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Kawamura AA, Brown L, Orsino A, Zubairi MS, Mylopoulos M. Navigating Challenging Conversations: The Interplay Between Inquiry and Knowledge Drives Preparation for Future Learning. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:304-314. [PMID: 37520507 PMCID: PMC10377743 DOI: 10.5334/pme.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Abstract
Introduction While some physicians hone their skills through informal learning in clinical practice, others do not. There is a lack of understanding of why some physicians seek improvement and how they use the workplace context to build their capabilities. Because physicians rarely pursue formal professional development activities to improve communication skills, examining physician-patient communication offers a powerful opportunity to illuminate important aspects of preparation for future learning in the workplace. Methods This qualitative observational study involved over 100 hours of observation of eight pediatric rehabilitation physicians as they interacted with patients and families at an academic teaching hospital in 2018-2020. Detailed field notes of observations, post-observation interviews, and exit interviews were the data sources. Data collection and analysis using a constructivist grounded theory approach occurred iteratively, and themes were identified through constant comparative analysis. Results Through their daily work, experienced physicians employ 'habits of inquiry' by constantly seeking a better understanding of how to navigate challenging conversations in practice through monitoring and attuning to situational and contextual cues, taking risks and navigating uncertainty while exploring new and varied ways of practicing, and seeking why their strategies are successful or not. Discussion Engaging in communication challenges drives physician learning through an interplay between habits of inquiry and knowledge: inquiry into how to improve their communication supported by existing conceptual knowledge to generate new strategies. These 'habits of inquiry' prompt continual reinvestment in problem solving to refine existing knowledge and to build new skills for navigating communication challenges in practice.
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Affiliation(s)
- Anne A. Kawamura
- Department of Pediatrics, University of Toronto, Canada
- Bloorview Research Institute, Toronto, Ontario, Canada
- Wilson Centre for Research in Education, Toronto, Ontario, Canada
| | - Leah Brown
- Faculty of Medicine, University of Toronto, Canada
| | - Angela Orsino
- Department of Pediatrics, University of Toronto, Canada
| | - Mohammad S. Zubairi
- Department of Pediatrics, McMaster University, Canada
- McMaster Education Research, Innovation, and Theory (MERIT) Program, McMaster University, Hamilton, Ontario, Canada
| | - Maria Mylopoulos
- Department of Pediatrics, University of Toronto, Canada
- Wilson Centre for Research in Education, Toronto, Ontario, Canada
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Cianciolo AT, Regehr G. The Case for Feedback-in-Practice as a Topic of Educational Scholarship. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:317-321. [PMID: 36222528 DOI: 10.1097/acm.0000000000005013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The importance of clinical performance feedback is well established and the factors relevant to its effectiveness widely recognized, yet feedback continues to play out in problematic ways. For example, learning culture modifications shown to facilitate feedback have not seen widespread adoption, and the learner-educator interactions prescribed by research rarely occur organically. Nevertheless, medical learners achieve clinical competence, suggesting a need to expand educational scholarship on this topic to better account for learner growth. This Scholarly Perspective argues for a more extensive exploration of feedback as an educational activity embedded in clinical practice , where joint clinical work that involves an educator and learner provides a locus for feedback in the midst of performance. In these clinically embedded feedback episodes, learning and performance goals are constrained by the task at hand, and the educator guides the learner in collaboratively identifying problematic elements, naming and reframing the source of challenge, and extrapolating implications for further action. In jointly conducting clinical tasks, educators and learners may frequently engage in feedback interactions that are both aligned with workplace realities and consistent with current theoretical understanding of what feedback is. However, feedback embedded in practice may be challenged by personal, social, and organizational factors that affect learners' participation in workplace activity. This Scholarly Perspective aims to provide a conceptual framework that helps educators and learners be more intentional about and fully participatory in this important educational activity. By topicalizing this feedback-in-practice and exploring its integration with the more commonly foregrounded feedback-on-practice , future educational scholarship may achieve optimal benefit to learners, educators, and clinical practice.
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Affiliation(s)
- Anna T Cianciolo
- A.T. Cianciolo is associate professor, Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois; ORCID: https://orcid.org/0000-0001-5948-9304
| | - Glenn Regehr
- G. Regehr is senior scientist and associate director, Center for Health Education Scholarship, and professor, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002-3144-331X
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Wolff M, Hammoud M, Carney M. Developing Master Adaptive Learners: Implementation of a Coaching Program in Graduate Medical Education. West J Emerg Med 2023; 24:71-75. [PMID: 36735006 PMCID: PMC9897244 DOI: 10.5811/westjem.2022.12.57636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/27/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Margaret Wolff
- University of Michigan Medical School, Department of Emergency Medicine and Pediatrics, Ann Arbor, Michigan
| | - Maya Hammoud
- University of Michigan Medical School, Department of Obstetrics and Gynecology, Ann Arbor, Michigan
| | - Michele Carney
- University of Michigan Medical School, Department of Emergency Medicine and Pediatrics, Ann Arbor, Michigan
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Tavares W, Piquette D, Luong D, Chiu M, Dyte C, Fraser K, Clark M. Exploring the Study of Simulation as a Continuing Professional Development Strategy for Physicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 43:188-197. [PMID: 36728972 DOI: 10.1097/ceh.0000000000000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Practicing physicians have the responsibility to engage in lifelong learning. Although simulation is an effective experiential educational strategy, physicians seldom select it for continuing professional development (CPD) for reasons that are poorly understood. The objective of this study was to explore existing evidence on simulation-based CPD and the factors influencing physicians' engagement in simulation-based CPD. METHODS A scoping review of the literature on simulation-based CPD included MEDLINE, Embase, and CINAHL databases. Studies involving the use of simulation for practicing physicians' CPD were included. Information related to motivations for participating in simulation-based CPD, study objectives, research question(s), rationale(s), reasons for using simulation, and simulation features was abstracted. RESULTS The search yielded 8609 articles, with 6906 articles undergoing title and abstract screening after duplicate removal. Six hundred sixty-one articles underwent full-text screening. Two hundred twenty-five studies (1993-2021) were reviewed for data abstraction. Only four studies explored physicians' motivations directly, while 31 studies described incentives or strategies used to enroll physicians in studies on simulation-based CPD. Most studies focused on leveraging or demonstrating the utility of simulation for CPD. Limited evidence suggests that psychological safety, direct relevance to clinical practice, and familiarity with simulation may promote future engagement. DISCUSSION Although simulation is an effective experiential educational method, factors explaining its uptake by physicians as a CPD strategy are unclear. Additional evidence of simulation effectiveness may fail to convince physicians to participate in simulation-based CPD unless personal, social, educational, or contextual factors that shape physicians' motivations and choices to engage in simulation-based CPD are explored.
