Show Notes
Description
Dr Namrita Odackal visits the studio as we consider graded responsibility in medical education. Moving trainees from supervision to independence is the goal. Reframing autonomy as graded responsibility can transform the way we teach, coach, and assess our learners. Tune in to learn how!
Topics
Resident Supervision
Resident Autonomy
Graded Responsibility
Learning Objectives
At the end of this activity, participants should be able to:
- Define autonomy and graded responsibility within graduate medical education.
- Differentiate between traditional autonomy-based models and entrustment-based frameworks.
- Apply strategies for incorporating graded responsibility into clinical teaching environments.
- Evaluate faculty and program practices to optimize the balance between supervision and learner independence.
FD-ED Credit
This episode is approved for FD-ED credit through the Center for Faculty Development at Nationwide Children’s Hospital. FD-ED credit expires 3 years from this episode’s release date.
Guest
Dr Namrita Odackal
Assistant Professor of Pediatrics
The Ohio State University College of Medicine
Links
ACGME Common Program Requirements
ACGME Program Requirements for Graduate Medical Education in Pediatrics
Curated Collections for Clinician Educators: Key Papers on Graduated Responsibility in Residency Education
Twelve Tips for Teaching and Supervising Post-Graduate Trainees in Clinic
Episode Transcript
[Dr Mike Patrick]
This episode of FAMEcast is brought to you by the Center for Faculty Advancement, Mentoring, and Engagement at The Ohio State University College of Medicine.
[MUSIC]
[Dr Mike Patrick]
Hello, everyone, and welcome to another episode of FAMEcast. We are a faculty development podcast from The Ohio State University College of Medicine.
This is Dr. Mike coming to you from the campus of Ohio State. It’s episode 22. We are calling this one Graded Responsibility, the missing link in medical education.
I want to welcome all of you to the program. We are so happy to have you with us. You know, in graduate medical education, we often talk about autonomy as the ultimate goal, you know, something trainees strive for as they grow into independent physicians.
But what if autonomy is not something we simply give and instead something that emerges through a more intentional process? What does that look like? Well, today, we are going to explore the balance between supervision and independence, and how reframing autonomy as graded responsibility can transform the way we teach, coach, and assess learners in clinical environments.
Of course, in our usual FAMEcast fashion, we have a terrific guest joining us in the studio to discuss the topic. Dr. Namrita Odackal is an assistant professor of pediatrics at Ohio State. And she is also program director of the Neonatal Perinatal Medicine Fellowship at Nationwide Children’s Hospital.
Before we get to her, I do want to remind you that if your institution or department requires Faculty Development Education Credit, also known as FDED credit, then we have good news for you. Select episodes of FAMEcast, they’re the ones that deal with teaching and learners, come with FDED credit from the Center for Faculty Development at Nationwide Children’s Hospital. It’s really easy to claim credit, just listen to the podcast, which you are about to do.
And then look for the FDED link in the show notes over at famecast.org for this episode. Follow that link to Cloud CME, register or sign into your free account. You’ll need to take a very brief survey, and that is located in the materials tab once you get there.
And then you score the credit, and you can even download a transcript of your credits to share with your institution or department. Just some examples of past episodes that we have with that FDED credit, and we’ll put a list of those in the show notes for you so you can find them easily. But you know, we’ve talked about things like mentorship and coaching, teaching on a busy clinical service, the evolving role of artificial intelligence in medical education, tips and tricks for giving an engaging presentation to learners and even using social media to engage medical learners.
All of those are past episodes with that FDED credit, and there are more. By the way, that credit’s good for three years, and since this podcast is not three years old yet, all of those do count. So, if you need an hour or two of faculty development credit as part of your job, we may have what you need right here.
Also want to remind you the information presented in FAMEcast is for general educational purposes only. Your use of this audio program is subject to the FAMEcast Terms of Use Agreement, which you can find at famecast.org. So, let’s take a quick break.
We’ll get Dr. Namrita Odackal settled into the studio, and then we will be back to talk about graded responsibility, the missing link in medical education. It’s coming up right after this.
