Bridging the Gap Between the Classroom and the Clerkship: A Clinical Reasoning Curriculum for Third-Year Medical Students

INTRODUCTION

Clinical reasoning is the complex cognitive process that drives the diagnosis of disease and treatment of patients. There is a national call for medical educators to develop clinical reasoning curricula in undergraduate medical education. To address this need, we developed a longitudinal clinical reasoning curriculum for internal medicine clerkship students.

METHODS

We delivered six 1-hour sessions to approximately 40 students over the 15-week combined medicine-surgery clerkship at Penn State College of Medicine. We developed the content using previous work in clinical reasoning, including the American College of Physicians' Teaching Medicine Series book Teaching Clinical Reasoning. Students applied a clinical reasoning diagnostic framework to written cases during each workshop. Each session followed a scaffold approach and built upon previously learned clinical reasoning skills. We administered a pre- and postsurvey to assess students' baseline knowledge of clinical reasoning concepts and perceived confidence in performing clinical reasoning skills. Students also provided open-ended responses regarding the effectiveness of the curriculum.

RESULTS

The curriculum was well received by students and led to increased perceived knowledge of clinical reasoning concepts and increased confidence in applying clinical reasoning skills. Students commented on the usefulness of practicing clinical reasoning in a controlled environment while utilizing a framework that could be deliberately applied to patient care.

DISCUSSION

The longitudinal clinical reasoning curriculum was effective in reinforcing key concepts of clinical reasoning and allowed for deliberate practice in a controlled environment. The curriculum is generalizable to students in both the preclinical and clinical years.

Adoption and Use of Mobile Learning in Continuing Professional Development by Health and Human Services Professionals

INTRODUCTION

Health and human services professionals are increasingly using mobile devices to support clinical decision-making and evidence-based practice. However, research on self-directed learning in an era of growing digital technology utilization is underdeveloped. This study explored the adoption and use of mobile learning as a continuing professional development (CPD) activity.

METHODS

A mixed-methods case study using semistructured interviews and a web-based questionnaire was conducted with health and human services professionals in Newfoundland and Labrador, Canada.

RESULTS

Respondents reported using a smartphone (53.8%), tablets (50.4%), YouTube (43.0%), and mobile apps (35.8%) for CPD. The highest-rated benefits of mobile learning included improved access to information (M = 3.51); potential for enhanced knowledge acquisition (M = 3.45); staying up to date (M = 3.44); and verifying information (M = 3.40). The greatest barriers included cost of some apps and resources (M = 3.07); websites/programs not functional on mobile devices (M = 2.84); workplace barriers preventing access to digital resources (M = 2.82); and social media use linked to negative perceptions of professionalism (M = 2.65). Interview respondents described the flexibility and convenience of mobile learning, the level of autonomy it offered, and the advantages of learning on their own time. Technical issues, particularly for rural and remote practitioners, and digital professionalism also emerged as potential barriers.

DISCUSSION

A systems model organizes the factors influencing the adoption and use of mobile devices and resources to support "just-in-time" learning. Addressing policies, practices, and regulations that enable or inhibit adoption of mobile learning for CPD may foster enhanced use to support better clinical decision-making, improved accuracy, and greater patient safety.

Innovative pedagogical practices in higher education: An integrative literature review

BACKGROUND

Higher education teachers are increasingly challenged to adopt student-centered approaches.

AIMS

To determine the strategic guidelines which promote a conceptual change in higher education students, in the context of student-centered approaches to teaching.

METHODOLOGY

Integrative literature review, using the PICO method, applied to the ERIC and EBSCO electronic databases. We analyzed 10 articles that were published between 2012 and 2016.

RESULTS

We identified four thematic categories: dissonance between concepts and approaches to teaching; mixed approaches with ICTs association; digital simulation; approaches employed in large classes.

CONCLUSION

The use of new pedagogical practices promotes the involvement of students, improves critical and creative thinking, reduces apathy and contributes to peer-learning.

