opportunity for medical students to share basic science knowledge with allied health professionals and acquire a working knowledge of core competencies that are expected of practicing physicians.

Keywords: Competency; Medical education; Anatomy; Teaching assistant; Physician assistant program

Introduction

Competency-based medical education for undergraduate and graduate training is widely accepted and has become the dominant curriculum model for medical schools in the United States [1] and around the world [2]. The Association of American Medical Colleges (AAMC) has developed guidelines for medical school curriculum development and identified specific core competencies for medical school graduates. Physician competency domains emphasized by the AAMC include: i) compassionate, appropriate and effective patient care; ii) knowledge for practice; iii) practice-based learning and improvement; iv) interpersonal and communication skills; v) professionalism; vi) system-based practice; vii) interprofessional collaboration; and viii) personal and professional development. Competency-based graduate medical education programs have also been developed in surgery [3], geriatrics [4], internal medicine and family medicine [5], pathology [6,7] and psychiatry [8]. Many of these graduate training programs have developed innovative curricula to help physicians acquire core medical competencies.

The �core entrustable professional activities for entering residency� established by the AAMC include technical skills and nontechnical competencies such as communication, teamwork, decision-making and error management. Compared to technical skills, the nontechnical competencies are difficult to teach. Nonetheless, nontechnical competencies are of crucial importance for medical practice. Studies indicate that adverse events in health care are often caused by a failure in communication and/or teamwork [9-11]. Therefore, in response to the compelling need for improving physician�s nontechnical skills, postgraduate residency programs in various disciplines have developed courses with an emphasis on nontechnical competency domains [12-16]. One approach, �multidisciplinary team simulation�, has been described as a successful program for teaching both technical and nontechnical skills [17,18]. Unfortunately, literature reviews indicate that the level of evidence supporting the value of this approach is low and the impact of this type of training on patient care has not yet been objectively assessed [19]. Literature review also indicates that nontechnical skill training in surgical residency is marginally effective. The overall strength of the evidence concerning training outcome measures was graded as �moderate� in teamwork, �low� in patient-centered communication, decision making and coping with stress, and �very low� in patient safety and error management [20]. These findings emphasize the crucial importance of early nontechnical core competency training during medical education.

As preclinical science faculty and a medical student, we believe that the acquisition and strengthening of AAMC Core Competencies, especially the nontechnical competencies, should be a continuous process. It should begin during the early years of medical education in order to facilitate a smooth transition to competency-based clinical training and medical practice. However, there are virtually no reports on how medical educators can help medical students gain physician competencies during the early years of medical training, particularly in complex domains such as interpersonal communication skills, professionalism, and life-long learning skills. These competencies are difficult to teach using traditional methods of instruction, such as lectures, case studies and assigned reading. Objective methods for assessing medical competencies related to personal and professional development are often lacking.

To explore methods for strengthening medical students� competency training during preclinical undergraduate medical education, we established an anatomy Teaching Assistant (TA) program for rising second year medical students. Medical students who have completed their first year of preclinical basic science education are recruited to help teach Physician Assistant (PA) students in a Human Anatomy course. Medical students assume a leadership role in the course. They work alongside the faculty and assist PA students in cadaveric dissection. The medical students are encouraged to engage in scholarship by creating innovative teaching resources. Through these activities, the anatomy TA program provides medical students with a rich opportunity to gain an independent and professional identity. Here, we describe the implementation of this TA program, and document its effectiveness in helping medical students gain competencies expected of practicing physicians.

Methods

Anatomy course for Physician Assistant (PA) students

Promoting the Development of Core Competencies during Early Medical Education: Implementation of a Teaching Assistant Program in Anatomy Course

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