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Page history last edited by ctanders@uci.edu 8 years, 10 months ago

Life-Long Learning:  Creation of the Personal “MOTA” (Maintenance of Training in Anesthesiology) Portfolio: A Workshop for CA-2 Residents


Competency: Professionalism


Subcompetency: “Demonstrates a committment to carrying out professional responsibilities (1)”


Background and Purpose

Professionalism is at the core of the contract physicians have with the society they serve(2).  As medical science has advanced, so has public expectations that their physicians will dedicate themselves to continuous improvement in quality health care delivery(3).  Thus, a key component of professionalism is the willingness to be a self-directed, life-long learner. Physicians are expected to demonstrate this through Maintenance of Certification post graduation.


Residents within the Department of Anesthesiology and Perioperative Care at the University of California, Irvine are subject to several “minimal professional requirements”: 90% conference attendance, minimum performance on the in-training exam, logging of cases, maintenance of ACLS & PALS certification, etc.  Data on performance requirements are documented electronically in a structured portfolio over which the resident has little creative control.  Residents not infrequently demonstrate lack of personal investment in these documentation requirements evidenced by comments from the Clinical Coordinator and Program Director, who must frequently remind them to submit the informantion.  Compliance is encouraged mainly through punitive measures (eg. loss of education funds if not done).


The purpose of this class is to educate residents beginning their CA-2 year on MOCA (Maintenance of Certification in Anesthesia).  The main outcome of the class is for residents to create an electronic “Maintenance of Training in Anesthesia,” or “MOTA” portfolio modeled after MOCA that they will utilize during their CA-2 & CA-3 years.  Based on Knowles’ Andragogy, adult learning requires relevance (4).  In addition, for portfolios to be successful, they must be learner-generated (5). It is hoped that a resident-generated model of MOCA will promote more independent, self-directed learning and documentation of key milestones.  Furthermore, active participation in this portfolio could possibly make the transition to MOCA an acceptable and obvious “next- step” in the life-long learning process of the young professional. 


1)ABA Clinical competency Evaluaton www.theaba.org.

2) Madewell JH, Lifelong Learning and the Maintenance of Certification. Am. Coll. Rad. 2004: 199-203.

3) Committee on Quality of Health Care in America, Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press 2001.

4) Bennett EE, Blanchard RD, Hinchey KT, Applying Knowles’ Andragogy to Resident Teaching. Academic Med. 2012; 87(1): 129.

5) Holmboe E, Hawkins R. Pratical Guide to the Evaluation of Clinical Competence. Chapter 7. Mosby 2008.



Goals and Objectives


Each CA-2 resident will develop a portfolio modeled after the ABA MOCA electronic database.  By using this portfolio, the resident will develop the knowledge, skills and attitudes to initiate and document life-long learning during training and post-graduation as they enter the MOCA process.


Session Learning Objectives:   By the end of this session, the resident will be able to


  1. State the purpose of the MOCA process
  2. Identify self-directed learning opportunities during residency that model those required in MOCA documentation.
  3. Work with his/her class to create a personal MOTA electronic portfolio in which to document his/her continuing professional development.
  4. Demonstrate willingness to meet the professional obligation of life-long learning through a written committment to actively engage in the MOTA.


Course Context/Materials

This class is meant for CA-2 residents( N=10-12).  They will have already had training and experience using an electronic portfolio data-base, education on evidence based searches and practice with reflective writing. The workshop will take place as a breakout one for the CA-2 residents during the resident weekend retreat in July.


The Instructor will need a laptop, projector & screen.  Materials for group work are listed below.


Learning/Teaching Techniques




Content Description

Teaching/Learning Priniciples

How will your practice change throughout life?


10 minutes

Senior faculty who trained 30 years ago presents brief PPT. quiz in which residents guess if a drug, monitor, piece of anesthesia equipment was available to him during his residency. Audience Response System (ARS) used to answer Yes or No.

Opener used as attention grabber to promote receptiveness to the workshop’s concept.


Participatory through ARS


How will you keep up?


Time: 15 minutes

Residents are divided into pairs. They are to assume they are in a non-academic private practice setting. Pairs are to reflect  on their obligation to patients to remain current.  How will they do so?  How will they prove it?


Active, participatory learning to promote analysis & responsiveness.

Brief introduction by faculty instructor to MOCA followed by video.



15 minutes 

05 minutes for questions

20 minutes


Residents watch the ABA introductory video on MOCA which outlines the 4 steps: Professional Standing,  Life-long learning documentation (CME), cognitive exam, attestation of practice performance improvement 

Formal presentation to promote skill-building.

It is situational, practical learning because residents will be actually doing this during their career; identification with their future Community of Practice.

Instructions for creation of the CA-2 class MOTA: Step 1.