The impact of combining concept-based learning and concept-mapping pedagogies on nursing students' clinical reasoning abilities

BACKGROUND

Integrating contemporary teaching strategies into the nursing curriculum is an effective approach to enhance undergraduate clinical-judgment and reasoning abilities.

OBJECTIVE

This study aims to document the impact of blending the teaching strategies of concept-based learning and concept-mapping to enhance nursing students' clinical-reasoning abilities.

DESIGN

A quasi experimental design is used to guide data collection from second year students.

SETTING AND PARTICIPANTS

A consecutive sample of all students undertaking adult health nursing courses at a private university in Jordan and meeting the eligibility criteria resulted in (N = 40).

METHOD

Data was collected via a questionnaire and observation to reveal students' independence in both clinical-reasoning and clinical-judgment. General Clinical-Reasoning Behavior Scale, Independence in Clinical-Reasoning and Clinical-Judgment scales were completed by the students at the beginning and end of the courses.

RESULTS

Despite requesting extensive preparation time, concept-based learning and concept-mapping as student-centered approaches enabled the move away from a content laden approach towards constructing criteria against which various patients' encounters were reflected. This study documented enhancement in students' independence in clinical-reasoning and clinical-judgment as they learned to take command of the elements of their clinical-reasoning. Significant improvement in students' general clinical-reasoning behavior was also documented.

CONCLUSION

The data collection tools utilized in this study can be used as clinical teaching aides, hence maximizing the impact of blended teaching strategies by providing the faculty with specific feedback regarding students' clinical reasoning and judgment abilities. Institutionalizing these processes by initiating relevant policies and guidelines is essential to help students take command of their clinical-reasoning, maturity, and responsibility in a practice area that is constantly changing and evolving.

Active teaching model to promote critical thinking

OBJECTIVE

To present the experience of elaboration and implementation of the Active Teaching Model to Promote Critical Thinking (MEAPC), associated to Problem-Based Learning (PBL), for undergraduate students in Nursing.

METHOD

Case report on the experience of the educational intervention (MEAPC + PBL) with undergraduate students in Nursing, in a 20-hour course on Basic Life Support (BLS). The MEAPC was validated by judges to guide the analysis of clinical cases. Critical Thinking (CT) skills were assessed using the California Critical Thinking Skills Test.

RESULT

The educational intervention took place in two phases: elaboration and implementation, allowing not only the production of knowledge about BLS, but also the development of CT and exchange of experiences for teaching-learning.

CONCLUSION

The association of the MEAPC to the PBL in the course of BLS organized the learning, gave opportunity to acquire knowledge and to stimulate the skills of the CT.

Clinical Cybersecurity Training Through Novel High-Fidelity Simulations

BACKGROUND

Cybersecurity risks in health care systems have traditionally been measured in data breaches of protected health information, but compromised medical devices and critical medical infrastructure present risks of disruptions to patient care. The ubiquitous prevalence of connected medical devices and systems may be associated with an increase in these risks.

OBJECTIVE

This article details the development and execution of three novel high-fidelity clinical simulations designed to teach clinicians to recognize, treat, and prevent patient harm from vulnerable medical devices.

METHODS

Clinical simulations were developed that incorporated patient-care scenarios featuring hacked medical devices based on previously researched security vulnerabilities.

RESULTS

Clinicians did not recognize the etiology of simulated patient pathology as being the result of a compromised device.

CONCLUSIONS

Simulation can be a useful tool in educating clinicians in this new, critically important patient-safety space.

