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Price N, Jowsey T, Weller J. Reflecting on insight and insights into reflection: a systematic review of insight and reflection in post graduate medical education. ANZ J Surg 2023; 93:2589-2599. [PMID: 37749849 DOI: 10.1111/ans.18693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/29/2023] [Accepted: 09/02/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Clinicians recognize insight as important for safe independent medical practice. Clinical education literature focuses on self-reflection. The aim of this review is to describe how clinical educators conceptualize reflection and ask is it analogous to how clinicians conceptualize insight? METHODS Using PRISMA guidelines, a systematic review of the literature around insight and reflection in postgraduate medical education was undertaken. A thematic analysis of the concepts of insight and reflection was performed. RESULTS A total of 75 reports were included in the analysis. The literature focussed predominantly on reflection with little discussion of insight. Three main themes were generated: episodic reflection; cyclic reflection; reflection as a state. Reflection as a state seemed to be the professional quality most often aspired to but was less well defined in terms of educational interventions. When more than one model was described, it was often with a reflective state being the ideal that episodic or cyclic reflection may approximate. It is not clear that it is possible to progress up the hierarchy. CONCLUSION We present a novel description of a hierarchy from discrete episodes of reflection, to cyclic processes that involve reflection, through to a state in which the practitioner is reflective. There is no unified understanding of how an individual ascends this hierarchy, or a cohesive description of what insight is for an independent medical practitioner. This review highlights the need for research into how practicing clinicians conceptualize and characterize insight in their training and practice.
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Affiliation(s)
- Neil Price
- Centre for Medical and Health Sciences Education, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tanisha Jowsey
- Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Jennifer Weller
- Centre for Medical and Health Sciences Education, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Xu F, Han L, Zhao S, Wang Y, Zhang Q, Xiong E, Huang S, Zhang G, He H, Deng S, Che Y, Li Y, Xie L, Chen X. The role of anesthesiologists' perceived self-efficacy in anesthesia-related adverse events. BMC Anesthesiol 2022; 22:190. [PMID: 35725376 PMCID: PMC9208201 DOI: 10.1186/s12871-022-01732-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-efficacy, as the vital determinant of behavior, influencing clinicians' situation awareness, work performance, and medical decision-making, might affect the incidence of anesthesia-related adverse events (ARAEs). This study was employed to evaluate the association between perceived self-efficacy level and ARAEs. METHODS A cross-sectional study was performed in the form of an online self-completion questionnaire-based survey. Self-efficacy was evaluated via validated 4-point Likert scales. Internal reliability and validity of both scales were also estimated via Cronbach's alpha and validity analysis. According to the total self-efficacy score, respondents were divided into two groups: normal level group and high level group. Propensity score matching and multivariable logistic regression were employed to identify the relationship between self-efficacy level and ARAEs. RESULTS The response rate of this study was 34%. Of the 1011 qualified respondents, 38% were women. The mean (SD) age was 35.30 (8.19) years. The Cronbach's alpha of self-efficacy was 0.92. The KMO (KMO and Bartlett's test) value of the scale was 0.92. ARAEs occurred in 178 (33.0%) of normal level self-efficacy group and 118 (25.0%) of high level self-efficacy group. Before adjustment, high level self-efficacy was associated with a decreased incidence of ARAEs (RR [relative risk], 0.76; 95% CI [confidence interval], 0.62-0.92). After adjustment, high level self-efficacy was also associated with a decreased incidence of ARAEs (aRR [adjusted relative risk], 0.63, 95% CI, 0.51-0.77). In multivariable logistic regression, when other covariates including years of experience, drinking, and the hospital ranking were controlled, self-efficacy level (OR [odds ratio], 0.62; 95% CI, 0.46-0.82; P = 0.001) was significantly correlated with ARAEs. CONCLUSIONS Our results found a clinically meaningful and statistically significant correlation between self-efficacy and ARAEs. These findings partly support medical educators and governors in enhancing self-efficacy construction in clinical practice and training.
