Development and evaluation of standardized narrative cases depicting the general surgery professionalism milestones.
OBJECTIVE
Residency programs now are required to use educational milestones, which has led to the need for new methods of assessment. The literature suggests that narrative cases are a promising tool to track residents' progress. This study demonstrates the process for developing and evaluating narrative cases representing the five levels of the professionalism milestones.


METHODS
In 2013, the authors identified 28 behaviors in the Accreditation Council for Graduate Medical Education general surgery professionalism milestones. They modified previously published narrative cases to fit these behaviors. To evaluate the quality of these cases, the authors developed a 28-item, five-point scale instrument, which 29 interdisciplinary faculty completed. The authors compared the faculty ratings by narrative case and specialty with the authors' initial rankings of the cases by milestone level. They used t tests and analysis of variance to compare mean scores across specialties.


RESULTS
The authors developed 10 narrative cases, 2 for each of the 5 milestone levels. Each case contained at least 20 of the 28 behaviors identified in the milestones. Mean faculty ratings matched the milestone levels. Reliability was good (G coefficient = 0.86, phi coefficient = 0.85), indicating consistency in raters' ability to determine the proper milestone level for each case.


CONCLUSIONS
The authors demonstrate a process for using specialty-specific milestones to develop narrative cases that map to a spectrum of professionalism behaviors. This process can be applied to other competencies and specialties to facilitate faculty awareness of resident performance descriptors and provide a frame of reference for milestones assessment.
A. Rawlings is assistant professor, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri. A.D.C. Knox is a resident, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada. Y.S. Park is assistant professor, Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois. S. Reddy is associate professor, Department of Medicine, Section of Hospital Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois. S.R. Williams is clinical associate professor, Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California. N. Issa is assistant professor, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. A. Jameel is professor, Department of Medical Oncology, Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, Pakistan. A. Tekian is associate professor, Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois.
Arthur
A
Rawlings
Aaron D C
AD
Knox
Yoon Soo
YS
Park
Shalini
S
Reddy
Sarah R
SR
Williams
Nabil
N
Issa
Abid
A
Jameel
Ara
A
Tekian
D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D004521:Educational Measurement / Q000379:methods*; D013502:General Surgery / Q000193:education* / Q000592:standards*; D006801:Humans; D007087:Illinois; D007396:Internship and Residency; D033262:Narration; D015203:Reproducibility of Results; D014481:United States