"Developing Experimental Design and Analysis Skills in Undergraduates": IUPS Teaching Satellite Meeting, Brazil, August 2017

This workshop was held at the Teaching Satellite Meeting of the International Union of Physiological Sciences (IUPS), August 5-8, 2017, in Buzios, Rio de Janiero, Brazil. The satellite meeting was attended by physiology educators from across the globe, of whom 34 attended this workshop. The aim of the workshop was to explore how experimental design is taught to students of physiology in different institutions, to consider the aspects that students find challenging, to share good practice, and to think about how experimental design teaching could be improved. Through small-group discussions that were then shared with the whole group, participants were challenged to develop the outline of a research project to investigate a broad topic and then to identify the challenges that students might face if they were given that task. Finally, the group thought about what, in practical terms, could be done to help develop experimental design skills in undergraduates. The outcomes of the discussions are summarized in this report.

A new approach to multi-professional end of life care training using a sequential simulation (SqS Simulation™) design: A mixed methods study

BACKGROUND

A need for improved education and training for hospital staff caring for patients in the last year of life was identified at an urban UK hospital. Sequential Simulation (SqS Simulation™) is a type of simulation that recreates a patient's journey, considering the longitudinal element of care and how this might impact on the patient's experiences, wishes and needs.

OBJECTIVES

The aim of this study was to investigate a new end of life care training intervention for multi-professional hospital staff, and its effect on their confidence in managing patients at the end of their life.

SETTING/PARTICIPANTS

Based on the results of a formal Training Needs Analysis, four SqS Simulation™ specialty-based courses were designed for general medical and surgical multidisciplinary teams in an acute UK hospital.

METHODS

Over three months, seven SqS Simulation™ sessions were attended by fifty-seven multidisciplinary healthcare professionals. A quasi-experimental mixed-methods study was conducted using open and closed-ended questionnaires, pre and post-intervention. Changes in course attendees' confidence levels were analysed and qualitative data from free-text answers informed potential reasons for any differences identified.

RESULTS

Confidence improved for all professional cohorts (p < 0.001). The differences were found to be highly significant for 'doctors' (p < 0.001), significant for 'therapists' (p = 0.02) and not significant for the 'nurses' cohort (p = 0.238). This was explored further using a qualitative explanatory framework. Categories included: Communicating with Families; Teamwork; Goal Planning; Do Not Attempt Cardiopulmonary Resuscitation; Course Usefulness; Prior Training; and Clinical Experience.

CONCLUSION

This study has shown an overall improvement in confidence across disciplines after attending a SqS Simulation™ course. The differences in quantitative results between disciplines were explored through the qualitative data and revealed a difference in what the professionals gained from it. Further studies are required to assess its effectiveness in maintaining confidence of end of life care in practice, as well as its benefit to patient outcomes.

An Interactive Session to Help Faculty Manage Difficult Learner Behaviors in the Didactic Setting

Introduction

The transition to more active learning during residency didactics has made the skill of managing difficult learner behaviors essential: Just one learner exhibiting difficult behavior can derail the educational experience for the room. Many educators feel uncomfortable handling these learners in real time and after the session.

Methods

We created an interactive session for a mixed group of educators at a medical education boot camp. After learning about a framework for addressing difficult learner behaviors, participants were paired and presented with the case of a withdrawn learner. For each pair, the cause of the behavior was different. With one of the pair role-playing the learner, they were asked to identify the problem and solutions together. Multiple etiologies for the identical behavior reinforced the need to address underlying causes to create an effective plan for behavior change. Strategies to address difficult behaviors in real time were also discussed in large-group format.

Results

Participants gave the session a mean score of 4.5 out of 5, indicating a high likelihood of changing their teaching practice. Free-response comments remarked on the role-play's educational value and the enjoyability of the session overall.

Discussion

This session was effective in giving participants a framework for dealing with difficult learner behaviors, as well as hands-on practice with these skills. While this was a short (30-minute), single session, its success with participants with a wide variety of experience levels suggests it would be highly adaptable to other settings and may benefit from future expansion into the clinical setting.

Medication Reconciliation in the Hospital: An Interactive Case-Based Session for Internal Medicine Residents

Introduction

Medication reconciliation is a complex process of creating and maintaining the most accurate medication list for a patient to help guide therapy. Done incorrectly, the process of medication reconciliation can lead to medical error and result in adverse events for patients. Medication reconciliation on inpatient medicine service is often done by internal medicine residents. However, published reports of educational interventions for residents are limited.

