- •Communities of practice are groups of people who share similar goals and interests and interact regularly.
- •Communities of practice have been effective in managing knowledge and improving performance across a wide range of settings.
- •Educational Innovations Project participants developed a close network of relationships, forming a successful and productive community of practice.
- •Professional organizations and accrediting bodies could consider this example as they seek to accelerate and sustain innovation.
The Education Innovations Project—A Community of Practice
Accreditation Council for Graduate Medical Education. Categorization of common program requirements. Available at: http://www.acgme-nas.org/ccpr.html. Accessed March 17, 2013.
Wenger E. Communities of practice: a brief introduction. Available at: http://www.ewenger.com/theory/. Accessed March 17, 2013.
Wenger E. Communities of practice: a brief introduction. Available at: http://www.ewenger.com/theory/. Accessed March 17, 2013.
Wenger E. Communities of practice: a brief introduction. Available at: http://www.ewenger.com/theory/. Accessed March 17, 2013.
Accreditation Council for Graduate Medical Education. Educational Innovations Project. Available at: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/140_EIP_PR205.pdf. Accessed October 7, 2013.
- 1.Evidence of institutional commitment (EIP was unfunded).
- 2.Two previous accreditation cycles with a total of at least 8 years cycle length.
- 3.A current rolling American Board of Internal Medicine Certification Examination program pass rate of >80%.
- 4.A program director or associate program director that had been in place for at least 4 years.
- 5.An agreement to submit an annual program information form (shorter than the standard site-visit-associated form) as a yearly report of educational and patient care outcomes.
- 6.A willingness to disseminate innovations at the spring APDIM meeting and one additional national educational meeting each year (EIP meetings occurred in conjunction with spring and fall APDIM meetings).
Accreditation Council for Graduate Medical Education. Educational Innovations Project. Available at: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/140_EIP_PR205.pdf. Accessed October 7, 2013.
EIP Programs Accepted in Initial Year | Type of Program |
Abington Hospital, Philadelphia, PA | Community |
Aurora Health, Milwaukee, WI | Community |
Banner Good Samaritan, Phoenix, AZ | Community |
Baystate Medical Center, Worcester, MA | Community |
Henry Ford Hospital, Detroit, MI | Community |
Long Island Jewish, Long Island, NY | Community |
Scripps Mercy Hospital, San Diego, CA | Community |
Summa Health System/Northeast Ohio University College of Medicine, Akron, OH | Community |
Hennepin County Medical Center, Minneapolis, MN | Municipal |
Beth Israel Deaconess, Boston, MA | University |
Duke University, Durham, NC | University |
Mayo Clinic, Rochester, MN | University |
Ohio State University, Columbus, OH | University |
Southern Illinois University, Springfield, IL | University |
University of Cincinnati, Cincinnati, OH | University |
University of Wisconsin Madison, WI | University |
Westchester New York Medical Center, Westchester, NY | University |
EIP Programs Accepted in Second Year | |
Indiana School of Medicine, Indianapolis, IN | University |
St. Barnabas Medical Center, Livingston, NJ | Community |
University of Pittsburgh, Pittsburgh, PA | University |
University of California San Francisco, San Francisco, CA | University |
Focus | Percent of Total Projects (n) |
---|---|
Inpatient education | 24% (17) |
Ambulatory education | 18% (13) |
Handoffs/transitions | 17% (12) |
Milestone-based evaluations | 11% (8) |
Improve learning | 7% (5) |
Teamwork training | 6% (4) |
Medical humanities | 4% (3) |
Advising residents | 4% (3) |
Wenger E. Communities of practice: a brief introduction. Available at: http://www.ewenger.com/theory/. Accessed March 17, 2013.