[MUSIC]
[Dr Mike Patrick]
Dr. Namrita Odackal is an assistant professor of pediatrics at The Ohio State University College of Medicine and program director of the Neonatal Perinatal Medicine Fellowship at Nationwide Children’s Hospital. She’s an educator and leader deeply invested in how trainees grow, not just in knowledge and skill, but in identity, confidence, and readiness for independent practice. And that brings us to today’s conversation, resident supervision versus autonomy. Before we dive in, though, let’s offer a warm FAMEcast welcome to our guest, Dr. Namrita Odackal. Thank you so much for stopping by the studio today.
[Dr Namrita Odackal]
Thank you. Thanks for having me. Excited to be here.
[Dr Mike Patrick]
Yes, I’m excited to talk about this because if there’s sort of a most important thing that residency is about, it is really preparing trainees for independent practice. I mean, that’s really the goal and research and those sorts of things. But if we start just with the big picture, what exactly does autonomy or independence mean in graduate medical education?
[Dr Namrita Odackal]
I think you said it best right there that the goal of medical education is autonomy. It is to get to autonomy, to get to independent practice. So, the ACGME in very clear terms says that we are to be preparing trainees to get to that point.
It is our destination. And all of the years of training that they go through is providing supervision along the way until they are able to demonstrate that, you know, I’m ready to be practicing on my own. The specific language autonomous practice is even incorporated into the evaluations that faculty or that program directors have to sort of commit to when they’re saying, hey, my trainee is ready to move out of this training program and to become a faculty or an attending or, you know, what have you within that subspecialty.
So whatever skills your subspecialty or specialty deems important to your field, that individual can do those things by themselves. And it doesn’t mean that they don’t continue to learn or that they don’t continue to collaborate or get help or that they even know everything because we all know we’re longitudinal learners, but that they no longer need supervision on the things that you have decided need to be at the junior level of being a faculty or being a junior level of that type of physician.
[Dr Mike Patrick]
Yeah, yeah. Not only is autonomy important for the program itself, like we are entrusted to produce physicians who can practice independently and have autonomy, but internally for each resident or fellow, it’s also just feels important to trainees, right, to be able to practice with autonomy. Why does that feel so important to our trainees?
[Dr Namrita Odackal]
Yeah, completely. It’s very tied to their professional identity formation. When you ask medical students when they start to feel like doctors, the number one thing that they will state is, I had autonomy, I was given responsibility, I was allowed to make decisions, and that’s what made me feel like a physician.
And it makes sense because that’s what we’re saying, when you are ready to be independent and doing this on your own, that’s when you’re taking on this sort of social contract of making decisions for your patients. So, it’s very much tied into what they identify with the goal. And so, it’s really important to them to feel like they’re getting autonomy.
They feel trusted. They feel that means that there’s been growth. And so that perception of autonomy carries a lot of weight, carries a lot of satisfaction, and the absence of that perception on the flip side carries a lot, can carry a lot of dissatisfaction if we don’t navigate that appropriately or if those expectations are misaligned.
And I don’t think they have to be, but I think there are some challenges with the ways that these words are used and the understandings that maybe faculty have versus trainees have about what autonomy means.
[Dr Mike Patrick]
Yeah, yeah. You know, a lot of times in practice, we have pathways that, like, this is how you do things. And, you know, either you remember what the pathway is or you look up the pathway.
And so, there’s a little less critical thinking with regard to some things. Like now, obviously, the pathway, whatever it is, is not going to apply to 100 percent of cases. There’s going to be nuance and such.
But for the most part, we can follow these pathways. But then there’s other areas in medicine where there’s more flexibility and maybe there’s not a concrete pathway. And maybe one attending faculty member likes to do things one way and another one likes to do it a different way.
But as long as each of them can think critically and kind of explain this is why I like to do it, there’s evidence behind it. And my whole point with this is that as trainees are working with different attendings or, you know, faculty members, from the faculty member’s standpoint, there can be a drive to say, no, this is the way that it’s done. And so, as trainees are working with different faculty members, they never really feel like they have autonomy because they just have to do it the way that the guy they’re working with does it.
And so, I just wanted to point out from the faculty member’s point of view, like if you have a trainee and maybe they want to do something a little different than the way that you would do it, but they can think critically and back up why they want to do it that way. Would you say that’s an important thing that we ought to keep in mind when we are precepting trainees?