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Affiliation(s)
- Feng Xu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Linlin Han
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Shuai Zhao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Yafeng Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Qingtong Zhang
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832002, China
| | - Erfeng Xiong
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China
| | - Shiqian Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Guixing Zhang
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Hong He
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Shiyu Deng
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Yingjie Che
- Department of Anesthesiology, The Eight Division Shihezi General Hospital, Shihezi, 832002, China
| | - Yan Li
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832002, China
| | - Liping Xie
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832002, China
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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Granchi N, Ting YY, Foley KP, Reid JL, Vreugdenburg TD, Trochsler MI, Bruening MH, Maddern GJ. Coaching to enhance qualified surgeons' non-technical skills: a systematic review. Br J Surg 2021; 108:1154-1161. [PMID: 34476480 DOI: 10.1093/bjs/znab283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/08/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The lack of an effective continuing professional development programme for qualified surgeons, specifically one that enhances non-technical skills (NTS), is an issue receiving increased attention. Peer-based coaching, used in multiple professions, is a proposed method to deliver this. The aim of this study was to undertake a systematic review of the literature to summarize the quantity and quality of studies involving surgical coaching of NTS in qualified surgeons. METHODS A systematic search of the literature was performed through MEDLINE, EMBASE, Cochrane Collaboration and PsychINFO. Studies were selected based on predefined inclusion and exclusion criteria. Data for the included studies was independently extracted by two reviewers and the quality of the studies evaluated using the Medical Education and Research Study Quality Instrument (MERSQI). RESULTS Some 4319 articles were screened from which 19 met the inclusion criteria. Ten studies involved coaching of individual surgeons and nine looked at group coaching of surgeons as part of a team. Group coaching studies used non-surgeons as coaches, included objective assessment of NTS, and were of a higher quality (average MERSQI 13.58). Individual coaching studies focused on learner perception, used experienced surgeons as coaches and were of a lower quality (average MERSQI 11.58). Individual coaching did not show an objective improvement in NTS for qualified surgeons in any study. CONCLUSION Surgical coaching of qualified surgeons' NTS in a group setting was found to be effective. Coaching of individual surgeons revealed an overall positive learner perception but did not show an objective improvement in NTS for qualified surgeons.
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Affiliation(s)
- N Granchi
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Y Y Ting
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - K P Foley
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - J L Reid
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - T D Vreugdenburg
- Research and Evaluation Incorporating ASERNIP-S, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - M I Trochsler
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - M H Bruening
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - G J Maddern
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Research and Evaluation Incorporating ASERNIP-S, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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Whittaker JD, Davison I. A Lack of Communication and Awareness in Nontechnical Skills Training? A Qualitative Analysis of the Perceptions of Trainers and Trainees in Surgical Training. JOURNAL OF SURGICAL EDUCATION 2020; 77:873-888. [PMID: 32037236 DOI: 10.1016/j.jsurg.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 11/22/2019] [Accepted: 01/19/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To examine the perceptions of surgical trainees and trainers towards nontechnical skills (NTS) as a concept, its role in training, and the challenges of developing these skills. DESIGN A case series of semistructured interviews using an interpretivist grounded theory approach for qualitative analysis. SETTING East Midlands (North) core surgical training programme in the United Kingdom. PARTICIPANTS Ten out of 81 volunteer core surgical trainees and academic educational supervisors (consultant surgeon trainers). RESULTS Understanding of NTS was consistent amongst trainers and trainees but the conceived definition of NTS was much broader than previous definitions. Most viewed NTS as important for surgeons. Trainees believed trainers did not appreciate or were unaware of NTS, likely because of a lack of discussion in practice. Trainers had several reasons for not discussing NTS including insufficient personal relationships with trainees and a lack of robust evidence on which to base discussions. A lack of insight into NTS and surgeon arrogance were suggested as barrier to effective learning. CONCLUSIONS Apparent discordant perceptions may be contributing to a lack of focused NTS feedback for surgeons in training. To implement NTS training changes, more will have to be done to develop a shared understanding.