Methods

We created a 1-hour session that was experiential, case based, and targeted to the level of a first-year resident. In total, 31 internal medicine residents completed the curriculum, which involved either a 1-hour classroom group activity or an individual virtual activity. The curriculum was evaluated using standard forms with qualitative feedback regarding learner satisfaction, pre- and postsession confidence survey, and pre- and postsession patient chart audits.

Results

Qualitative feedback demonstrated residents' positive experiences. There was no significant change in residents' confidence in portions of the medication reconciliation process. One month following the educational intervention, 100% of inpatient charts audited for review of the medication list were accurate, as compared to 67%-83% accuracy prior to the session.

Discussion

This novel case-based medication reconciliation teaching session, targeted at learners in an internal medicine residency, can easily be implemented at other institutions using the institution-specific electronic health record. The session was well received by residents, and we observed improved accuracy in the medication reconciliation process done by residents.

Qualitative Coding Boot Camp: An Intensive Training and Overview for Clinicians, Educators, and Administrators

INTRODUCTION

Qualitative coding is a tool for analyzing data involving strings of meaningful words. While many schools and universities have staff who can assist faculty with quantitative data analysis, qualitative data analysis is interpretive and requires both content-specific knowledge and research methodology tools. In this qualitative coding boot camp, we introduce clinician-educators, staff, and administrators to a general overview of qualitative coding and analysis.

METHODS

We designed and implemented an in-person training to help researchers who had limited exposure to qualitative research gain a general orientation to it. We provided an overview of qualitative data collection and qualitative coding and developed focused research questions related to sample interviews for participants to use in working together to develop a codebook. We concluded by discussing the iterative process of coding, how to work from codes to themes for a manuscript, and how to present and disseminate results.

RESULTS

To examine participants' learning during the boot camp session, we used a series of nonparametric sign tests to compare pre- and postsession responses on our evaluation form. The results of these tests showed significant growth in participant comfort with undertaking qualitative analysis.

DISCUSSION

Qualitative coding is an important skill for clinicians and their research teams to have, as it can help them to understand the experiences of those around them through an empirical lens. With this 2-hour training, we were able to increase participants' comfort level with the set of skills required to analyze qualitative data rigorously.

Approach to Clinical Assessment of Children With Medical Complexity

INTRODUCTION

General pediatricians have a major role in the care of children with medical complexity (CMC) in hospital and community settings. CMC are often affected by chronic multisystem diseases and functional limitations and may use a wheelchair or other aids for mobility. Dedicated training opportunities to perform comprehensive clinical assessments for this specialized population are lacking.

METHODS

We developed a module focused on special considerations for CMC history taking and physical examination that was piloted in a pediatric residency program. The 60-minute session included a video of a clinical assessment of a child in a wheelchair. The module offered suggestions for incorporating patients or standardized patients as optional activities. Target learners answered formative pre- and posttest questions to check understanding and completed a 1-minute paper to convey lessons learned. Qualitative content analysis identified themes in written responses.

RESULTS

Fifteen pediatrics residents in a single program participated in the module. Most had not received any formal training in complex care. Themes in learner knowledge of steps in a clinical encounter included defining family goals and providing anticipatory guidance. Themes from responses about anticipated changes in clinical practice included systematic and comprehensive approach to history taking, thorough examination, and importance of safe transfers.

DISCUSSION

Developed as part of a national initiative in complex care curriculum development, this module can be adapted for interprofessional learners who provide care for CMC, with the goal of enabling future members of health care teams to provide high-quality clinical assessments for CMC.