[Dr Namrita Odackal]
Yes. And I think that brings up this idea of how do we provide autonomy, although I’ll argue that we should be thinking about it as graded responsibility, which we’ll get into, but how do we essentially provide trainees with more progressive, independent practice when we may not know them for a while or when they’re doing something in a way that’s different than we are? And it’s a very challenging question and it’s very variable because everybody comes in, every faculty member comes in with their own baggage, right?
If you just saw a patient decompensate from something, you’re going to be much more vigilant about it than last week, or if you just made an error yourself, or if you’re fresh out of training and you’re establishing your style or you’ve only trained in one way and maybe have a more rigid model of how something should be done versus have been at several different institutions and have a better understanding that there are a lot of ways to get to that same end goal. So, there’s so many things that play into how we approach it.
So as faculty, so I think it’s really important to have that reflection and insight. What am I bringing to this that’s really not about the trainee and how do I kind of balance for that? Because that trainee needs to ultimately establish their own style.
And I think us being able to entrust a trainee with what it is that they need to do in order to get to the goal of patient care, right? It’s not just about this patient, but it’s about all the patients that that trainees can take care of down the road. That’s that main goal.
In order to do that, what the trainee needs to do is demonstrate an understanding of those foundational skills of that basic physiology or pathophysiology so that a faculty member can say, you know what, we are doing things differently, but you clearly have an understanding of what you need to know and are thinking about the right things. And therefore, the process is not as important as the outcome, as long as your process is grounded in the same things that I think are important as you do.
[Dr Mike Patrick]
Yeah. Yeah. Because, you know, obviously the knowledge base of your discipline is going to be important.
You know, new research and things that come along, we’re going to be wanting to keep up to date, but there’s always going to be things that we don’t know, even as faculty members. And so, knowing what we don’t know and where to find the answer is really key to being able to practice independently. And so, I would think that’s really an important thing.
Now, you talked about graded responsibility. Let’s focus in on that. What does that mean and how is that different from autonomy?
[Dr Namrita Odackal]
So typically, how trainees tend to think of supervision and autonomy and maybe some faculty as well is that it’s sort of a finite box. And as the bar of supervision goes down conventionally with the duration of time someone has been in training, the bar of autonomy goes up and that, you know, when the two parts make a whole. The idea of graded responsibility is that a faculty member has a longitudinal relationship or as a program you have a longitudinal relationship with a trainee and that you have observable evidence that a trainee has achieved some level of competence.
And that’s because you’ve observed them or you’ve gathered data of other folks that have observed them. They’ve demonstrated this. They’ve earned the right to have additional responsibility.
And so, then you change the quality of your supervision. It’s not a matter of quantity, but it’s a matter of quality. You change the quality, the characteristics of your supervision to afford them graduated responsibility or graded responsibility as they progress and demonstrate that they can handle it.
That can be more complex patients, acuity, different, you know, clinical context, difficult conversations, whatever that skill set is that you were evaluating them for. They can have that increased provision of entrustment towards that activity and therefore move towards having autonomy as the goal, right? That’s the destination, but the journey is this graded responsibility through their training.
[Dr Mike Patrick]
Yeah, yeah. I know I work in the emergency department and so we have trainees from, you know, from pediatrics, emergency medicine, family practice, all of them have different backgrounds. And, you know, one of the first questions that a lot of us ask are like, you know, what program are you in and what year are you in that program?
And so there is this thought that, well, if it’s a second year, then they must be a little bit more trustworthy. And if they’re a third year, they must be really trustworthy. But that’s not necessarily true, right?
I mean, you can have an intern who you could already start to maybe trust with some things. And then there are others that you may not get to that point until they’re a second year or even a third year. So, it really does have to be individualized, right?
We can’t just say, oh, we’re going to treat all of our second-year residents or fellows like this. It’s really an individual process.
[Dr Namrita Odackal]
Absolutely. It’s even more so. I feel like at this point, at least I’m a neonatologist and we’re feeling this to a great degree now with the CGMA changes that happened in 2025 where residents are seeing in pediatrics are seeing less time in intensive care.
And so, depending on the program that you trained in, depending on what your background is, a trainee is coming in with a variable amount of experience. And it seems like a reasonable initial amount of time of a training program should actually be evaluating what they’re coming in with and catching them up to speed with whatever baseline you expect trainees to have. And sometimes it takes a long time for folks to catch up to speed.