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Affiliation(s)
- Joshua D Whittaker
- Otolaryngology, Univerisity Hospitals Nottingham, Nottingham, United Kingdom.
| | - Ian Davison
- School of Education, Univeristy of Birmingham, Birmingham, United Kingdom
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Francis ER, Bernard S, Nowak ML, Daniel S, Bernard JA. Operating Room Virtual Reality Immersion Improves Self-Efficacy Amongst Preclinical Physician Assistant Students. JOURNAL OF SURGICAL EDUCATION 2020; 77:947-952. [PMID: 32199861 DOI: 10.1016/j.jsurg.2020.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/04/2020] [Accepted: 02/16/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess the impact on self-efficacy for preclinical physician assistant (PA) students through immersive virtual reality (VR) operating room simulation. DESIGN Randomized double-blinded controlled experiment measuring self-efficacy using Schwarzer and Jerusalem's general self-efficacy scale. An entirely novel operating room was created, casted, and filmed using VR software. Fifty-two preclinical PA students were randomly assigned to VR (n = 26) or traditional lecture (n = 26) and self-efficacy was measured in both conditions using a general self-efficacy scale given before and after the virtual experience. A mixed ANOVA, independent sample t tests, and paired samples t tests were performed. SETTING Shenandoah University Physician Assistant program, Winchester, Virginia. RESULTS Exposure to VR training after the traditional lecture improves self-efficacy amongst PA students (p < 0.05). Exposure to VR improved self-efficacy compared to traditional methods (p < 0.05). There was no difference in self-efficacy amongst PA students with the traditional model (p < 0.05). CONCLUSIONS The introduction of VR simulation improved preclinical PA student self-efficacy in the operating room setting.
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Affiliation(s)
- Erika R Francis
- University, School of Health Professions, Division of Physician Assistant Studies, Winchester, Virginia.
| | - Stephanie Bernard
- University, School of Health Professions, Division of Physician Assistant Studies, Winchester, Virginia
| | - Morgan L Nowak
- University, School of Health Professions, Division of Physician Assistant Studies, Winchester, Virginia
| | - Sarah Daniel
- Shenandoah University, School of Education and Leadership, Winchester, Virginia
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Milam LA, Cohen GL, Mueller C, Salles A. The Relationship Between Self-Efficacy and Well-Being Among Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2019; 76:321-328. [PMID: 30245061 PMCID: PMC6380924 DOI: 10.1016/j.jsurg.2018.07.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/11/2018] [Accepted: 07/30/2018] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Residency is a challenging time in the lives of physicians. In this study, we examined the relationship between general self-efficacy, defined as the belief in one's own capabilities in a variety of situations, and burnout and psychological well-being in a sample of surgical residents. DESIGN In the context of a larger study, a cross-sectional survey was administered to residents. The survey included measures of general self-efficacy, the emotional exhaustion and personal accomplishment domains of burnout, and general psychological well-being. We examined correlations between self-efficacy and these well-being outcomes and used multivariable linear regression models that controlled for age, gender, postgraduate year, ethnicity, and the interaction between gender and self-efficacy. SETTING We surveyed residents at Stanford Health Care, a tertiary care center, between the fall of 2010 and the spring of 2013. PARTICIPANTS One hundred and seventy nine residents from 9 surgical subspecialties responded to the survey for a response rate of 76%. RESULTS Residents reported high levels of self-efficacy, and over a third reported high emotional exhaustion. Eighty-nine percent of residents had average or high personal accomplishment. In adjusted regression analyses, general self-efficacy was negatively predictive of emotional exhaustion (B = -0.43, p = 0.0127) and positively predictive of personal accomplishment (B = 0.33, p = 0.0185) and general psychological well-being (B = 0.34, p = 0.0010). There was no interaction between gender and general self-efficacy in regression analyses (ps ≥ 0.6776). CONCLUSIONS Among other factors, self-efficacy appears to be significantly predictive of resident well-being. High self-efficacy suggests that residents feel prepared and capable. Interventions to improve residents' general self-efficacy should be explored as a possible mechanism to improve well-being.