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Affiliation(s)
- Walter Tavares
- Dr. Tavares: Assistant Professor and Scientist, Wilson Centre for Health Professions Education, Temerty Faculty of Medicine, Institute for Health Policy Management and Evaluation, University Health Network, University of Toronto, Toronto, Ontario, Canada, and York Region Paramedic and Senior Services, Community Health Services Department, Regional Municipality of York, Newmarket Ontario, Canada. Dr. Piquette: Assistant Professor, Inter-Department Division of Critical Care Medicine, University of Toronto, Staff Physician, Sunnybrook Health Sciences Centre, Centre Researcher, The Wilson Centre, Toronto, Ontario, Canada. Ms. Luong: Research Associate II, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. Dr. Chiu: Associate Professor, Department of Anesthesiology and Pain Medicine, Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr. Dyte: Clinical Lecturer and Anesthesiologist, Department of Anesthesia, Perioperative and Pain Medicine, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada. Dr. Fraser: Clinical Professor of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Dr. Clark: Clinical Associate Professor of Surgery, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
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Mausz J, Jackson NA, Lapalme C, Piquette D, Wakely D, Cheskes S. Protected 911: Development, Implementation, and Evaluation of a Prehospital COVID-19 High-Risk Response Team. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053004. [PMID: 35270696 PMCID: PMC8910754 DOI: 10.3390/ijerph19053004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 01/27/2023]
Abstract
Patients with COVID-19 who require aerosol-generating medical procedures (such as endotracheal intubation) are challenging for paramedic services. Although potentially lifesaving for patients, aerosolizing procedures carry an increased risk of infection for paramedics, owing to the resource limitations and complexities of the pre-hospital setting. In this paper, we describe the development, implementation, and evaluation of a novel pre-hospital COVID-19 High-Risk Response Team (HRRT) in Peel Region in Ontario, Canada. The mandate of the HRRT was to attend calls for patients likely to require aerosolizing procedures, with the twofold goal of mitigating against COVID-19 infections in the service while continuing to provide skilled resuscitative care to patients. Modelled after in-hospital 'protected code blue' teams, operationalizing the HRRT required several significant changes to standard paramedic practice, including the use of a three-person crew configuration, dedicated safety officer, call-response checklists, multiple redundant safety procedures, and enhanced personal protective equipment. Less than three weeks after the mandate was given, the HRRT was operational for a 12-week period during the first wave of COVID-19 in Ontario. HRRT members attended ~70% of calls requiring high risk procedures and were associated with improved quality of care indicators. No paramedics in the service contracted COVID-19 during the program.
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Affiliation(s)
- Justin Mausz
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (N.A.J.); (C.L.); (D.P.); (D.W.)
- Correspondence:
| | - Nicholas A. Jackson
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (N.A.J.); (C.L.); (D.P.); (D.W.)
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West Room HSC-2C1, Hamilton, ON L8S 4K1, Canada
| | - Corey Lapalme
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (N.A.J.); (C.L.); (D.P.); (D.W.)
| | - Dan Piquette
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (N.A.J.); (C.L.); (D.P.); (D.W.)
| | - Dave Wakely
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (N.A.J.); (C.L.); (D.P.); (D.W.)
| | - Sheldon Cheskes
- Sunnybrook Centre for Prehospital Medicine, 77 Brown’s Line, Suite 100, Toronto, ON M8W 3S2, Canada;
- Division of Emergency Medicine, University of Toronto, 6 Queen’s Park Cres. W., Toronto, ON M5S 3H2, Canada
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Using Peer Feedback to Promote Clinical Excellence in Hospital Medicine. J Gen Intern Med 2020; 35:3644-3649. [PMID: 32959350 PMCID: PMC7728945 DOI: 10.1007/s11606-020-06235-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
Hospitalists provide a significant amount of direct clinical care in both academic and community hospitals. Peer feedback is a potentially underutilized and low resource method for improving clinical performance, which lends itself well to the frequent patient care handoffs that occur in the practice of hospital medicine. We review current literature on peer feedback to provide an overview of this performance improvement tool, briefly describe its incorporation into multi-source clinical performance appraisals across disciplines, highlight how peer feedback is currently used in hospital medicine, and present practical steps for hospital medicine programs to implement peer feedback to foster clinical excellence among their clinicians.
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Sehlbach C, Teunissen PW, Driessen EW, Mitchell S, Rohde GGU, Smeenk FWJM, Govaerts MJB. Learning in the workplace: Use of informal feedback cues in doctor-patient communication. MEDICAL EDUCATION 2020; 54:811-820. [PMID: 32150761 PMCID: PMC7496915 DOI: 10.1111/medu.14148] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 06/02/2023]
Abstract
OBJECTIVES We expect physicians to be lifelong learners. Participation in clinical practice is an important potential source of that learning. To support physicians in this process, a better understanding of how they learn in clinical practice is necessary. This study investigates how physicians recognise and use informal feedback from interactions with patients in outpatient settings as learning cues to adjust their communication behaviours in daily practice. METHODS To understand physicians' use of informal feedback, we combined non-participant observations with semi-structured interviews. We enrolled 10 respiratory physicians and observed 100 physician-patient interactions at two teaching hospitals in the Netherlands. Data collection and analysis were performed iteratively according to the principles of constructivist grounded theory. RESULTS Following stages of open, axial and selective coding, we were able to conceptualise how physicians use cues to reflect on and adjust their communication. In addition to vast variations within and across patient encounters, we observed recurring adjustments in physicians' communication behaviours in response to specific informal feedback cues. Physicians recognised and used these cues to self-monitor communication performance. They had established 'communication repertoires' based on multiple patient interactions, which many saw as learning opportunities contributing to the development of expertise. Our findings, however, show differences in physicians' individual levels of sensitivity in recognising and using learning opportunities in daily practice, which were further influenced by contextual, personal and interpersonal factors. Whereas some described themselves as having little inclination to change, others used critical incidents to fine-tune their communication repertoires, and yet others constantly reshaped them, seeking learning opportunities in their daily work. CONCLUSIONS There is large variation in how physicians use learning cues from daily practice. To enhance learning in and from daily practice, we propose turning workplace learning into a collaborative effort with the aim of increasing awareness and the use of informal performance-relevant feedback.