Example Community of Practice Activities | EIP Examples |
---|---|
Problem solving | De-linking inpatient and ambulatory care Improving transitions of care Creating 16-hour duty shifts See also Table 2 |
Requests for information | Sharing ideas between programs Reviewing one another's programs Using an electronic social networking site |
Coordination and synergy | Receiving RRC-IM support Adopting national EIP coordinator |
Discussing developments | Meeting semi-annually Convening frequent conference calls |
Documentation projects | Publishing papers Collaborating in workshops Organizing yearly poster sessions |
Visits | Holding ad hoc retreats Arranging interprogram site visits |
Mapping knowledge and identifying gaps | Assessing ambulatory care milestones (Essentials of Ambulatory Care Study) Measuring ambulatory clinic structure affects patient care and learner satisfaction (Continuity Clinic Study) Assessing inpatient discharge milestones (initial project of the Educational Research Outcomes Collaborative–Internal Medicine—EROC-IM) |
Principle 1: Design for Evolution
Principle 2: Open Dialogue between Inside and Outside Perspectives
Principle 3: Invite Different Levels of Participation
Wenger E, McDermott R, Snyder WM. Cultivating communities of practice: a guide to managing knowledge: seven principles for cultivating communities of practice. Available at: http://hbswk.hbs.edu/archive/2855.html. Accessed March 17, 2013.
Principle 4: Develop Public and Private Community Spaces
Wenger E, McDermott R, Snyder WM. Cultivating communities of practice: a guide to managing knowledge: seven principles for cultivating communities of practice. Available at: http://hbswk.hbs.edu/archive/2855.html. Accessed March 17, 2013.
Epsilen.Available at: http://corp.epsilen.com/. Accessed August 7, 2012.
Principle 5: Focus on Value
Principle 6: Combine Familiarity and Excitement
Principle 7: Create Rhythm for the Community
- 1.Identify potential communities within the larger groups: EIP members were self-selected out of a common desire to improve care and education. The fact that many more programs wished to participate than were chosen suggests the potential for interest in additional CoPs within APDIM.
- 2.Provide the infrastructure: RRC-IM provided modest support and space for the semi-annual EIP meetings, with the expectation that EIP programs would engage with each other between meetings. Importantly, RRC-IM did not design this work specifically or proscribe specific outcomes; instead, they let front-line program directors determine what work was most important and gave them freedom to take this work where it needed to go. As programs in NAS innovate to produce outcomes, CoPs like EIP could provide safe spaces to determine the direction and significance of these innovations.
- 3.Measure value in nontraditional ways. If EIP had been measured solely by the number of curricula developed and papers published within the first 2 years, the project would have been considered a failure. Often, the effects of CoPs are delayed and results generally appear in the work of the individual programs, not in the CoP itself.4Wenger suggests listening to member stories along the way, as RRC-IM did, to elucidate the relationship between group activities, knowledge, and performance, and to have a long arc of time for measuring success. In addition, our CoP was given a general directive to improve care and learning and not a prespecified outcome. This flexibility led to the significant breadth of work indicated in the Appendix (online) that could not have been predicted from the outset.