And sometimes trainees need to take parental leave and they’re going to be gone for three months. And so that means that they’re going to have some, you know, a different timeline or they have other stressors or they had an exceptional amount of like procedural experience during their training. So definitely there is an acknowledgement and a movement towards having training be more individualized.
And instead of thinking about this timeline, and I think that also allows for more equity overall in training, it requires more investment and more thought from our side so that we are having those conversations and those observations and that re-evaluation. And it’s maybe not just at every six-month semi-annual review, but that there’s check-ins sooner to see, hey, how have they made progress? And, you know, people’s slopes of learning can be different too.
Even if you’re starting at the same place, somebody picks up on something faster, somebody picks up on something slower. So that greater responsibility that we’re discussing, it means you are having those conversations, those observations, that re-evaluation, understanding what that trainee is hoping to accomplish and what they’re comfortable with, what they feel their barriers are, and then sort of coming together to make those goals. So, you can say, okay, this is where your amount of responsibility is that I would entrust you with at this time.
But here, you know, now I’ve experienced you going to, I’ll just use a neonatology example, going to a delivery, I can see now that you are really able to handle routine delivery and administer NRP with, you know, you’re solid in those foundational skills. So, you, you know, you can go to those deliveries on your own at this point. In fact, you can start teaching that to younger learners because you’ve demonstrated that skill.
So, a person coming in with a lot of delivery room experience in their residency might be prepared to get there sooner in fellowship, but it takes a good amount of time to witness that sometimes, depending on the skill and investment from the program itself.
[Dr Mike Patrick]
Yeah, yeah. Do you have thoughts on disciplines where you really are seeing lots of different people? So, in other words, you know, you may have a group of fellows in perinatal medicine and you’re with those same folks for a long period of time, or even if it’s just for a month while you’re on service, let’s say, for a hospitalist.
But then in primary care, in emergency medicine, in urgent care medicine, and others, you may come across trainees that you just see once in a shift. How do you sort of as a division, you know, that’s overseeing these trainees kind of keep track of where people are, or is that something that you ought to just have that conversation at the beginning of every shift?
[Dr Namrita Odackal]
You know, the conversation doesn’t take that long to have. So, I think if you can just afford five minutes to say, hey, where are you on this skill? What is it you’re hoping to do?
This is my comfort level. This is where I want to be called and informed about everything. I think those five minutes go a really long way in building, you know, that rapport and that trust and expectation and understanding and ability to grow.
And I think there’s a lot of different ways that we can build an assessment in getting valuable information so that, you know, one person’s evaluation from one call or one shift, even if it’s the first time they’ve met, is still meaningful. So if you have that like just five minutes of conversation and then you have what we kind of call micro-assessments, I saw you take care of a patient that came in, you know, with a GI bug and you appropriately triaged and did all the things that I would expect of that, or you didn’t, or like you still have room for improvement. Even just that little bit of information without knowing that that trainee very well is valuable.
If you get 10 of those, you know, and say 10 people who have only met you once feel like you know what you’re doing, that’s still meaningful in a different way than somebody who’s watched you for a month or who’s watched you for three years. But, you know, that’s the goal, that’s the purpose of that competency committee then, that you’re taking all of this data collectively and saying, I have this kind of information, this kind of information, this kind of information. All of these are valuable to sort of fill in that picture of what the actual level of supervision this trainee needs.
And the ACG me talks about like going from direct supervision to indirect to oversight, you know, eventually getting to that that autonomous practice at the time of graduation. And so, it can help kind of navigate that trajectory. And sometimes it goes a little bit backwards or it doesn’t go linearly.
But all of those pieces of information, everyone I think can add value if we’re doing it kind of thoughtfully.
[Dr Mike Patrick]
Yeah, yeah, yeah. That makes sense. So that five-minute conversation at the beginning of your time together, especially if this is a new person, just to get an idea of kind of their baseline knowledge, what they want to work on, I really love that.
And that’s going to set you apart if you do that because a lot of faculty do not do that. But from the learner’s point of view, like taking that five minutes to have that brief conversation really shows that you are taking an effort to individualize your teaching based on what they need or what they feel that they need. And then I would imagine that feedback then as you go, maybe based on that initial conversation, it might make the feedback a little bit more meaningful if you kind of have that baseline established.