Time: 15 minutes

ARS to identify key professional standing information that should be included for Step 1 MOTA (eg. medical license, ACLS certification, etc.).

Collaborative & learner-centered in that residents are helping to determine criteria for their “MOTA”

BREAK (Residents can determine length)



Group Work - Breakout to separate rooms


Time: 45 minutes

Group  1- Develops MOTA Step  2: LLL (“CME”)

Group 2- Determines a cognitive exam to be used independently once a year for Step 3: Cognitive Exam

Group 3 -Creates rules for practice assessment submissions and evaluation in Step 4: Assessment & Practice Improvement


Catalyst & Brainstorming.

Collaborative, participatory, learner-centered.  Also builds skills in that groups independently reviewing materials to aid in decision-making.

Group Presentations


Time: 45 minutes


Each group has 10 minutes to present and 5 minutes for questions/comments.  

Intensifier.  Group must defend their “point of view.”

Learner centered and collaborative.


BREAK (Residents can opt for 10 minute break at this point if they desire)




Summary powerpoint slide of the MOTA posted

Election of Representatives

Committment to Act


Time: 20 minutes

  1. Instructor presents summary slide of the new MOTA
  2. Each group selects representative to meet with website developer to place on line for residents to use.
  3. Everyone spends time writing a reflective committment to independently follow the MOTA requirements and document regularly.


Commitment -to- act promotes self-reflection.  Experiential learning as they participate in the created MOTA.





Group 1 - Easel Board & Markers/ Instruction sheet/ Laptop with Internet Access/ LIst of potential CME activities paid by Department (Anesthesiology CME article sample, list of internet sites such as the ASA Patient Safety Foundation, ASA Clinical Site, Audiodigest CD program).


Group 2 - Easel Board & Markers/ Instruction sheet/ Laptop with Internet Access/ ABA Content Outline/ Samples of cognitive exams: SEE, ACE, old Written ABA Boards, Current reviews in anesthesia questions (Cannot use ITE or AKT for this).


Group 3 - Easel Board & Markers/ Instruction sheet/ Laptop with Internet Access/ Samples of practice assessment from the ABA MOCA website (If group selects simulation as part of the requirement, they must specify the type & guidelines for reflective evaluation of event).



Evaluation of Workshop


Resident evaluation of the workshop - Kirpatrick level 1 (Reaction to the experience)

Resident progress with MOTA will be reviewed by resident mentor during quarterly progress

meeting currently scheduled - Kirpatrick level 2,3 (Learning & Behavioral changes)

Comparison data of (1)no. of reminders to residents sent by coordinator to get required  for minimum professional materials pre-session vs. post-session & (2)comparison of CA-3 class who underwent training against prior class who did not have the MOTA workshop as CA-2’s. - Kirpatrick level 4 ( Results produce a practice change in response of residents to keeping up with required documentation & lecture attendance)

Current post-graduate resident progarm evaluation to include question on usefulness of MOTA in transitioning to MOCA



Comments (5)

ptanaka@stanford.edu said

at 2:32 pm on Mar 24, 2012

Hello Cindy
Great needs assessment. Do you have this implemented already or it is just your idea? If you do I really would like to hear your result experiences. I taught something similar for our residents, but still on embryonic phase. Nice correlation between objective and assessments. Do you have a portfolio template for the residents to look at? Also I like the variety of teaching learning principals trying to reach the best results. One last question have you seen any constraints in implementing this workshop? Overall fantastic idea, well described. Congratulations!!

ctanders@uci.edu said

at 3:50 pm on Mar 25, 2012

Thanks Pedro. This was an idea I came up with after a discussion with the program director about how she is tired of having to enforce the minimum professional obligations policy. I thought that having something they could tie to moca would be a motivation. I hope to institute this summer and am waiting for the PD to return from maternity leave to review with her. I don't have a template, but plan to show them the MOCA site and copy it as close as possible. We have alot of IT support in the dept, so I think we will be able to implement. There is a summer resident retreat that would probably work to do the initial work.

ptanaka@stanford.edu said

at 4:16 pm on Mar 25, 2012

I hope that works well Cindy. Please keep me posted.

Bev Wood said

at 8:06 am on Mar 27, 2012

This is an exciting and very comprehensive introduction to Maintenance of Training; should captivate the audience as you are engaging them frequently. You are right about the motivation, seems it is more confusion, but you have clarified. I like the idea of a final commitment to follow the requirements and document. Will be interesting to ssee what the outcomes of that activity are. Keep us posted, please, as to the success, changes needed, reaction of participants, etc.

Win May said

at 10:55 pm on Apr 9, 2012

I like that you have them develop the MOTA portfolio to make it more relevant for them. Your comparison data lends itself to a research project. Since you have not implemented it as yet, it could be a prospective study. Linking it to MOCA is also good motivation. Thank you for your thoughtful work.

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