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Affiliation(s)
- Laurel A Milam
- Washington University in St. Louis, Department of Surgery, St. Louis, Missouri
| | - Geoffrey L Cohen
- Stanford University, Department of Psychology, Stanford, California
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Scaffidi MA, Khan R, Walsh CM, Pearl M, Winger K, Kalaichandran R, Lin P, Grover SC. Protocol for a randomised trial evaluating the effect of applying gamification to simulation-based endoscopy training. BMJ Open 2019; 9:e024134. [PMID: 30804029 PMCID: PMC6443058 DOI: 10.1136/bmjopen-2018-024134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Simulation-based training (SBT) provides a safe environment and effective means to enhance skills development. Simulation-based curricula have been developed for a number of procedures, including gastrointestinal endoscopy. Gamification, which is the application of game-design principles to non-game contexts, is an instructional strategy with potential to enhance learning. No studies have investigated the effects of a comprehensive gamification curriculum on the acquisition of endoscopic skills among novice endoscopists. METHODS AND ANALYSIS Thirty-six novice endoscopists will be randomised to one of two endoscopy SBT curricula: (1) the Conventional Curriculum Group, in which participants will receive 6 hours of one-on-one simulation training augmented with expert feedback and interlaced with 4 hours of small group teaching on the theory of colonoscopy or (2) the Gamified Curriculum Group, in which participants will receive the same curriculum with integration of the following game-design elements: a leaderboard summarising participants' performance, game narrative, achievement badges and rewards for top performance. In line with a progressive learning approach, simulation training for participants will progress from low to high complexity simulators, starting with a bench-top model and then moving to the EndoVR virtual reality simulator. Performance will be assessed at three points: pretraining, immediately post-training and 4-6 weeks after training. Assessments will take place on the simulator at all three time points and transfer of skills will be assessed during two clinical colonoscopies 4-6 weeks post-training. Mixed factorial ANOVAs will be used to determine if there is a performance difference between the two groups during simulated and clinical assessments. ETHICS AND DISSEMINATION Ethical approval was obtained at St. Michael's Hospital. Results of this trial will be submitted for presentation at academic meetings and for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03176251.
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Affiliation(s)
| | - Rishad Khan
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition, Learning Institute, and Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- The Wilson Centre, University of Toronto, Toronto, Canada
| | - Matthew Pearl
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | - Kathleen Winger
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | | | - Peter Lin
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Communication through simulation: Developing a curriculum to teach interpersonal skills. Surgery 2018; 164:802-809. [DOI: 10.1016/j.surg.2018.05.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/11/2018] [Accepted: 05/01/2018] [Indexed: 11/20/2022]
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Yovanoff MA, Chen HE, Pepley DF, Mirkin KA, Han DC, Moore JZ, Miller SR. Investigating the Effect of Simulator Functional Fidelity and Personalized Feedback on Central Venous Catheterization Training. JOURNAL OF SURGICAL EDUCATION 2018; 75:1410-1421. [PMID: 29574019 PMCID: PMC6139271 DOI: 10.1016/j.jsurg.2018.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/16/2018] [Accepted: 02/22/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare the effect of simulator functional fidelity (manikin vs a Dynamic Haptic Robotic Trainer [DHRT]) and personalized feedback on surgical resident self-efficacy and self-ratings of performance during ultrasound-guided internal jugular central venous catheterization (IJ CVC) training. In addition, we seek to explore how self-ratings of performance compare to objective performance scores generated by the DHRT system. DESIGN Participants were randomly assigned to either manikin or DHRT IJ CVC training over a 6-month period. Self-efficacy surveys were distributed before and following training. Training consisted of a pretest, 22 practice IJ CVC needle insertion attempts, 2 full-line practice attempts, and a posttest. Participants provided self-ratings of performance for each needle insertion and were presented with feedback from either an upper level resident (manikin) or a personalized learning system (DHRT). SETTING A study was conducted from July 2016 to February 2017 through a surgical skills training program at Hershey Medical Center in Hershey, Pennsylvania. PARTICIPANTS Twenty-six first-year surgical residents were recruited for the study. Individuals were informed that IJ CVC training procedures would be consistent regardless of participation in the study and that participation was optional. All recruited residents opted to participate in the study. RESULTS Residents in both groups significantly improved their self-efficacy scores from pretest to posttest (p < 0.01). Residents in the manikin group consistently provided higher self-ratings of performance (p < 0.001). Residents in the DHRT group recorded more feedback on errors (228 instances) than the manikin group (144 instances). Self-ratings of performance on the DHRT system were able to significantly predict the objective score of the DHRT system (R2 = 0.223, p < 0.001). CONCLUSION Simulation training with the DHRT system and the personalized learning feedback can improve resident self-efficacy with IJ CVC procedures and provide sufficient feedback to allow residents to accurately assess their own performance.
