Strengthening the Core Curriculum

How does one determine what makes for a successful pediatric core curriculum? And how does one do this when there is a lack of available literature on the topic? These are the questions that Melissa M. Argraves, MD, is seeking to answer through her scholarship at Children’s Hospital of Philadelphia (CHOP).

Dr. Argraves is a third-year Rheumatology fellow who is also completing a Master’s in Medical Education at the University of Pennsylvania’s Graduate School of Education (GSE). In thinking about what qualitative work she could do after completing the research block of her program, as well as how core curriculums exist at institutions across the U.S., her scholarship was born.

“The Accreditation Council of Graduate Medical Education (ACGME) lists the core areas of knowledge that are universal to all fellowships,” explains Dr. Argraves. “Since fellowship programs tend to be fairly small, it doesn’t make sense to have each individual fellowship teach these core topics because doing so would require having multiple experts. Instead, a single institutional topic expert is identified, and this expert teaches all the fellows across the institution.”

In addition to learning about research methodologies and how to critically appraise literature, fellows also learn important professional development skills such as fellowship role transitions (from years dedicated to clinical service to years dedicated to scholarly pursuits) and how to secure a job upon graduation. Simultaneously, fellows may gain a sense of community by engaging with their counterparts in other fellowship programs at their institution, which, in turn, is able to create a more cohesive culture for its learners.

With CHOP having recently launched its core curriculum—which, as Dr. Argraves notes, was previously driven through the Fellows Association, and with the hiring of Mackenzie Frost, MD, MedEd, to continue to promote fellowship education, the timing of Dr. Argraves’ scholarship couldn’t be more perfect.

In collaboration with Dr. Frost; Jay Mehta, MD, MS, the Academic Director for the Research and Capstone Blocks of Penn GSE’s master’s program in Medical Education; and qualitative experts Ashley Martin, MPH, and Diana Worsley, MPH, Dr. Argraves designed her study using an appreciative inquiry framework. She will soon conduct the next phase of her study: interviews.

Asking questions

The interview portion of Dr. Argraves work will be qualitative and semi-structured, comprised of varying types of questions aimed at identifying thematic saturation. Questions will include the content and structure of programs used at each individual institution, which aspects of the program are working, and what improvements need to be made, says Dr. Argraves.

In preparation for conducting these interviews, she and the team put together a list of 25 pediatric institutions that offer a core curriculum program for fellows to see if factors such as size, location and number of years in operation have any impact. The team was very deliberate in terms of the institutions they chose and are hoping to obtain a “heterogeneous sample.”

For the purposes of this study, interviews will be limited to institutional leadership. However, Dr. Argraves says she recognizes how “integral the fellow perspective is to understanding the value of a core curriculum” and is open to pursuing similar work where she would speak with fellows about their experiences in the future.

Right now, she is hoping to have data to analyze this winter and a finished product in spring 2022 to use for her master’s level Capstone project.

Future aspirations

Dr. Argraves says she hopes to submit the findings from her research for publication in a peer-reviewed journal or present them at an annual meeting. such as the Association of Pediatric Program Directors (APPD). Which avenue she chooses will come down to timing.

“It depends on timing and what’s happening and when,” says Dr. Argraves. “If there aren’t any conferences happening at the time I finish my project, then it makes sense for me to go straight to publication.”

Her only worry about not publishing her work? “That if I don’t publish my work on this topic, someone else at another institution will,” Dr. Argraves says. “That’s why dissemination will be important. I really want to help other people develop or improve this type of curriculum. I also want to encourage more people to pursue scholarship around this and similar topics.”

And while timing around publication and dissemination of the information is important, what’s more important to Dr. Argraves is using her findings to create an “implementation toolkit” to guide the development of a pediatric fellowship core curriculum.

Though Dr. Argraves admits she doesn’t know what she will discover in terms of her study’s results, there are a few things she’s sure of:

• Study design is an extremely important piece of the entire project, saying “The stronger [your design] is going into a study, the better set up you are to succeed”
• Having multiple perspectives to guide her efforts was helpful as well, with one caveat: “When there are so many different perspectives and opinions, you can’t please everyone. At some point, you have to put your foot down and say, ‘I appreciate your help, but this is my project’”.

Going through the COVID-19 pandemic and completing her master’s program virtually offered Dr. Argraves some fresh insight as well, saying: “The pandemic has made the idea of virtual meetings more acceptable, so I’m hoping from a recruitment standpoint, this is a positive.”

Though she has not completed her research or published yet, Dr. Argraves is already thinking ahead about what she hopes people will take away from her work.

“I want people to understand what a fellowship core curriculum is, since it might not always be obvious to them,” she shares. “I also want to figure out what makes a program valuable and to deliver high-quality education. I hope this is a good way to begin to do that.”