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Affiliation(s)
- Carolin Sehlbach
- Department of Educational Development and ResearchSchool of Health Professions EducationFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
| | - Pim W. Teunissen
- Department of Educational Development and ResearchSchool of Health Professions EducationFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Obstetrics and GynaecologyAmsterdam University Medical CentreAmsterdamthe Netherlands
| | - Erik W. Driessen
- Department of Educational Development and ResearchSchool of Health Professions EducationFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
| | | | - Gernot G. U. Rohde
- Department of Respiratory MedicineUniversity HospitalGoethe UniversityFrankfurt am MainGermany
| | - Frank W. J. M. Smeenk
- Department of Educational Development and ResearchSchool of Health Professions EducationFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Respiratory MedicineCatharina HospitalEindhoventhe Netherlands
| | - Marjan J. B. Govaerts
- Department of Educational Development and ResearchSchool of Health Professions EducationFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
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Shariff F, Hatala R, Regehr G. The nature of learning from simulation: Now I know it, now I'll do it, I'll work on that. MEDICAL EDUCATION 2020; 54:652-659. [PMID: 32162379 DOI: 10.1111/medu.14153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 06/10/2023]
Abstract
CONTEXT Ongoing learning in complex clinical environments requires health professionals to assess their own performance, manage their learning, and modify their practices based on self-monitored progress. Self-regulated learning (SRL) theory suggests that although learners may be capable of such learning, they often need guidance to enact it effectively. Debriefings following simulation may be an ideal time to support learners' use of SRL in targeted areas, but the extent to which they are optimally fostering these practices has not been examined. METHODS A qualitative study informed by grounded theory methodology was conducted in the context of three interprofessional in situ trauma simulations at our level 1 trauma centre. A total of 18 participants were interviewed both immediately and 5-6 weeks after the simulation experience. Transcripts were analysed using an iterative constant comparative approach to explore concepts and themes regarding the nature of learning from and after simulation. RESULTS During initial interviews, there were many examples of acquired content knowledge and straightforward practice changes that might not require ongoing SRL to enact well in practice. However, even for skills identified as needing to be 'worked on,' SRL strategies were lacking. At follow-up interviews, some participants had evolved more specific learning goals and rudimentary plans for implementation and improvement, but suggested this was prompted by the study interview questions rather than the simulation debriefing itself. CONCLUSIONS Overall, participants did not engage in fulsome development of SRL plans based on the simulation and debriefing; however, there were elements of SRL present, particularly after participants were given time to reflect on the interview questions and their own goals. This suggests that simulation training can support the use of SRL. However, debriefing approaches might be better optimised to take full advantage of the opportunity to encourage and foster SRL in practice after the simulation is over.
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Affiliation(s)
- Farhana Shariff
- Division of General Surgery, Center for Health Education Scholarship, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Rose Hatala
- Department of Medicine, Center for Health Education Scholarship, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Glenn Regehr
- Department of Surgery, Center for Health Education Scholarship, The Universtiy of British Columbia, Vancouver, British Columbia, Canada
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Bowen JL, Boscardin CK, Chiovaro J, Ten Cate O, Regehr G, Irby DM, O'Brien BC. A view from the sender side of feedback: anticipated receptivity to clinical feedback when changing prior physicians' clinical decisions-a mixed methods study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:263-282. [PMID: 31552531 DOI: 10.1007/s10459-019-09916-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 08/30/2019] [Indexed: 05/23/2023]
Abstract
When physicians transition patients, the physician taking over may change the diagnosis. Such a change could serve as an important source of clinical feedback to the prior physician. However, this feedback may not transpire if the current physician doubts the prior physician's receptivity to the information. This study explored facilitators of and barriers to feedback communication in the context of patient care transitions using an exploratory sequential, qualitative to quantitative, mixed methods design. Twenty-two internal medicine residents and hospitalist physicians from two teaching hospitals were interviewed and data were analyzed thematically. A prominent theme was participants' reluctance to communicate diagnostic changes. Participants perceived case complexity and physical proximity to facilitate, and hierarchy, unfamiliarity with the prior physician, and lack of relationship to inhibit communication. In the subsequent quantitative portion of the study, forty-one hospitalists completed surveys resulting in 923 total survey responses. Multivariable analyses and a mixed-effects model were applied to survey data with anticipated receptivity as the outcome variable. In the mixed-effects model, four factors had significant positive associations with receivers' perceived receptivity: (1) feedback senders' time spent on teaching services (β = 0.52, p = 0.02), (2) receivers' trustworthiness and clinical credibility (β = 0.49, p < 0.001), (3) preference of both for shared work rooms (β = 0.15, p = 0.006), and (4) receivers being peers (β = 0.24, p < 0.001) or junior colleagues (β = 0.39, p < 0.001). This study suggests that anticipated receptivity to feedback about changed clinical decisions affects clinical communication loops. Without trusting relationships and opportunities for low risk, casual conversations, hospitalists may avoid such conversations.
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Affiliation(s)
- Judith L Bowen
- Department of Medical Education and Clinical Sciences, Spokane Academic Center, Elson S Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
- Portland Veterans Affairs Health Care System, Portland, OR, USA.
| | - Christy Kim Boscardin
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco, CA, USA
| | - Joseph Chiovaro
- Portland Veterans Affairs Health Care System, Portland, OR, USA
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Olle Ten Cate
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco, CA, USA
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Glenn Regehr
- Department of Surgery and Centre for Health Education Scholarship, University of British Columbia, British Columbia, Canada
| | - David M Irby
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco, CA, USA
| | - Bridget C O'Brien
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco, CA, USA
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Wolter S, Duprée A, ElGammal A, Runkel N, Heimbucher J, Izbicki JR, Mann O, Busch P. Mentorship Programs in Bariatric Surgery Reduce Perioperative Complication Rate at Equal Short-Term Outcome-Results from the OPTIMIZE Trial. Obes Surg 2020; 29:127-136. [PMID: 30187421 DOI: 10.1007/s11695-018-3495-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to determine the efficacy of coaching on outcome in low volume centers of excellence and to evaluate the influence of mentorship programs on the center development. BACKGROUND The number of bariatric procedures has increased steadily in the last years. Providing nationwide bariatric care on a high professional level needs structures to train and guide upcoming centers and ensure high quality in patient care. METHODS A prospective multicentered, observational study including laparoscopic sleeve gastrectomies (SG) and Roux-en-Y gastric bypass (RYGB) procedures was performed. Twelve emerging bariatric centers were coached by five experienced bariatric centers. Surgeons of the mentor centers gave guidance on pre- and postsurgical management of their patients including complications and proctored the first interventions. The results were compared regarding operative outcomes, percentage of excess weight loss, complications, and resolution of comorbidities. RESULTS A total of 214 of 293 patients (73.0%) completed the study. The most frequently reported complications were wound infection (4.4%), disorder of emptying stomach/new reflux (2.4%), anastomotic leaks, intra-abdominal secondary hemorrhage, and dumping syndrome (2.0% each). The mortality rate was zero. We found no difference in overall complication rates or resolution of obesity-related comorbidities when comparing experienced surgeons with less experienced surgeons. CONCLUSIONS Our results suggest that under the conditions of the practices of this study, coaching and mentoring were associated with comparable outcomes both in experienced and emerging centers. In addition, mentorship programs ensure equal outcome quality in terms of improvement of obesity-associated comorbidities. TRIAL REGISTRATION NCT Number: NCT01754194 .
