Education Columns

Thomas W. Hahn, MD, Jensena Carlson, MD, and Patrick Huffer, MD

Self-assessment, goal setting, and self-directed learning are important skills that facilitate lifelong learning and are assessed through the ACGME Practice-Based Learning and Improvement Subcompetency: Demonstrates self-directed learning. Individualized learning plans (ILPs) are one method to promote these skills in learners. Research shows that use of ILPs by medical learners provides a framework for learning and also improves motivation.^1,2 Much of the ILP literature is in pediatrics, and there is little in the literature regarding ILPs for family medicine residents.^3,4 Historically, our residency program has used detailed education plans for residents who need additional support, but not for all residents.

When the Milestones framework was implemented in 2014, our residents were not fond of the idea of determining their own Milestones levels biannually, but they did want to have an active role in self-assessment and planning their residency educational experience. Thus, we developed an individualized learning plan called the Goal-Oriented Assessment of Learning (GOAL) as a modality for resident self-assessment, education planning, and goal setting in place of doing self-milestones. The GOAL aims to frame the residency education experience around future career goals, and also serves as a template for residents to keep track of their residency experiences, which can facilitate creating a curriculum vitae in the future.

The GOAL form (Word) is a comprehensive document that has eight categories:

• Core values
• Career goals
• Residency goals
• Self-assessment
• Tracking of pursuits and activities
• Short-term professional SMART goals
• Short-term personal SMART goals
• Mentors/team members

Notably, the self-assessment portion encourages residents to think about the six ACGME Core Competencies (patient care, medical knowledge, system-based practice, practice-based learning and improvement, professionalism, and communication). Residents receive an introductory lecture to the GOAL as interns, and are given time to fill out the form for the first time during the lecture. Residents update the GOAL every 6 months and review it at their biannual meetings with the associate program director (APD) and with their assigned faculty advisor. It takes about 30 minutes to fill out the GOAL initially and 15 minutes to update it every 6 months. Because the GOAL is comprehensive, it is expected that some portions will be left blank by interns (for example, residents in our program will not be able to list their journal club until postgraduate year 2) and that as residency progresses, the form will be more complete.

Residents who complete the GOAL find it to be useful for thinking about long-term plans and for setting specific goals for the upcoming 6 months. The most common complaint about the GOAL is that it is another piece of “busy work,” so we have condensed the form from five pages to two pages to make it more manageable. Residents continue to confirm that the GOAL is more useful and desirable than completing self-milestones.

Initially we had trouble getting all residents to complete the GOAL. We have solved this problem by making the GOAL the focus of APD meetings, and most importantly by making the GOAL a required component of the evaluation packets that are reviewed biannually by clinic faculty and by our Clinical Competency Committee. This latter idea to include the GOAL in evaluation packets was suggested by residents, as they felt that it is important for their faculty and evaluators to know their goals. The GOAL can easily be adapted for health professionals in all fields and at various levels of training, including students and faculty.

References

1. Stuart E, Sectish TC, Huffman LC. Are residents ready for self directed learning? A pilot program of individualized learning plans in continuity clinic. Ambul Pediatr. 2005;5:298-301.
2. Chan SW, Chien WT. Implementing contract learning in a clinical context: report on a study. J Adv Nurs. 2000;31(2):298-305.
3. Li ST, Tancredi DJ, Co JP, West DC. Factors associated with successful self-directed learning using individualized learning plans during pediatric residency. Acad Pediatr. 2010;10(2):124-130.
4. Sectish TC, Floriani V, Badat MC, Perelman R, Bernstein HH. Continuous professional development: raising the bar for pediatricians. Pediatrics. 2002; 110(1 Pt 1):152-156.