Appendix
Collaborative Work |
Batalden MK, Warm EJ, Logio LS. Beyond curricular design of convenience: replacing noon conference with an academic half day in three internal medicine residency programs. Acad Med. 2013;88(5):644-651. |
Chang A, Bowen J, Buranosky RA, Frankel RM, Ghosh N, Rosenblum MJ, Thompson S, Green ML. Transforming primary care training—patient-centered medical home entrustable professional activities for internal medicine residents. J Gen Intern Med. 2013;28(6):801-809. |
Heist K, Post J, Meade LB, Brandenburg S. Do learners and teachers agree? Am J Med. 2013;126(3):270-274. |
Leasure EL, Jones RR, Meade LB, Sanger MI, Thomas KG, Tilden VP, Bowen JL, Warm EJ. There is no “i” in teamwork in the patient centered medical home: defining teamwork competencies for academic practice. Acad Med. 2013;88(5):585-592. |
Meade LB, Caverzagie KJ, Jones RR, O'Malley CW, Yamazaki K, Zaas A, Swing S. Playing with milestones in the educational sandbox: Q-sort results from an educational collaborative. Acad Med. 2013;88(8):1142-1148. |
Rosenblum M, Aulakh S, Luciano G, Varney A. Competency-based progression: concept to reality, competency-based progression: concept to reality. Acad Int Med Insight. 2011;9:20-21. |
Individual Program Work |
Aberegg SK, O'Brien JM, Lucarelli M, Terry PB. The search-inference framework: a proposed strategy for novice clinical problem solving. Med Educ. 2008;42(4):389-395. PubMed PMID: 18338991 |
Bump GM, Bost JE, Buranosky R, Elnicki M. Faculty member review and feedback using a sign-out checklist: improving intern written sign-out. Acad Med. 2012;87(8):1125-1131. PubMed PMID: 22722359 |
Caverzagie KJ, Shea JA, Kogan JR. Resident identification of learning objectives after performing self-assessment based upon the ACGME core competencies. J Gen Intern Med. 2008;23(7):1024-1027. PubMed PMID: 18612737 |
Cox LM, Logio LS. Patient safety stories: a project utilizing narratives in resident training. Acad Med. 2011;86(11):1473-1478. PubMed PMID: 21952066 |
Crowley MJ, Barkauskas CE, Srygley FD, Kransdorf EP, LeBlanc TW, Simel DL, McNeill DB. A comparative resident site visit project: a novel approach for implementing programmatic change in the duty hours era. Acad Med. 2010;85(7):1140-1146. PubMed PMID: 20592509 |
Gonzalo J, Herzig S, Reynolds E, Yang J. Factors associated with non-compliance during 16-hour long call shifts. J Gen Intern Med. 2012;27(11):1424-1431. doi: 10.1007/s11606-012-2047-z. Epub 2012 Apr 13. PubMed PMID: 22528621 |
Heflin MT, Pinheiro S, Kaminetzky CP, McNeill D. ‘So you want to be a clinician-educator…’: designing a clinician-educator curriculum for internal medicine residents. Med Teach. 2009;31(6):e233-e240. PubMed PMID: 19296370 |
Hildebrand C, Trowbridge E, Roach MA, Sullivan AG, Broman AT, Vogelman B. Resident self-assessment and self-reflection: University of Wisconsin-Madison's Five-Year Study. J Gen Intern Med. 2009;24(3):361-365. PubMed PMID: 19156469 |
Holland R, Meyers D, Hildebrand C, Bridges AJ, Roach MA, Vogelman B. Creating champions for health care quality and safety. Am J Med Qual. 2010;25(2):102-108. PubMed PMID: 19966115 |
Jasti H, Sheth H, Verrico M, Perera S, Bump G, Simak D, Buranosky R, Handler SM. Assessing patient safety culture of internal medicine house staff in an academic teaching hospital. J Grad Med Educ. 2009;1(1):139-145. PubMed PMID: 21975721 |
Kimura BJ, Amundson SA, Phan JN, Agan DL, Shaw DJ. Observations during development of an internal medicine residency training program in cardiovascular limited ultrasound examination. J Hosp Med. 2012;7(7):537-542. PubMed PMID: 22592969 |
Kimura BJ, Shaw DJ, Agan DL, Amundson SA, Ping AC, DeMaria AN. Value of a cardiovascular limited ultrasound examination using a hand-carried ultrasound device on clinical management in an outpatient medical clinic. Am J Cardiol. 2007;100(2):321-325. PubMed PMID: 17631091 |