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Affiliation(s)
- Stefan Wolter
- Department of General-, Visceral- and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Anna Duprée
- Department of General-, Visceral- and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Alexander ElGammal
- Department of General-, Visceral- and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Norbert Runkel
- Department of General- and Visceral Surgery, Schwarzwald Baar Hospital, Villingen-Schwenningen, Germany
| | | | - Jakob R Izbicki
- Department of General-, Visceral- and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Oliver Mann
- Department of General-, Visceral- and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Philipp Busch
- Department of General-, Visceral- and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Bowen JL, Ilgen JS, Regehr G, Cate OT, Irby DM, O'Brien BC. Reflections From the Rearview Mirror: Internal Medicine Physicians' Reactions to Clinical Feedback After Transitions of Responsibility. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1953-1960. [PMID: 31192795 DOI: 10.1097/acm.0000000000002831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Learning from practice is important for continuous improvement of practice. Yet little is known about how physicians assimilate clinical feedback and use it to refine their diagnostic approaches. This study described physicians' reactions to learning that their provisional diagnosis was either consistent or inconsistent with the subsequent diagnosis, identified emotional responses to those findings, and explored potential consequences for future practices. METHOD In 2016-2017, 22 internal medicine hospitalist and resident physicians at Oregon Health & Science University completed semistructured interviews. Critical incident prompts elicited cases of patient care transitions before the diagnosis was known. Interview questions explored participants' subsequent follow-up. Matrix analysis of case elements, emotional reactions, and perceived practice changes was used to compare patterns of responses between cases of confirming versus disconfirming clinical feedback. RESULTS Participants described 51 cases. When clinical feedback confirmed provisional diagnoses (17 cases), participants recalled positive emotions, judged their performance as sufficient, and generally reinforced current approaches. When clinical feedback was disconfirming (34 cases), participants' emotional reactions were mostly negative, frequently tempered with rationalizations, and often associated with perceptions of having made a mistake. Perceived changes in practice mostly involved nonspecific strategies such as "trusting my intuition" and "broadening the differential," although some described case-specific strategies that could be applied in similar contexts in the future. CONCLUSIONS Internists' experiences with posttransition clinical feedback are emotionally charged. Internists' reflections on clinical feedback experiences suggest they are primed to adapt practices for the future, although the usefulness of those adaptations for improving practice is less clear.
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Affiliation(s)
- Judith L Bowen
- J.L. Bowen was professor, Department of Medicine, Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, Oregon, at the time of the study. The author is now professor, Department of Medical Education and Clinical Sciences, and associate dean for curriculum, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington; ORCID: https://orcid.org/0000-0001-6914-0413. J.S. Ilgen is associate professor, Department of Emergency Medicine, and associate director, Center for Leadership and Innovation in Medical Education, University of Washington School of Medicine, Seattle, Washington. G. Regehr is professor, Department of Surgery, and senior scientist and associate director of research, Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada, and holds an affiliated appointment with the Maastricht University School of Health Professions Education, Maastricht, the Netherlands. O. ten Cate is professor of medical education, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands, and adjunct professor of medicine, School of Medicine, University of California, San Francisco, San Francisco, California. D.M. Irby is professor emeritus of medicine, School of Medicine, and senior scholar, Center for Faculty Educators, University of California, San Francisco, San Francisco, California. B.C. O'Brien is associate professor of medicine, School of Medicine, and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California
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Klasen JM, Driessen E, Teunissen PW, Lingard LA. 'Whatever you cut, I can fix it': clinical supervisors' interview accounts of allowing trainee failure while guarding patient safety. BMJ Qual Saf 2019; 29:727-734. [PMID: 31704890 DOI: 10.1136/bmjqs-2019-009808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/17/2019] [Accepted: 10/28/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Learning is in delicate balance with safety, as faculty supervisors try to foster trainee development while safeguarding patients. This balance is particularly challenging if trainees are allowed to experience the educational benefits of failure, acknowledged as a critical resource for developing competence and resilience. While other educational domains allow failure in service of learning, however, we do not know whether or not this strategy applies to clinical training. METHODS We conducted individual interviews of clinical supervisors, asking them whether they allowed failure for educational purposes in clinical training and eliciting their experiences of this phenomenon. Participants' accounts were descriptively analysed for recurring themes. RESULTS Twelve women and seven men reported 48 specific examples of allowing trainee failure based on their judgement that educational value outweighed patient risk. Various kinds of failures were allowed: both during operations and technical procedures, in medication dosing, communication events, diagnostic procedures and patient management. Most participants perceived minimal consequences for patients, and many described their rescue strategies to prevent an allowed failure. Allowing failure under supervision was perceived to be important for supporting trainee development. CONCLUSION Clinical supervisors allow trainees to fail for educational benefit. In doing so, they attempt to balance patient safety and trainee learning. The educational strategy of allowing failure may appear alarming in the zero-error tolerant culture of healthcare with its commitment to patient safety. However, supervisors perceived this strategy to be invaluable. Viewing failure as inevitable, they wanted trainees to experience it in protected situations and to develop effective technical and emotional responses. More empirical research is required to excavate this tacit supervisory practice and support its appropriate use in workplace learning to ensure both learning and safety.