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Affiliation(s)
- Mary A Yovanoff
- Department of Industrial and Manufacturing Engineering, Penn State, University Park, Pennsylvania
| | - Hong-En Chen
- Department of Industrial and Manufacturing Engineering, Penn State, University Park, Pennsylvania
| | - David F Pepley
- Department of Mechanical and Nuclear Engineering, Penn State, University Park, Pennsylvania
| | - Katelin A Mirkin
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - David C Han
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jason Z Moore
- Department of Mechanical and Nuclear Engineering, Penn State, University Park, Pennsylvania
| | - Scarlett R Miller
- Department of Industrial and Manufacturing Engineering, Penn State, University Park, Pennsylvania; School of Engineering Design, Technology, and Professional Programs, Penn State, University Park, Pennsylvania.
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Belfrage A, Grotmol KS, Lien L, Moum T, Wiese RV, Tyssen R. Medical school predictors of later perceived mastery of clinical work among Norwegian doctors: a cohort study with 10-year and 20-year follow-up. BMJ Open 2017; 7:e014462. [PMID: 28947437 PMCID: PMC5623388 DOI: 10.1136/bmjopen-2016-014462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Doctors' self-perceived mastery of clinical work might have an impact on their career and patient care, in addition to their own health and well-being. The aim of this study is to identify predictors at medical school of perceived mastery later in doctors' careers. DESIGN A cohort of medical students (n=631) was surveyed in the final year of medical school in 1993/1994 (T1), and 10 (T2) and 20 (T3) years later. SETTING Nationwide healthcare institutions. PARTICIPANTS Medical students from all universities in Norway. MAIN OUTCOME MEASURES Perceived mastery of clinical work was measured at T2 and T3. The studied predictors measured at T1 included personality traits, medical school stress, perceived medical recording skills, identification with the role of doctor, hazardous drinking and drinking to cope, in addition to age and gender. Effects were studied using multiple linear regression models. RESULTS Response rates: T1, 522/631 (83%); T2, 390/522 (75%); and T3, 303/522 (58%). Mean scores at T2 and T3 were 22.3 (SD=4.2) and 24.5 (3.0) (t=8.2, p<0.001), with no gender difference. Adjusted associations at T2 were: role identification (β=0.16; p=0.006; 95% CI 0.05 to 0.28), perceived medical recording skills (β=0.13; p=0.02; 95% CI 0.02 to 0.24) and drinking to cope (β=-2.45; p=0.001; 95% CI -3.88 to -1.03). Adjusted association at T3 was perceived medical recording skills (β=0.11; p=0.015; 95% CI 0.02 to 0.21). CONCLUSIONS Perceived medical recording skills and role identification were associated with higher perceived mastery. Medical schools should provide experiences, teaching and assessment to enhance students' physician role identification and confidence in their own skills. Drinking to cope was associated with lower perceived mastery, which indicates the importance of acquiring healthier coping strategies in medical school.
