- GME —
- graduate medical education
- IIPE —
- Initiative for Innovation in Pediatric Education
- LOI —
- letter of intent
As the Residency Review and Redesign Project came to a close in 2009, the Initiative for Innovation in Pediatric Education (IIPE) was ushered in as the next phase of ongoing evaluation and transformation of pediatric residency education. The mission of the IIPE is to initiate, facilitate, and oversee innovative change in pediatric residency education through carefully monitored, outcome-directed experimentation.1 The IIPE pursues this mission by supporting residency programs in their pursuit of innovative educational projects via a structured process for project review, consultation, monitoring, and dissemination.
At the start of the IIPE, leaders of the Residency Review and Redesign Project wrote, “We need to recognize that conducting the business of graduate medical education (GME) is a project that is never complete and requires acknowledgment of a certain degree of ambiguity and uncertainty.”2 Recognizing that GME is a complex system, the IIPE leadership adopted developmental evaluation as its approach to program evaluation because it embraces ambiguity and uncertainty and because it could inform program development. Specifically, developmental evaluation aims to facilitate systematic, data-informed reflection and decision-making as the program evolves, whereas traditional evaluation approaches generally aim to improve a relatively stable program (process evaluation) or judge the merit and worth of an established program (outcome evaluation).3 Furthermore, because learning in a complex system may occur in a rapid-response, 3-phase, Do-Observe-Respond cycle, developmental evaluation may play out differently here than in the traditional 4-phase Plan-Do-Study-Act cycle.4
As 2012 progresses, the IIPE continues to develop. This IIPE column serves as an update for the Pediatrics readership, and as an example of developmental evaluation. True to developmental evaluation as an ongoing and iterative process, we (the author on behalf of IIPE leadership) provide a snapshot rather than a comprehensive report, organized around the Do-Observe-Reflect cycle. For “Do,” we reviewed tracking data (eg, progress reports) to understand some of what IIPE has done. For “Observe,” the author conducted informal interviews at the end of 2011 with a variety of stakeholders in the IIPE (n = 11), including individuals who expressed interest in the IIPE, actual IIPE participants, and IIPE Review Committee members. For “Respond,” plans have been made to discuss these observations with IIPE leadership in the first part of 2012, and, with their guidance, implement changes to further develop and enhance this initiative.
With limited knowledge of what to expect, the IIPE sought to initiate innovative change in pediatric residency education with the first invitation to participate in 2009. As of cycles completed by December 2011, 31 letters of intent (LOIs) have been submitted and reviewed by the IIPE Review Committee. Twelve LOIs have progressed to full proposals, and, of these, 5 met criteria for being designated as an IIPE project.
In addition to reviewing and providing feedback on LOIs and full proposals, the IIPE review team has revised its criteria rating forms (available at www.innovatepeds.org). The IIPE project support team (researchers with qualitative and quantitative expertise) has spearheaded initiatives in data sharing and in program evaluation. The IIPE participants and IIPE leadership have met at the Association of Pediatric Program Directors Annual Meeting for project updates and feedback from IIPE peers. Participants are in contact with IIPE leadership on an ad hoc basis (eg, arranging conference calls with content experts). Although it is premature to provide substantive evidence of this “doing,” IIPE participants have, at minimum, shared their work through these IIPE columns, and at national and regional conferences. Two IIPE projects have secured grant funding from different sources: their institution, foundations, and/or federal agencies.
Early iterations of developmental evaluation provided information to assist IIPE leadership in the “Observe” phase. For example, the IIPE project support team explored a shift in LOI response rates through a survey of applicants. In the following paragraphs, observations obtained from conversations with IIPE stakeholders are highlighted.
There was general agreement among interviewees around the benefits of participating in a program that promoted innovation in residency education. These benefits included gaining prestige or recognition at the national level through a rigorous selection process, garnering various means of support for innovative projects (eg, consultations around project design), and simply being invited to think creatively. In particular, the IIPE participants mentioned other benefits, such as partnering on the project with colleagues at their own institutions, collaborating with IIPE participants in other institutions, and developing mentoring-type relationships with junior faculty. For example, one participant described rich networking within and beyond the Department of Pediatrics, whereas another talked about attracting key faculty and energizing faculty development. IIPE participants also spoke about the exciting, generative nature of innovation. For example, participants in IIPE projects designed to improve the transfer of patients from one health care provider to another spoke of unexpected, rapid spread of interest in and adoption of educational innovations.
Challenges to participating in programs designed to support innovation in pediatric education also surfaced in the interviews. Interviewees talked about limited time, a prevailing and potentially restrictive climate of change in GME, and the disconnect between espoused value of innovation in education on the one hand and local and national resources to support innovation on the other. The IIPE participants and members of the IIPE Review Committee commented on the knotty issue of balancing rigorous research and evaluation standards with the knowledge, skills, and interests that program directors, as prospective project leaders, typically bring to the table.
In developmental evaluation, evaluators bring forth information that engenders reflection and aids in decision-making. As stated in a previous section, plans have been made to respond to the observations shared in this article. Preliminary reflections suggest that the IIPE's greatest resource may be the participants themselves, who are driven to transform pediatric education through systematic, data-informed processes, and are committed to sharing what they have learned about, and through, transformation. We invite your participation through informal discussions or more formal correspondence in shaping the IIPE leadership's response to what has been done with regard to innovation in pediatric education, and what has been observed to date.
The author thanks Dr Boyd Richards for his expert advice and thoughtful review of the manuscript.
- Accepted February 15, 2012.
- Address correspondence to Dorene Balmer, PhD, RD, 701 West 168th St, Hammer Health Science Center, Lobby 10-A, New York, NY 10032. E-mail:
FINANCIAL DISCLOSURE: The author has indicated she has no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
- Jones MD Jr
- McGuinness GA,
- Jones MD Jr
- Patton MQ
- Copyright © 2012 by the American Academy of Pediatrics