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Affiliation(s)
- Jennifer M Klasen
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, University Hospital Basel, Basel, Switzerland
| | - Erik Driessen
- Education Development and Research, Maastricht University, Maastricht, The Netherlands
| | - Pim W Teunissen
- Workplace Learning in Healthcare, School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, The Netherlands.,Department of Obstetrics an Gynecology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Lorelei A Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Medicine, University of Western Ontario, London, Ontario, Canada
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Aakre CA, Pencille LJ, Sorensen KJ, Shellum JL, Del Fiol G, Maggio LA, Prokop LJ, Cook DA. Electronic Knowledge Resources and Point-of-Care Learning: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:S60-S67. [PMID: 30365431 DOI: 10.1097/acm.0000000000002375] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE The authors sought to summarize quantitative and qualitative research addressing electronic knowledge resources and point-of-care learning in a scoping review. METHOD The authors searched MEDLINE, Embase, PsycINFO, and the Cochrane Database for studies addressing electronic knowledge resources and point-of-care learning. They iteratively revised inclusion criteria and operational definitions of study features and research themes of interest. Two reviewers independently performed each phase of study selection and data extraction. RESULTS Of 10,811 studies identified, 305 were included and reviewed. Most studies (225; 74%) included physicians or medical students. The most frequently mentioned electronic resources were UpToDate (88; 29%), Micromedex (59; 19%), Epocrates (50; 16%), WebMD (46; 15%), MD Consult (32; 10%), and LexiComp (31; 10%). Eight studies (3%) evaluated electronic resources or point-of-care learning using outcomes of patient effects, and 36 studies (12%) reported objectively measured clinician behaviors. Twenty-five studies (8%) examined the clinical or educational impact of electronic knowledge resource use on patient care or clinician knowledge, 124 (41%) compared use rates of various knowledge resources, 69 (23%) examined the quality of knowledge resource content, and 115 (38%) explored the process of point-of-care learning. Two conceptual clarifications were identified, distinguishing the impact on clinical or educational outcomes versus the impact on test setting decision support, and the quality of information content versus the correctness of information obtained by a clinician-user. CONCLUSIONS Research on electronic knowledge resources is dominated by studies involving physicians and evaluating use rates. Studies involving nonphysician users, and evaluating resource impact and implementation, are needed.
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Affiliation(s)
- Christopher A Aakre
- C.A. Aakre is assistant professor of medicine and senior associate consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota. L.J. Pencille is program coordinator, Knowledge and Delivery Center, Center for Translational Informatics and Knowledge Management, Mayo Clinic, Rochester, Minnesota. K.J. Sorensen is assistant professor of medical education and unit head, Knowledge Management Technologies, Center for Translational Informatics and Knowledge Management, Mayo Clinic, Rochester, Minnesota. J.L. Shellum is section head, Knowledge and Delivery Center, Center for Translational Informatics and Knowledge Management, Mayo Clinic, Rochester, Minnesota. G. Del Fiol is assistant professor of biomedical informatics, University of Utah School of Medicine, Salt Lake City, Utah, and co-chair, Clinical Decision Support Work Group at Health Level Seven (HL7). L.A. Maggio is associate professor of medicine and associate director of technology and distributed learning, Department of Medicine, Uniformed Services University, Bethesda, Maryland. L.J. Prokop is reference librarian, Plummer Library, Mayo Clinic, Rochester, Minnesota. D.A. Cook is professor of medicine and medical education; researcher, Center for Translational Informatics and Knowledge Management; associate director, Office of Applied Scholarship and Education Science; and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Cutrer WB, Atkinson HG, Friedman E, Deiorio N, Gruppen LD, Dekhtyar M, Pusic M. Exploring the characteristics and context that allow Master Adaptive Learners to thrive. MEDICAL TEACHER 2018; 40:791-796. [PMID: 30033795 DOI: 10.1080/0142159x.2018.1484560] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Because change is ubiquitous in healthcare, clinicians must constantly make adaptations to their practice to provide the highest quality care to patients. In a previous article, Cutrer et al. described a metacognitive approach to learning based on self-regulation, which facilitates the development of the Master Adaptive Learner (MAL). The MAL process helps individuals to cultivate and demonstrate adaptive expertise, allowing them to investigate new concepts (learn) and create new solutions (innovate). An individual's ability to learn in this manner is driven by several internal characteristics and is also impacted by numerous aspects of their context. In this article, the authors examine the important internal and contextual factors that can impede or foster Master Adaptive Learning.
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Affiliation(s)
- William B Cutrer
- a Department of Pediatrics, Vanderbilt University School of Medicine , Nashville , TN , USA
| | | | | | - Nicole Deiorio
- c Department of Emergency Medicine, Oregon Health and Science University , Portland , OR , USA
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Bowen JL, O'Brien BC, Ilgen JS, Irby DM, Ten Cate O. Chart stalking, list making, and physicians' efforts to track patients' outcomes after transitioning responsibility. MEDICAL EDUCATION 2018; 52:404-413. [PMID: 29383741 DOI: 10.1111/medu.13509] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/14/2017] [Accepted: 10/16/2017] [Indexed: 05/23/2023]
Abstract
CONTEXT Transitions of patient care responsibility occur frequently between physicians. Resultant discontinuities make it difficult for physicians to observe clinical outcomes. Little is known about what physicians do to overcome the practical challenges to learning these discontinuities create. This study explored physicians' activities in practice as they sought follow-up information about patients. METHODS Using a constructivist grounded theory approach, semi-structured interviews with 18 internal medicine hospitalist and resident physicians at a single tertiary care academic medical center explored participants' strategies when deliberately conducting follow-up after they transitioned responsibility for patients to other physicians. Following open coding, the authors used activity theory (AT) to explore interactions among the social, cultural and material influences related to follow-up. RESULTS The authors identified three themes related to follow-up: (i) keeping lists to track patients, (ii) learning to create tracking systems and (iii) conducting follow-up. Analysis of participants' follow-up processes as an activity system highlighted key tensions in the system and participants' work adaptations. Tension within functionality of electronic health records for keeping lists (tools) to find information about patients' outcomes (object) resulted in using paper lists as workarounds. Tension between paper lists (tools) and protecting patients' health information (rules) led to rule-breaking or abandoning activities of locating information. Finding time to conduct desired follow-up produced tension between this and other activity systems. CONCLUSION In clinical environments characterised by discontinuity, lists of patients served as tools for guiding patient care follow-up. The authors offer four recommendations to address the tensions identified through AT: (i) optimise electronic health record tracking systems to eliminate the need for paper lists; (ii) support physicians' skill development in developing and maintaining tracking systems for follow-up; (iii) dedicate time in physicians' work schedules for conducting follow-up; and (iv) engage physicians and patients in determining guidelines for longitudinal tracking that optimise physicians' learning and respect patients' privacy.