Then what does that feedback look like, especially in a busy clinical practice or maybe it’s during NICU rounds and you’ve got so many patients you’ve got to get through? What does feedback look like, you know, in the real world?
[Dr Namrita Odackal]
Yeah. So, there’s this idea of, again, kind of these micro-feedback versus the longer feedback. So again, it can be just a matter of seconds.
Hey, you know, you told me you really wanted to work on your conversation skills when you’re delivering challenging news. And right before you go into an encounter about communicating with a family, you establish that with the trainee, like, what is it you want to work on? They say, this is, I’m really working on breaking, like on introducing myself.
I always forget to do that. And then when you leave the conversation, you take those 30 seconds. You know, this is the thing you really wanted to work on was introducing yourself.
You did a great job. You remembered to introduce yourself and that really helps establish rapport. Or, hey, you actually forgot, you know, and so that’s a really like simple example, obviously, but it doesn’t need to take, again, it doesn’t need to take very long.
And to your point, when you are addressing the thing that they have thought about that they want to work on, one, it reminds them that it’s something that they want to work on, right? Because they might just go in reflexively and just do, as opposed to think about growing. So, it makes it much more of an intentional process for the trainee.
And then they get that very specific feedback, making it feel individualized, making them walk away with saying, hey, I actually developed in the thing that I wanted to. Or you come up with ways together, like these are, you know, these are ways that you could potentially continue to improve on that thing. And in that sort of debrief after, you are again doing your reevaluation of, is this person ready to have increased responsibility?
[Dr Mike Patrick]
So that five-minute conversation at the beginning, the feedback as we go, you know, brief feedback, and then I would imagine at the end of your time together, especially if it’s just a shift, if you’re with someone for an entire month, then, you know, this may not be as necessary. But at the end of your time together, maybe recap and be like, this is what you can work on moving forward. These are the things that you did that were great.
That final cap of feedback, I think, is that also important?
[Dr Namrita Odackal]
Yeah, I think so. And then, you know, there’s this formative feedback and there’s the summative feedback. And then there’s the times where you need to have a longer conversation if something really needs a lot of improvement, because there’s ideas of, you can provide the kind of positive tidbits along the way or the small things along the way.
But then the big picture, like the big picture is, I think you have, you know, I have high expectations of where you’re going to go. And these are the things that are going to help you grow and get there. And it has to be, again, about them growing as opposed to, this is how I would do something.
You can use yourself as a, you know, backboard of this is my experience. But again, it’s about what that trainee’s goals are, which are going to include, you know, graduating from their program and how you can help, how you think that they can be the most exceptional trainee that they can.
[Dr Mike Patrick]
What are some challenges that faculty face when we’re trying to balance supervision with autonomy?
[Dr Namrita Odackal]
I think we’ve; we’ve touched on a few of those. So, one is feeling like you don’t know that trainee well. How do you trust somebody when you’ve just met them?
Again, I think that communication component is a good solution. You just have a dialogue and you’re transparent. This is, you know, how, how comfortable are you doing this procedure?
How many times have you done it in the past? And then, you know, based on that saying, okay, this is if that procedure comes up, you, it seems like you have enough experience with it. And there’s a lot of resources available.
Like for example, just for procedures, you can go on MedHub and see that they’re qualified to do this procedure independently. And so, you can, you can kind of have validations, not just, you’re not just alone in this, in this situation. So, I think that that communication helps alleviate a little bit of that.
I have just met this trainee. I think keeping the end goal in sight. So, I mentioned, you know, we always talk about patient safety first before, before, you know, the learners, our responsibility towards the learners.
But it’s not just about the patient that’s in front of you. It’s about all of the patients that that trainee is eventually going to be taken care of. And how are they going to be capable of doing that if they don’t get a chance now?
So, it is up to us to kind of learn how to, how to provide that greater responsibility and give them space to grow even when it’s a little uncomfortable for us. And the third thing, sort of self-reflection. So, checking ourselves at the door.
Why is it that maybe I am stepping in so quickly to correct something? Is it because it was a stylistic difference? Is it because I, you know, am just uncomfortable in this situation giving, giving control to somebody else and remembering that it’s not about us and, and sort of finding ways to balance our own biases, our own challenges, having that self-reflection, taking the time to do that.
[Dr Mike Patrick]
Yeah. Yeah. And I would imagine this is more difficult than it sounds.