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Affiliation(s)
- Anna Belfrage
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Kjersti Støen Grotmol
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Regional Centre of Excellence in Palliative Care, Oslo University Hospital, Oslo, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Torbjørn Moum
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ragna Veslemøy Wiese
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Reidar Tyssen
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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Khan R, Scaffidi MA, Walsh CM, Lin P, Al-Mazroui A, Chana B, Kalaichandran R, Lee W, Grantcharov TP, Grover SC. Simulation-Based Training of Non-Technical Skills in Colonoscopy: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e153. [PMID: 28778849 PMCID: PMC5562936 DOI: 10.2196/resprot.7690] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/30/2017] [Indexed: 12/12/2022] Open
Abstract
Background Non-technical skills (NTS), such as communication and professionalism, contribute to the safe and effective completion of procedures. NTS training has previously been shown to improve surgical performance. Moreover, increases in NTS have been associated with improved clinical endoscopic performance. Despite this evidence, NTS training has not been tested as an intervention in endoscopy. Objective The aim of this study is to evaluate the effectiveness of a simulation-based training (SBT) curriculum of NTS on novice endoscopists’ performance of clinical colonoscopy. Methods Novice endoscopists were randomized to 2 groups. The control group received 4 hours of interactive didactic sessions on colonoscopy theory and 6 hours of SBT. Hours 5 and 6 of the SBT were integrated scenarios, wherein participants interacted with a standardized patient and nurse, while performing a colonoscopy on the virtual reality (VR) simulator. The NTS (intervention) group received the same teaching sessions but the last hour was focused on NTS teaching. The NTS group also reviewed a checklist of tasks relevant to NTS concepts prior to each integrated scenario case and was provided with dedicated feedback on their NTS performance during the integrated scenario practice. All participants were assessed at baseline, immediately after training, and 4 to 6 weeks post-training. The primary outcome measure is colonoscopy-specific performance in the clinical setting. Results In total, 42 novice endoscopists completed the study. Data collection and analysis is ongoing. We anticipate completion of all assessments by August 2017. Data analysis, manuscript writing, and subsequent submission for publication is expected to be completed by December 2017. Conclusions Results from this study may inform the implementation of NTS training into postgraduate gastrointestinal curricula. NTS curricula may improve attitudes towards patient safety and self-reflection among trainees. Moreover, enhanced NTS may lead to superior clinical performance and outcomes in colonoscopy. Trial Registration Clinicaltrial.gov NCT02877420; https://www.clinicaltrials.gov/ct2/show/NCT02877420 (Archived by WebCite at http://www.webcitation.org/6rw94ubXX NCT02877420)
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Affiliation(s)
- Rishad Khan
- St. Michael's Hospital, Division of Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - Michael A Scaffidi
- St. Michael's Hospital, Division of Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - Catharine M Walsh
- Hospital for Sick Children, Division of Gastroenterology, Hepatology, and Nutrition, Learning Institute, and Research Institute, University of Toronto, Toronto, ON, Canada.,The Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Peter Lin
- St. Michael's Hospital, Division of Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - Ahmed Al-Mazroui
- St. Michael's Hospital, Division of Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - Barinder Chana
- St. Michael's Hospital, Division of Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - Ruben Kalaichandran
- St. Michael's Hospital, Division of Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - Woojin Lee
- St. Michael's Hospital, Division of Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - Teodor P Grantcharov
- St. Michael's Hospital, Department of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Samir C Grover
- St. Michael's Hospital, Division of Gastroenterology, University of Toronto, Toronto, ON, Canada
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12
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Wood TC, Raison N, Haldar S, Brunckhorst O, McIlhenny C, Dasgupta P, Ahmed K. Training Tools for Nontechnical Skills for Surgeons-A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2017; 74:548-578. [PMID: 28011262 DOI: 10.1016/j.jsurg.2016.11.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/11/2016] [Accepted: 11/28/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Development of nontechnical skills for surgeons has been recognized as an important factor in surgical care. Training tools for this specific domain are being created and validated to maximize the surgeon's nontechnical ability. This systematic review aims to outline, address, and recommend these training tools. DESIGN A full and comprehensive literature search, using a systematic format, was performed on ScienceDirect and PubMed, with data extraction occurring in line with specified inclusion criteria. SETTING Systematic review was performed fully at King's College London. RESULTS A total of 84 heterogeneous articles were used in this review. Further, 23 training tools including scoring systems, training programs, and mixtures of the two for a range of specialities were identified in the literature. Most can be applied to surgery overall, although some tools target specific specialities (such as neurosurgery). Interrater reliability, construct, content, and face validation statuses were variable according to the specific tool in question. CONCLUSIONS Study results pertaining to nontechnical skill training tools have thus far been universally positive, but further studies are required for those more recently developed and less extensively used tools. Recommendations can be made for individual training tools based on their level of validation and for their target audience. Based on the number of studies performed and their status of validity, NOTSS and Oxford NOTECHS II can be considered the gold standard for individual- and team-based nontechnical skills training, respectively, especially when used in conjunction with a training program.