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Affiliation(s)
- Judith L Bowen
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, California, USA
| | - Jonathan S Ilgen
- Department of Emergency Medicine, and Associate Director, Center for Leadership and Innovation in Medical Education, University of Washington, School of Medicine, Seattle, Washington, USA
| | - David M Irby
- Department of Medicine, University of California, San Francisco, California, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Wolff M, Stojan J, Cranford J, Whitman L, Buckler S, Gruppen L, Santen S. The impact of informed self-assessment on the development of medical students' learning goals. MEDICAL TEACHER 2018; 40:296-301. [PMID: 29179635 DOI: 10.1080/0142159x.2017.1406661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE This study investigates the contributions of self-assessment (SA) and external feedback on the development of learning goals (LG) and the influence on LG recall and implementation in medical students. METHODS Following a standardized patient (SP) assessment, 168 pre-clinical medical students completed a SA, received SP feedback and created a LG. LG were categorized by source. Two weeks later, students recalled LG and described implementation. Chi-squared analyses were used to test the associations. RESULTS SA influenced LG for 82.8% of students whereas SP feedback influenced LG for 45.9%. Students rarely generated LG based on SA when they received discordant feedback (5.4%), but sometimes incorporated feedback discordant from their SA into LG (14.9%). Students who created LG based on SP feedback were more likely to recall LG than those who created LG based on SA, 89.7 versus 67.6%, p < 0.05 and implement their LG, 72.4 versus 48.9%, χ2(1) = 5.3, p = 0.017. Students who reported receiving effective feedback were more likely to implement their LG than those reporting adequate feedback, 60.9 versus 37.9%, χ2(1) = 8.0, p = 0.01. CONCLUSIONS SA is an essential part of goal setting and subsequent action. Perception of feedback plays a crucial role in LG implementation.
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Affiliation(s)
- Margaret Wolff
- a Department of Emergency Medicine , University of Michigan Medical School , Ann Arbor , MI , USA
- b Department of Pediatrics , University of Michigan Medical School , Ann Arbor , MI , USA
| | - Jennifer Stojan
- b Department of Pediatrics , University of Michigan Medical School , Ann Arbor , MI , USA
- c Department of Internal Medicine , University of Michigan Medical School , Ann Arbor , MI , USA
| | - James Cranford
- d Department of Psychiatry , University of Michigan Medical School , Ann Arbor , MI , USA
| | - Laurie Whitman
- e Office of Medical Student Education , University of Michigan Medical School , Ann Arbor , MI , USA
| | - Stacie Buckler
- e Office of Medical Student Education , University of Michigan Medical School , Ann Arbor , MI , USA
| | - Larry Gruppen
- f Department of Learning Health Sciences , University of Michigan Medical School , Ann Arbor , MI , USA
| | - Sally Santen
- a Department of Emergency Medicine , University of Michigan Medical School , Ann Arbor , MI , USA
- f Department of Learning Health Sciences , University of Michigan Medical School , Ann Arbor , MI , USA
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Ratka-Krüger P, Wölber JP, Blank J, Holst K, Hörmeyer I, Vögele E. MasterOnline Periodontology and Implant Therapy-revisited after seven years: A case study of the structures and outcomes in a blended learning CPD. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2018; 22:e7-e13. [PMID: 27995723 DOI: 10.1111/eje.12249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION There is a great need for postgraduate training and continuing professional development (CPD), specifically in the field of periodontology. Despite the plenty of periodontal CPDs, there is a lack of information about the performance of CPDs in a blended learning setting. This study is a case study of the structures and outcomes in a blended learning CPD programme in periodontology, the MasterOnline Periodontology and Implant Therapy hosted by the University of Freiburg's Dental School. MATERIAL AND METHODS The structures of the blended learning CPD were analysed with the aims to (i) make explicit how various innovative educational methods and ICT tools can be successfully applied to a Web-supported postgraduate periodontology training programme, (ii) identify the programme's impact on learning transfer in students' dental practices and (iii) identify other outcomes, synergies and any changes required during the existence. Using qualitative interviewing, the various types of learning transfer and elements of the study programme that foster transfer could be exemplified. RESULTS A period of 7 years was analysed. In this duration, 50 students successfully graduated to a master of science. Qualitative interviews were performed with six students and four teachers affirming the learning transfer in a blended learning setting. CONCLUSIONS This case study shows that blended learning can be a successful approach for CPD in dentistry.
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Affiliation(s)
- P Ratka-Krüger
- Department of Operative Dentistry and Periodontology, University Freiburg - Medical Center, Freiburg, Germany
| | - J P Wölber
- Department of Operative Dentistry and Periodontology, University Freiburg - Medical Center, Freiburg, Germany
| | - J Blank
- praxisHochschule, Köln, Germany
| | - K Holst
- Department of Operative Dentistry and Periodontology, University Freiburg - Medical Center, Freiburg, Germany
| | - I Hörmeyer
- Department of Operative Dentistry and Periodontology, University Freiburg - Medical Center, Freiburg, Germany
| | - E Vögele
- Educational Research and Consultancy Rottenburg, Germany
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Merzel C, Halkitis P, Healton C. Pedagogical Scholarship in Public Health: A Call for Cultivating Learning Communities to Support Evidence-Based Education. Public Health Rep 2017; 132:679-683. [PMID: 28977779 PMCID: PMC5692162 DOI: 10.1177/0033354917733745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Public health education is experiencing record growth and transformation. The current emphasis on learning outcomes necessitates attention to creating and evaluating the best curricula and learning methods for helping public health students develop public health competencies. Schools and programs of public health would benefit from active engagement in pedagogical research and additional platforms to support dissemination and implementation of educational research findings. We reviewed current avenues for sharing public health educational research, curricula, and best teaching practices; we identified useful models from other health professions; and we offered suggestions for how the field of public health education can develop communities of learning devoted to supporting pedagogy. Our goal was to help advance an agenda of innovative evidence-based public health education, enabling schools and programs of public health to evaluate and measure success in meeting the current and future needs of the public health profession.
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Affiliation(s)
- Cheryl Merzel
- College of Global Public Health, New York University, New York, NY, USA
| | | | - Cheryl Healton
- College of Global Public Health, New York University, New York, NY, USA
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Kennedy AB, Munk N. Experienced Practitioners' Beliefs Utilized to Create a Successful Massage Therapist Conceptual Model: a Qualitative Investigation. Int J Ther Massage Bodywork 2017; 10:9-19. [PMID: 28690704 PMCID: PMC5495388 DOI: 10.3822/ijtmb.v10i2.367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The massage therapy profession in the United States has grown exponentially, with 35% of the profession’s practitioners in practice for three years or less. Investigating personal and social factors with regard to the massage therapy profession could help to identify constructs needed to be successful in the field. Purpose This data-gathering exercise explores massage therapists’ perceptions on what makes a successful massage therapist that will provide guidance for future research. Success is defined as supporting oneself and practice solely through massage therapy and related, revenue-generating field activity. Participants and Setting Ten successful massage therapy practitioners from around the United States who have a minimum of five years of experience. Research Design Semistructured qualitative interviews were used in an analytic induction framework; index cards with preidentified concepts printed on them were utilized to enhance conversation. An iterative process of interview coding and analysis was used to determine themes and subthemes. Results Based on the participants input, the categories in which therapists needed to be successful were organized into four main themes: effectively establish therapeutic relationships, develop massage therapy business acumen, seek valuable learning environments and opportunities, and cultivate strong social ties and networks. The four themes operate within specific contexts (e.g., regulation and licensing requirements in the therapists’ state), which may also influence the success of the massage therapist. Conclusions The model needs to be tested to explore which constructs explain variability in success and attrition rate. Limitations and future research implications are discussed.