Letting go. Because at the end of the day, as the attending physician, we’re legally responsible for what happens with that patient, and we have a duty to patient safety and satisfaction and all of those things. And so, I would imagine it is difficult to let go when we could still have some, you know, there’s some, still some implications for us as practitioners.
How do you suggest that, that we get over that hurdle of really letting go when it’s time to do so?
[Dr Namrita Odackal]
It’s challenging. I think, you know, we don’t get trained on how to do that as, as, as med students, residents, fellows, we, we don’t, we don’t get trained on a lot of these really professional development components that end up being important, you know, in academic medicine and, and outside of academic medicine as well. Speaking with your colleagues who are doing this is helpful.
So, we all get evaluated on our balance of autonomy and supervision, our programs get evaluated on it. So, we know it’s really important to trainees. And again, there is that disconnect of what they believe autonomy is versus what it’s meant to be sometimes.
But it’s something that we know some folks do really well. So, you can look at them for examples of how to do so. I’ll take that example of in the delivery room.
I, I had a hard time like not intervening or saying something when, you know, a patient is, needs some additional respiratory support. And I talked to some of my colleagues and they said they literally don’t put gloves on, and they stand, they’re back to the wall so that they can have some distance. They can still watch and they can still intervene.
But that, you know, that reflex, when you know that you are able to intervene, it’ll only take seconds. That reflex, there’s a little bit of a barrier to that. So, there might be like physical distance you need to, to put in at times or, or, you know, actions you need to take to kind of help yourself remember what the goals are.
[Dr Mike Patrick]
Yeah. It’s kind of like driver’s ed, you know, they’ve got that brake over on the passenger side. They really don’t want to use it, but it’s there.
[Dr Namrita Odackal]
And you had mentioned like, you know, different subspecialties or different specialties in different areas of medicine. And I think it’s easier in some and harder than others. Like in pediatrics, we tend to be very micromanaging.
There’s a different sort of social contract with families than there is in adult medicine. My husband’s in plum critical care at OSU and we talk about all the time how, you know, it’s just different, the things that we provide supervision for as pediatricians than they do in adult medicine. So, it is quite variable depending on the context.
[Dr Mike Patrick]
Yeah, yeah, absolutely. I would think that a lot of this change, and it is kind of a, you know, a new paradigm for resident education and fellow education. And a lot of it is driven through the ACGME.
And as they come out with, oh, this is the way that we need to do it. And it can be like, oh, they’re changing the rules again. Oh, we need to do this differently.
But at the same time, the work that they’re doing and how it influences the physicians that are coming out of the system, it really is worth that paradigm shift, right?
[Dr Namrita Odackal]
Yeah. And competency-based medical education, which, you know, is all the buzz right now, has still been around and it’s been around internationally. And competency-based education has been around, you know, outside of medicine as well.
So even now when we have the milestones in our six competencies, that’s competency-based education, the idea of EPAs and this sort of paradigm shift of how we’re evaluating is relatively new to us. But I think it is, I think it is worth, you know, continuing to have an open mindset as medicine changes and as we get better clarity on what our goals are. And to also, like, learn from all of these other folks that have already been doing EPAs and CBME for a while.
Like, right now, you know, starting in spring 2020, EPAs are going to start to be a part of our assessment and evaluation of whether trainees can graduate and be ready for that autonomous practice. And so, we’re all getting ready to incorporate EPAs into our evaluation system and into our curriculum. There are others who have already been there and who say, you know, there’s a ton of data that comes out of here then and you don’t know what to do with it.
So I think we can learn from all of this, be open-minded, and think about how to be incorporating them in thoughtfully and intentionally in a way that gets us where we want to go and doesn’t just flip it for the sake of flipping it, which is, of course, nobody’s goal, but actually gets us to better assessments, more holistic evaluation, and for us to reach that goal of us all being able to say, I 100% trust this training now that they’re graduating to be able to take care of patients in this specialty autonomously.
Yeah.
[Dr Mike Patrick]
For those who may be wondering, EPA stands for entrustable professional activities. Can you speak to what those are exactly? Like just hearing the word entrustable professional activities, you kind of get an idea, but can you define that for us?