Leenstra JL, Beckman TJ, Reed DA, Mundell WC, Thomas KG, Krajicek BJ, Cha SS, Kolars JC, McDonald FS. Validation of a method for assessing resident physicians' quality improvement proposals. J Gen Intern Med. 2007;22(9):1330-1334. PubMed Central PMCID: PMC2219765 |
Mathis BR, Warm EJ, Schauer DP, Holmboe E, Rouan GW. A multiple choice testing program coupled with a year-long elective experience is associated with improved performance on the internal medicine in-training examination. J Gen Intern Med. 2011;26(11):1253-1257. PubMed PMID: 21499831 |
Meade LB, Borden SH, McArdle P, Rosenblum MJ, Picchioni MS, Hinchey KT. From theory to actual practice: creation and application of milestones in an internal medicine residency program, 2004-2010. Med Teach. 2012;34(9):717-723. PubMed PMID: 22646298 |
Mourad M, Vidyarthi AR, Hollander H, Ranji SR. Shifting indirect patient care duties to after hours in the era of work hours restrictions. Acad Med. 2011;86(5):586-590. PubMed PMID: 21436665 |
Nabors C, Peterson SJ, Lee WN, Mumtaz A, Shah T, Sule S, Gutwein AH, Forman L, Eskridge E, Wold E, Stallings GW, Burak KK, Karmen C, Behar CF, Carosella C, Yu S, Kar K, Gennarelli M, Bailey-Wallace G, Goldberg R, Guo G, Frishman WH. Experience with faculty supervision of an electronic resident sign-out system. Am J Med. 2010;123(4):376-381. PubMed PMID: 20362760 |
Nabors C, Peterson SJ, Weems R, Forman L, Mumtaz A, Goldberg R, Kar K, Borges JA, Doctor I, Lubben O, Pherwani N, Frishman WH. A multidisciplinary approach for teaching systems-based practice to internal medicine residents. J Grad Med Educ. 2011;3(1):75-80. PubMed PMID: 22379526 |
Rosenblum M, Picchioni M, Borden SH, Stefan M, et al. The Baystate Manager Model. Acad Intern Med Insight. 2007;5(2):18. |
Salem JK, Jones RR, Sweet DB, Hasan S, Torregosa-Arcay H, Clough L. Improving care in a resident practice for patients with diabetes. J Grad Med Educ. 2011;3(2):196-202. PubMed PMID: 22655142 |
Shunk R, Dulay M, Julian K, Cornett P, Kohlwes J, Tarter L, Hollander H, O'Brien B, O'Sullivan P. Using the American Board of Internal Medicine practice improvement modules to teach internal medicine residents practice improvement. J Grad Med Educ. 2010;2(1):90-95. PubMed PMID: 21975892 |
Tess AV, Yang JJ, Smith CC, Fawcett CM, Bates CK, Reynolds EE. Combining clinical microsystems and an experiential quality improvement curriculum to improve residency education in internal medicine. Acad Med. 2009;84(3):326-334. PubMed PMID: 19240439 |
Thanarajasingam U, McDonald FS, Halvorsen AJ, Naessens JM, Cabanela RL, Johnson MG, Daniels PR, Williams AW, Reed DA. Service census caps and unit-based admissions: resident workload, conference attendance, duty hour compliance, and patient safety. Mayo Clin Proc. 2012;87(4):320-327. PubMed PMID: 22469344 |
Thomas MR, Beckman TJ, Mauck KF, Cha SS, Thomas KG. Group assessments of resident physicians improve reliability and decrease halo error. J Gen Intern Med. 2011;26(7):759-764. PubMed Central PMCID: PMC3138588 |
Varney A, Todd C, Hingle S, Clark M. Description of a developmental criterion-referenced assessment for promoting competence in internal medicine residents. J Grad Med Educ. 2009;1(1):73-81. PubMed PMID: 21975710 |
Warm EJ, Schauer DP, Diers T, Mathis BR, Neirouz Y, Boex JR, Rouan GW. The ambulatory long-block: an accreditation council for graduate medical education (ACGME) educational innovations project (EIP). J Gen Intern Med. 2008;23(7):921-926. PubMed PMID: 18612718 |
Were MC, Li X, Kesterson J, Cadwallader J, Asirwa C, Khan B, Rosenman MB. Adequacy of hospital discharge summaries in documenting tests with pending results and outpatient follow-up providers. J Gen Intern Med. 2009;24(9):1002-1006. PubMed PMID: 19575268 |
West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA. 2011;306(9):952-960. PubMed PMID: 21900135 |
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Article Info
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing the manuscript.