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Affiliation(s)
- Anne B Kennedy
- Department of Biomedical Sciences, Division of Behavioral, Social, and Population Health, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Niki Munk
- Department of Health Sciences, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, IN, USA
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Nisbet G, Dunn S, Lincoln M, Shaw J. Development and initial validation of the interprofessional team learning profiling questionnaire. J Interprof Care 2017; 30:278-87. [PMID: 27152532 DOI: 10.3109/13561820.2016.1141188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Informal workplace interprofessional learning occurs as health professionals interact with each other as part of everyday work practice. Participation in interprofessional team meetings is a practical way to foster learning. However, a gap exists in the availability of a reliable and valid instrument that adequately captures the nuances of informal workplace interprofessional learning in this setting. The purpose of this study was to develop a questionnaire to measure the different components of interprofessional learning that contribute to the quality of interprofessional learning within the interprofessional team meeting. Questionnaire items were developed from a review of the literature and interviews with health professionals. Exploratory factor analysis was used to determine the underlying factor structure. Two hundred and eighty-five health professionals completed a 98-item questionnaire. After elimination of unreliable items, the remaining items (n = 41) loaded onto four factors named personal and professional capacity; turning words into action-"walk the talk"; the rhetoric of interprofessional learning-"talk the talk"; and inclusiveness. Internal consistency was high for all sub-scales (Cronbach's alpha 0.91, 0.87, 0.83, and 0.83, respectively). Content, construct, and concurrent validity were assessed. The instrument developed in this study indicated consistency and robust psychometric properties. Future studies that further test the psychometric properties of the questionnaire will help to establish the usefulness of this measure in establishing evidence for the perceived effectiveness of interprofessional learning in a healthcare setting.
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Affiliation(s)
- Gillian Nisbet
- a Faculty of Health Sciences , The University of Sydney , Lidcombe , New South Wales , Australia
| | - Stewart Dunn
- b Sydney Medical School, Royal North Shore Hospital , The University of Sydney , Sydney , New South Wales , Australia
| | - Michelle Lincoln
- a Faculty of Health Sciences , The University of Sydney , Lidcombe , New South Wales , Australia
| | - Joanne Shaw
- c Psycho-oncology Co-operative Research Group, School of Psychology , The University of Sydney , Sydney , New South Wales , Australia
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Cutrer WB, Miller B, Pusic MV, Mejicano G, Mangrulkar RS, Gruppen LD, Hawkins RE, Skochelak SE, Moore DE. Fostering the Development of Master Adaptive Learners: A Conceptual Model to Guide Skill Acquisition in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:70-75. [PMID: 27532867 DOI: 10.1097/acm.0000000000001323] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Change is ubiquitous in health care, making continuous adaptation necessary for clinicians to provide the best possible care to their patients. The authors propose that developing the capabilities of a Master Adaptive Learner will provide future physicians with strategies for learning in the health care environment and for managing change more effectively. The concept of a Master Adaptive Learner describes a metacognitive approach to learning based on self-regulation that can foster the development and use of adaptive expertise in practice. The authors describe a conceptual literature-based model for a Master Adaptive Learner that provides a shared language to facilitate exploration and conversation about both successes and struggles during the learning process.
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Affiliation(s)
- William B Cutrer
- W.B. Cutrer is assistant professor, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee. B. Miller is senior associate dean for health sciences education and executive vice president for educational affairs, Vanderbilt University School of Medicine, Nashville, Tennessee. M.V. Pusic is assistant professor of emergency medicine and director, Division of Learning Analytics, NYU School of Medicine, New York, New York. G. Mejicano is senior associate dean for education, Oregon Health & Science University, School of Medicine, Portland, Oregon. R.S. Mangrulkar is associate dean for medical student education, University of Michigan Medical School, Ann Arbor, Michigan. L.D. Gruppen is professor, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan. R.E. Hawkins is vice president, medical education outcomes, American Medical Association, Chicago, Illinois. S.E. Skochelak is group vice president, medical education, American Medical Association, Chicago, Illinois. D.E. Moore Jr is professor of medical education and administration and director, Office for Continuous Professional Development, Vanderbilt University School of Medicine, Nashville, Tennessee
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Mylopoulos M, Brydges R, Woods NN, Manzone J, Schwartz DL. Preparation for future learning: a missing competency in health professions education? MEDICAL EDUCATION 2016; 50:115-23. [PMID: 26695471 DOI: 10.1111/medu.12893] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 04/27/2015] [Accepted: 08/18/2015] [Indexed: 05/21/2023]
Abstract
CONTEXT Evidence suggests that clinicians may not be learning effectively from all facets of their practice, potentially because their training has not fully prepared them to do so. To address this gap, we argue that there is a need to identify systems of instruction and assessment that enhance clinicians' 'preparation for future learning'. Preparation for future learning (PFL) is understood to be the capacity to learn new information, to use resources effectively and innovatively, and to invent new strategies for learning and problem solving in practice. CURRENT STATE Education researchers have developed study designs that use dynamic assessments to measure what trainees have acquired in the past, as well as what they are able to learn in the present. More recently, researchers have also started to emphasise and measure whether and how trainees take action to gain the information they need to learn. Knowing that there are study designs and emerging metrics for assessing PFL, the next question is how to design instruction that helps trainees develop PFL capacities. Although research evidence is still accumulating, the current evidence base suggests training that encourages 'productive failure' through guided discovery learning (i.e. where trainees solve problems and perform tasks without direct instruction, though often with some form of feedback) creates challenging conditions that enhance learning and equip trainees with PFL-related behaviours. CONCLUSIONS Preparation for future learning and the associated capacity of being adaptive as one learns in and from training and clinical practice have been missed in most contemporary training and assessment systems. We propose a research agenda that (i) explores how real-world adaptive expert activity unfolds in the health care workplace to inform the design of instruction for developing PFL, (ii) identifies measures of behaviours that relate to PFL, and (iii) addresses potential sociocultural barriers that limit clinicians' opportunities to learn from their daily practice.