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Affiliation(s)
- Thomas Charles Wood
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Nicholas Raison
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.
| | - Shreya Haldar
- Department of Opthalmology, Stoke Mandeville Hospital, Aylesbury, United Kingdom
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Craig McIlhenny
- Department of Urology, NHS Forth Valley, Larbert, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
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Thompson CV, Naumann DN, Fellows JL, Bowley DM, Suggett N. Post-traumatic stress disorder amongst surgical trainees: An unrecognised risk? Surgeon 2017; 15:123-130. [DOI: 10.1016/j.surge.2015.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 10/22/2022]
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Forgione A, Guraya SY. The cutting-edge training modalities and educational platforms for accredited surgical training: A systematic review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:51. [PMID: 28567070 PMCID: PMC5426099 DOI: 10.4103/jrms.jrms_809_16] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/10/2016] [Accepted: 12/27/2016] [Indexed: 11/18/2022]
Abstract
Background: Historically, operating room (OR) has always been considered as a stand-alone trusted platform for surgical education and training. However, concerns about financial constraints, quality control, and patient safety have urged the surgical educators to develop more cost-effective, surgical educational platforms that can be employed outside the OR. Furthermore, trained surgeons need to regularly update their surgical skills to keep abreast with the emerging surgical technologies. This research aimed to explore the value of currently available modern surgical tools that can be used outside the OR and also elaborates the existing laparoscopic surgical training programs in world-class centers across the globe with a view to formulate a blended and unified structured surgical training program. Materials and Methods: Several data sources were searched using MeSH terms “Laparoscopic surgery” and “Surgical training” and “Surgical curriculum” and “fundamentals of endoscopic surgery” and “fundamentals of laparoscopic surgery” and “Telementoring” and “Box trainer.” The eligibility criteria used in data extraction searched for original and review articles and by excluding the editorial articles, short communications, conference proceedings, personal view, and commentaries. Data synthesis and data analysis were done by reviewing the initially retrieved 211 articles. Irrelevant and duplicate and redundant articles were excluded from the study. Results: Finally, 12 articles were selected for this systematic review. Data results showed that a myriad of cutting-edge technical innovations have provided modern surgical training tools such as the simulation-based mechanical and virtual reality simulators, animal and cadaveric labs, telementoring, telerobotic-assisted surgery, and video games. Surgical simulators allow the trainees to acquire surgical skills in a tension-free environment without supervision or time constraints. Conclusion: The existing world-renowned surgical training centers employ various clusters of training tools that essentially endeavor to embed the acquisition of knowledge and technical skills. However, a unified training curriculum that may be accepted worldwide is currently not available.
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Affiliation(s)
- Antonello Forgione
- Department of Surgical Oncology and Minimally Invasive Surgery, AIMS Academy, Niguarda Hospital, Milan, Italy
| | - Salman Y Guraya
- Department of Surgery, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
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15
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Youngson GG. Nontechnical skills in pediatric surgery: Factors influencing operative performance. J Pediatr Surg 2016; 51:226-30. [PMID: 26644073 DOI: 10.1016/j.jpedsurg.2015.10.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/30/2015] [Indexed: 11/24/2022]
Abstract
Technical competence is an essential aspect of intraoperative performance but is in itself insufficient to ensure an optimal surgical outcome. A list of other skills complement technical ability and these relate, among others, to surgical judgment and intraoperative decision-making processes as well as the role of the operating surgeon as leader of the surgical team. This article outlines the composite set of nontechnical skills (NTS) and the factors which influence surgical performance by virtue of this skill set. A framework has been developed to allow identification, teaching, and assessment of NTS known as Nontechnical Skills for Surgeons (NOTSS), and the relevance and influence of NOTSS during the intraoperative performance of pediatric surgery is presented.
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Affiliation(s)
- George G Youngson
- Department of Paediatric Surgery, Royal Aberdeen Children's Hospital, Foresterhill, Aberdeen, AB25 22G Scotland, United Kingdom.
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