The Normalization Project: The Progress and Limitations of Promoting LGBTQ Research and Teaching in Mainland China

This article reflects on the author's own experience of promoting LGBTQ research and teaching in mainland China, where the fight for institutional legitimacy and recognition has been a core element in this journey. After a historical survey of how Chinese LGBTQ research has grown out of the particular sociopolitical milieu, it focuses on a discussion of the "normalization project"-a key approach to both create and expand the institutional space for LGBTQ studies. Apart from the positive effects this project entails, this article also critically examines its limitations by bringing into the picture certain critical perspectives.

An International Educational Training Course for Conducting Systematic Reviews in Health Care: The Joanna Briggs Institute's Comprehensive Systematic Review Training Program

BACKGROUND

The cornerstone of evidence-based health care is the systematic review of international evidence. Systematic reviews follow a rigorous, standardized approach in their conduct and reporting, and as such, education and training are essential prior to commencement.

AIMS

This study reports on the evolution of the Joanna Briggs Institute Comprehensive Systematic Review Training Program (JBICSRTP) as an exemplar approach for teaching systematic review methods.

RESULTS

The Joanna Briggs Institute (JBI) is an international research and development center at the University of Adelaide, South Australia. Its mission is to promote and facilitate evidence-based best practice globally, largely through the provision of education and training. JBI was one of the first to consider all forms of evidence in systematic reviews, and as such, implementation of standardized training was essential. Since 1999, JBI has offered a systematic review training program. The JBICSRTP is now delivered face to face over 5 days, with an optional online component; the content aligns to that proposed in the Sicily statement. Over the last 3 years, JBI and its Collaboration have trained over 3,300 people from over 30 countries. A "train-the-trainer" (TtT) style program was established to cope with demand, and to date, hundreds of trainers have been licensed across the globe to deliver the JBICSRTP.

LINKING EVIDENCE TO ACTION

Providing standardized training materials, ensuring open and ongoing communication, and adopting a TtT style program while still allowing for local adaptability are strategies that have led to the establishment of a highly skilled global training network and ensured the success and longevity of the JBICSRTP.

I-PASS Mentored Implementation Handoff Curriculum: Implementation Guide and Resources

Introduction

Communication failures during shift-to-shift handoffs of patient care have been identified as a leading cause of adverse events in health care institutions. The I-PASS Handoff Program is a comprehensive handoff program that has been shown to decrease rates of medical errors and adverse events. As part of the spread and adaptation of this program, a comprehensive implementation guide was created to assist individuals in the implementation process.

Methods

The I-PASS Mentored Implementation Guide grew out of materials created for the original I-PASS Study, Society of Hospital Medicine (SHM) mentored implementation programs, and the experience of members of the I-PASS Study Group. The guide provides a comprehensive framework of all elements required to implement the large-scale I-PASS Handoff Program and contains detailed information on generating institutional support, training activities, a campaign, measuring impact, and sustaining the program.

Results

Thirty-two sites across North America utilized the guide as part of the SHM program. The guide served as a main reference for 477 hours of mentoring phone calls between site leads and their mentors. Postprogram surveys from wave 2 sites revealed that 85% (N = 34) of respondents felt the quality of the guide was very good/excellent. Site leads noted that they referenced the guide most often during the early part of the program and that they referenced the sections on the curriculum and handoff observations most often.

Discussion

The I-PASS Mentored Implementation Guide is an essential resource for those looking to implement the large-scale I-PASS Handoff Program at their institution.

Is Medical Education Ready for Generation Z?

Sigis a 21-year-old who is considering medical school. Accustomed to hard work, he has received all As in college, while majoring in computer engineering. Sig longs to do something meaningful-to make a difference in the lives of others. He feels paralyzed with self-doubt about incurring massive debt associated with medical school. He also dislikes the idea of taking courses that don't seem relevant. Four years of medical school seems like an eternity, and then there is residency. Sig has never faced such a hard decision. It is disrupting his sleep. On one hand, he could make a good living with his bachelor's degree, but will the job be satisfying? On the other hand, he can commit to 7 or more years of medical education, with more debt, but potentially more enjoyable work. Sig has also heard a lot about dissatisfaction and burnout among physicians. Sig talks with his parents, whose advice he values. He will take some time off to make the best decision. He is in no hurry.