[Dr Namrita Odackal]
Yeah. So, it’s this idea that we are really making our evaluation system and our curriculum based around competency-based medical education and through EPAs, which are going to be sort of a predetermined set of activities that a specialty or subspecialty decides in collaboration with our accrediting bodies. These are the things that we believe patients need from these physicians.
And so, we are now going to develop our curriculum and our assessment to make sure that we’re meeting those goals. And we’ve had milestones in the past. Milestones are basically more granular.
EPAs are supposed to be these like overarching, generalized activities that each of the physicians should be doing that are then sort of defined more specifically by each specialty or subspecialty. So, for example, like you can take care of an acute patient in neonatology. That might mean, you know, being able, that will include all of the different competencies and milestones.
It’ll include needing to be able to diagnose, triage, understand medicine, communicate with families, communicate with consultation teams, follow up. So, it incorporates a lot of those granular things that we’re already assessing for. But at the end of the day, we’re saying the entrustable professional activity of taking care of an acute patient.
I entrust this training to do that.
[Dr Mike Patrick]
Yeah. Yeah. So, there’s a whole list of things that you need to do within that area to say, okay, you’ve sort of become entrustable with that activity.
And then is there a way then to kind of communicate where individual trainees are with other faculty members? So, like if you’re in charge of the fellowship, you have a better idea of like where everybody is. Is that something that like at a faculty meeting, you know, you can talk about the fellows and sort of, you know, say where each of them are, but then that can, you know, then you feel like you’re pointing out people who may, you know, may need a little bit more work.
It can get uncomfortable.
[Dr Namrita Odackal]
Yeah, it can. It’s a really great question. I think at the foundation of what you’re asking is that we should be having this growth mindset, right?
So, it’s not punitive. Same thing goes for feedback. I’m telling you this so that you can be better.
I’m telling you this because our goal is for you, for patient care and for you to graduate and for you to graduate well. And for me to say you can do that thing. And so, in order to get there, we need to be thinking about feedback as not being punitive, about evaluation as not being negative, but being an assessment.
I’m just, I’m just assessing based on all the information based on your perspective and everyone who’s invested in you and our patients telling me where, telling us where you are. And so, we, like in our division in Neonatology, have made transparent where, where fellows are from a procedural standpoint, because there’s also a lot of discussion about like, who’s up for intubation first, for example, it’s a hot, hot commodity, intubation procedures. And so clearly communicating, you know, this trainee has received, reached whatever competency we expect, or has not yet reached competency to be unsupervised or supervised is very helpful in them being able to advocate like, no, I still need additional procedures.
And in overall folks needing to know how much supervision do I need to provide? So, you’re entirely right. We need to be communicating this, not just within program leadership, not just within the CCC, but to all the folks that are training these residents and fellows so that we can all kind of be on that same board.
And so that five-minute conversation maybe doesn’t have to be, it removes one of those barriers to that conversation where somebody has to say, you know, I’m not quite where I want to be. So, I think there’s a cultural shift. I think there’s a necessary amount of communication and transparency, and that’s all very nuanced and challenging because to your point, you don’t want anyone to feel like they’re being pointed out or they’re feeling, you know, like they’re behind.
I think it’s getting to the idea that everything needs to be individualized and it’s not a comparison. It’s not that person versus you. One day in the future, you know, there’s this idea that we’re going to be moving away from this time-based programming and saying it’s just competency based.
So, it’s not that it needs to be two years or three years, but that it is just whatever time you need, each individual needs. And the logistics of that are quite beyond me about how we’re going to get there, but maybe we’ll see that in our future.
[Dr Mike Patrick]
I would think that this is a great opportunity for junior faculty members to, you know, maybe develop some QI projects around how do you get to where we want to be as we think about, you know, graduated responsibilities and really working toward autonomy, which is going to be so different from one discipline to another. We’ve been using neonatology and perinatal medicine and emergency medicine as examples, but there are tons of other examples and each of them are individually nuanced. And it may be, you know, as you’re thinking about publications and promotion, getting involved in QI work on how do we best get there in my discipline, it seems like there’s a lot of opportunity to sort of refine things based on what it is that the trainees are learning and practicing.
[Dr Namrita Odackal]
Yeah, yeah, completely. And across this, I mean, I think the interesting other part about that is that across institutions, it’ll be different too. You know, so not only just across disciplines, but depending on how big your division is, like you mentioned, you know, if you have a ton of fellows versus just a handful of fellows, it’s going to look different.