Interactive Multimodal Curriculum on Use and Interpretation of Inpatient Telemetry

INTRODUCTION

Inpatient telemetry monitoring is a commonly used technology designed to detect and monitor life-threatening arrhythmias. However, residents are rarely educated in the proper use and interpretation of telemetry monitoring.

METHODS

We developed a training module containing an educational video, PowerPoint presentation, and hands-on interactive learning session with a telemetry expert. The module highlights proper use of telemetry monitoring, recognition of telemetry artifact, and interrogation of telemetry to identify clinically significant arrhythmias. Learners completed pre- and postcurriculum knowledge-based assessments and a postcurriculum survey on their experience with the module. In total, the educational curriculum had three 60-minute sessions.

RESULTS

Thirty-two residents participated in the training module. Residents scored higher on the posttest (77% ± 12%) than on the pretest (70% ± 12%), t(31) = -4.3, p < .001. Wilcoxon signed rank tests indicated PGY-3s performed better on the posttest (Mdn = 0.86) than on the pretest (Mdn = 0.72), z = -2.19, p = .031. PGY-2s also performed better on the posttest (Mdn = 0.86) than on the pretest (Mdn = 0.76), z = -2.04, p = .042. There was no difference between pretest (Mdn = 0.66) and posttest (Mdn = 0.71) scores for PGY-1s, z = -1.50, p = .142. The majority of residents reported that the telemetry curriculum boosted their self-confidence, helped prepare them to analyze telemetry on their patients, and should be a required component of the residency.

DISCUSSION

This module represents a new paradigm for teaching residents how to successfully and confidently interpret and use inpatient telemetry.

Dissecting the role of sessional anatomy teachers: A systematic literature review

Worldwide there is a growing reliance on sessional teachers in universities. This has impacted all disciplines in higher education including medical anatomy programs. The objective of this review was to define the role and support needs of sessional anatomy teachers by reporting on the (1) qualifications, (2) teaching role, (3) training, and (4) performance management of this group of educators. A systematic literature search was conducted on the 27 July 2017 in Scopus, Web of Science, and several databases on the Ovid, ProQuest and EBSCOhost platforms. The search retrieved 5,658 articles, with 39 deemed eligible for inclusion. The qualifications and educational distance between sessional anatomy teachers and their students varied widely. Reports of cross-level, near-peer and reciprocal-peer teaching were identified, with most institutes utilizing recent medical graduates or medical students as sessional teachers. Sessional anatomy teachers were engaged in the full spectrum of teaching-related duties from assisting students with cadaveric dissection, to marking student assessments and developing course materials. Fourteen institutes reported that training was provided to sessional anatomy teachers, but the specific content, objectives, methods and effectiveness of the training programs were rarely defined. Evaluations of sessional anatomy teacher performance primarily relied on subjective feedback measures such as student surveys (n = 18) or teacher self-assessment (n = 3). The results of this systematic review highlight the need for rigorous explorations of the use of sessional anatomy teachers in medical education, and the development of evidence-based policies and training programs that regulate and support the use of sessional teachers in higher education. Anat Sci Educ 11: 410-426. © 2017 American Association of Anatomists.

Healthcare at the Crossroads: The Need to Shape an Organizational Culture of Humanistic Teaching and Practice

BACKGROUND

Changes in the organization of medical practice have impeded humanistic practice and resulted in widespread physician burnout and dissatisfaction.

OBJECTIVE

To identify organizational factors that promote or inhibit humanistic practice of medicine by faculty physicians.

DESIGN

From January 1, 2015, through December 31, 2016, faculty from eight US medical schools were asked to write reflectively on two open-ended questions regarding institutional-level motivators and impediments to humanistic practice and teaching within their organizations.

PARTICIPANTS

Sixty eight of the 92 (74%) study participants who received the survey provided written responses. All subjects who were sent the survey had participated in a year-long small-group faculty development program to enhance humanistic practice and teaching. As humanistic leaders, subjects should have insights into motivating and inhibiting factors.

APPROACH

Participants' responses were analyzed using the constant comparative method.

KEY RESULTS

Motivators included an organizational culture that enhances humanism, which we judged to be the overarching theme. Related themes included leadership supportive of humanistic practice, responsibility to role model humanism, organized activities that promote humanism, and practice structures that facilitate humanism. Impediments included top down organizational culture that inhibits humanism, along with related themes of non-supportive leadership, time and bureaucratic pressures, and non-facilitative practice structures.

CONCLUSIONS

While healthcare has evolved rapidly, efforts to counteract the negative effects of changes in organizational and practice environments have largely focused on cultivating humanistic attributes in individuals. Our findings suggest that change at the organizational level is at least equally important. Physicians in our study described the characteristics of an organizational culture that supports and embraces humanism. We offer suggestions for organizational change that keep humanistic and compassionate patient care as its central focus.

Fellow as Clinical Teacher (FACT) Curriculum: Improving Fellows' Teaching Skills During Inpatient Consultation

INTRODUCTION

Multiple barriers, including time constraints, a demanding teaching environment, and lack of longitudinal relationships with residents, make it challenging for fellows and learners to engage in effective teaching during consultation.

METHODS

The Fellow as Clinical Teacher (FACT) curriculum was developed to overcome such barriers and improve fellow teaching in the setting of inpatient consultation. The FACT curriculum consists of two 45- to 60-minute small-group sessions designed for subspecialty fellows. The first session focuses on overcoming barriers to teaching and application of the principles of adult learning theory. The second introduces the PARTNER (partner with resident, assess the learner, reinforce positives, teaching objectives, new knowledge, execute recommendations, review) framework for teaching during consultation and uses video examples to model the application of this framework, allowing fellows to practice its implementation through role-play.

RESULTS

Previously, the FACT curriculum was shown to improve teaching skills of rheumatology and pulmonary/critical care fellows as evaluated by objective structured teaching exercises. Here, the curriculum has been expanded to 51 internal medicine and pediatrics fellows in 15 different training programs. The curriculum improved fellow teaching skills as assessed by self-assessment surveys. It was highly rated by participants, and fellows reported being more likely to teach during consultation following this educational intervention.

DISCUSSION

The FACT curriculum can be integrated into subspecialty training programs to improve the teaching skills of internal medicine and pediatrics fellows in the setting of inpatient consultation. Ultimately, improved teaching from fellows may have broad-reaching effects for residents, patients, and the fellows themselves.

A multiple-perspective approach for the assessment and learning of ultrasound skills

Ultrasound has become a core skill in many specialties. We evaluated the learning and assessment of ultrasound skills in Obstetrics-Gynaecology in a series of eight studies. In the clinical setting, we found that trainees as well as experienced clinicians struggle with technical aspects of performance such as image optimization. We examined how to improve these aspects of performance in the simulated setting by determining mastery learning levels and exploring learning curves for novices. We then examined how to improve the efficiency of training as well as transfer of learning through the use of dyad practice as compared with single practice. We found that the use of simulation-based training focusing on technical aspects of performance in addition to clinical training led to sustained improvements in performance after two months of clinical training in all aspects of performance. In addition, we found an interaction effect between initial simulation-based training and subsequent clinical training on trainees' need for supervision. These findings suggest that simulation-based training can work as preparation for future learning rather than merely as added learning. Finally, we found that the use of simulation-based initial training led to a large decrease in patients' discomfort, improvements in their perceived safety and confidence in their ultrasound operator. However, simulation-based training comes at a cost and in the final study we developed a model for conducting cost-effectiveness studies and provided data from an example study on how to link training costs with quality of care.