So that’s probably part of the challenge as well. There are so many, but that it is so highly variable depending on your specific program.
[Dr Mike Patrick]
Yeah, yeah. Well, this has been a really fantastic conversation. We are going to have a lot of resources for folks in the show notes.
If you head over to Famecast.org, you’ll find them there in the show notes for this particular episode. We will have links to the ACGME common program requirements. We also have one just because we are in pediatrics, both of us.
We have the ACGME program requirements for graduate medical education in pediatrics. However, once you go to the ACGME site, you can find all of the disciplines, medical and surgical, to see what those program requirements look like. And then we also have a curated collection for clinical educators, five key papers on graduated responsibility in resident education.
So, if you want to learn more about these topics, you can check those out. And then also from medical teacher, 12 tips for teaching and supervising postgraduate trainees in clinic. So, these resources are great starting points, especially if you do want to get involved in some QI work that may raise some questions that then you can come up with an AIM statement and figure out exactly what it is that you want to try to improve.
But it seems like there’s a lot of opportunity there. So once again, Dr. Namrita Odackal, assistant professor of pediatrics and program director of neonatal perinatal medicine fellowship at Nationwide Children’s Hospital. Thank you so much for stopping by and chatting with us today.
[Dr Namrita Odackal]
It was a pleasure. Thank you.
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[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making FAMEcast a part of it. We really do appreciate your support. And of course, thanks again to our guests this week, Dr. Namrita Odackal, assistant professor of pediatrics at Ohio State and program director of the neonatal perinatal medicine fellowship at Nationwide Children’s Hospital. Don’t forget, there might be an easier way for you to subscribe and listen to our podcast. We are available in Apple Podcasts, Spotify, iHeartRadio, Amazon Music, Audible, and really most other podcast apps for iOS and Android. Just search for FAMEcast.
We also have a landing site where we have our entire archive of past programs, show notes for each of the episodes, our terms of use agreement, and a handy contact page if you would like to suggest a future topic for the program. And that landing site is Famecast.org. Reviews are also helpful wherever you get your podcasts.
We always appreciate when you share your thoughts about the show. And once again, if your institution or department requires faculty development education credit, also known as FDED, we have good news for you. Select episodes of FAMEcast, including this one.
Those that deal with teaching and learners come with FDED credit from the Center for Faculty Development at Nationwide Children’s Hospital. It’s actually really easy to claim credit. You’ve already listened to the podcast, so you’ll just want to go over to Famecast.org, find the show notes for this episode, look for the FDED link in the show notes, follow that link to Cloud CME. You’ll need to register or sign in. It’s free. And then once you’re there, you’ll need to take a brief survey.
It’s in the materials tab and you’ll score the credit. You can even download a transcript of your credits to share with your institution or department. I already mentioned some of the episodes that we have with that FDED credit.
We’ll have a list of them as well in the show notes, so you can check those out. But everything from mentorship and coaching to using AI in our medical teaching, tips and tricks for giving an engaging presentation, even using social media to engage medical learners, and there are more. So just head on over to Famecast.org and you can check those out. I also want to let you know about a couple of other podcasts that I host. One is if you are a pediatric provider, we have PediaCast CME. That is a podcast for pediatric providers offering free continuing medical education credit for those who listen.
And it is category one credit, by the way. And since Nationwide Children’s is jointly accredited by lots of professional organizations, we can give that credit not only to physicians, but nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists. So, if you’re a pediatric provider and you work with some of those other professionals, let them know that PediaCast CME is available and they can use it to get their CE credit.
And again, it is category one credit. Shows and details are available at the landing site for that program, PediacastCME.org. You can also listen wherever podcasts are found.
Just search for PediaCast CME. And then you may be a faculty member in the health sciences and also a parent. And if you are not a pediatric provider, you may want to know some child health information.
And so, we also have an evidence-based podcast for moms and dads. And we cover pediatric news and we interview pediatric and parenting experts. Shows are available at the landing site for that program, Pediacast.org.
Also available wherever podcasts are found. Simply search for PediaCast. Thanks again for stopping by.
And until next time, this is Dr. Mike saying, stay focused, stay balanced, and keep reaching for the stars. So long, everybody.
[MUSIC]