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Affiliation(s)
- Maria Mylopoulos
- Wilson Centre, Undergraduate Medical Professions Education and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Brydges
- Wilson Centre and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole N Woods
- Wilson Centre and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Julian Manzone
- Wilson Centre, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Daniel L Schwartz
- Graduate School of Education, Stanford University, Stanford, California, USA
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Abstract
OBJECTIVE To explore surgeons' perceptions of and potential concerns about coaching. BACKGROUND There is growing recognition that the traditional model of continuing professional development is suboptimal. This has led to increasing interest in alternative strategies that take place within the actual practice environment such as coaching. However, if coaching is to be a successful strategy for continuing professional development, it will need to be accepted by surgeons. METHODS This was a qualitative interview-based study using a constructivist grounded theory approach. Participants included 14 surgeons from University of Toronto-affiliated hospitals. RESULTS Participants expressed 3 main concerns about coaching: questioning the value of technical improvement ("As you get older if you don't have the stimulation from surgery to get better or to do things that are different and you are so good at so much, why bother [with coaching]?" P009), worry about appearing incompetent ("I think it would be perceived as either a sign of weakness or a sign of inability" P532), and concern about losing autonomy ("To me that would be real coaching where it's self-identified, I'm motivated, I find the person and then they coach me" P086). CONCLUSIONS AND RELEVANCE Coaching faces unique challenges in the context of a powerful surgical culture that values the portrayal of competency and instills the value of surgical autonomy. This study suggests that hanging on to these tightly held values of competency and autonomy is actually limiting the ways, and extent to which, surgeons can improve their practice.
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Knox S, Dunne S, Cullen W, Dunne CP. A qualitative assessment of practitioner perspectives post-introduction of the first continuous professional competence (CPC) guidelines for emergency medical technicians in Ireland. BMC Emerg Med 2015; 15:11. [PMID: 26003408 PMCID: PMC4494191 DOI: 10.1186/s12873-015-0037-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/13/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In November 2013, the Irish Regulator for emergency medical technicians (EMTs) introduced the first mandatory requirement for registrants to demonstrate evidence of continuous professional development (CPD)/continuous professional competence (CPC). This qualitative study assessed the experience of practitioners with CPC-related materials provided to them by the Regulator in addition to identifying perceived or encountered practical challenges and suggested improvements six months following introduction of the requirement. METHODS Five fora were utilised, comprising two distinct groupings: a group of student EMTs (n = 62) and four discrete groups of qualified EMTs (total n = 131) all of whom had commenced the newly-introduced CPC process. All 193 volunteers were members of the Civil Defence (an auxiliary/voluntary organisation) and represented a nationwide distribution of personnel. Responses were categorised as 'perceived' challenges to CPC, relating to student EMTs, and 'experienced' challenges to CPC, relating to qualified EMTs. Responses also included suggestions from both groups of EMTs on how to improve the current system and guidance material. Audio/visual recordings were made, transcribed and then analysed using NVivo (version 10). A coding framework was developed which identified unifying themes. RESULTS All participants agreed that CPC for pre-hospital practitioners was a welcomed initiative believing that CPC activities would help ensure that EMTs maintain or enhance their skills and be better enabled to provide quality care to the patients they might encounter. Two specific areas were identified by both groups as being challenging: 1) the practicalities of completing CPC and 2) the governance and administration of the CPC process. Challenging practicalities included: ability of voluntary EMTs to gain access to operational placements with paramedics and advanced paramedics; the ability to experience the number of patient contacts required and the definition of what constitutes a 'patient contact'. With regard to the governance and administration of CPC, it was suggested that in order to enhance the process, the Regulator should provide: an outline of the CPC audit process; examples of cases studies and reflective practice; templates for portfolios; and should establish a central hub for CPC information. CONCLUSION These groups of Irish EMTs appeared keen to participate in continuous professional competence activities. In addition, these EMTs identified areas that, in their opinion, required clarification by the Regulator related to the practicalities of CPC and the governance and administration of CPC. More information, dissemination of sample requirements and further effective engagement with the Regulator could be used to refine the current CPC requirements for EMTs.
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Affiliation(s)
- Shane Knox
- Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
- Health Services Executive, National Ambulance Service College, Dublin, Ireland.
| | - Suzanne Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Walter Cullen
- Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Colum P Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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Hastings RH, Rickard TC. Deliberate Practice for Achieving and Maintaining Expertise in Anesthesiology. Anesth Analg 2015; 120:449-59. [DOI: 10.1213/ane.0000000000000526] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kjaer NK, Steenstrup AP, Pedersen LB, Halling A. Continuous professional development for GPs: experience from Denmark. Postgrad Med J 2014; 90:383-7. [PMID: 24864203 DOI: 10.1136/postgradmedj-2012-131679] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Continuous professional development (CPD) for Danish general practitioners (GPs) is voluntary and based on funded accredited activities. There is an ongoing discussion on how to improve this current system by introducing mandatory elements. To inform this debate, we set out to identify GPs' current use of CPD and to explore the motives behind their choices. METHODS A mixed-methods study with a combined qualitative and quantitative approach was used. In 2012, two focus group interviews were conducted, followed up the same year by an online questionnaire sent to 1079 randomly chosen Danish GPs. RESULTS Focus groups: CPD activities are chosen based on personal needs analysis, and in order to be professionally updated, to meet engaged colleagues and to prevent burnout. GPs also attend CPD to assess their own pre-existing level of competence. CPD activities need to be experienced as being both meaningful and relevant in order to have an impact. Questionnaire: The response rate was 686/1079 (63%). GPs spend on average 10.5 days per year on accredited, voluntary CPD activities. Workplace-related CPD activities and practice-based small group learning played a significant role. The main motivation for choice of CPD activities included academic interest, experience of patient-related problems in their own surgeries and medical topics where the GPs felt insufficiently confident. CONCLUSIONS Danish GPs are frequent users of voluntary accredited CPD. Their CPD choices are motivated by topics strengthening their professional capacity and preventing burnout. There would seem to be no need for a mandatory system.
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Affiliation(s)
- N K Kjaer
- Department of Postgraduate Medical Education, Region of Southern Denmark, Sonderborg, Denmark Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Sonderborg, Denmark
| | - A P Steenstrup
- The project; Systematic Continuous Professional Development for GPs in Denmark, A joint project from the Organisation of General Practitioners and Danish Regions, Copenhagen, Denmark
| | - L B Pedersen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Sonderborg, Denmark Centre of Health Economics Research, COHERE, University of Southern, Odense, Denmark
| | - A Halling
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Sonderborg, Denmark
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Nisbet G, Lincoln M, Dunn S. Informal interprofessional learning: an untapped opportunity for learning and change within the workplace. J Interprof Care 2013; 27:469-75. [DOI: 10.3109/13561820.2013.805735] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Barnes E, Bullock AD, Bailey SER, Cowpe JG, Karaharju-Suvanto T. A review of continuing professional development for dentists in Europe(*). EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2013; 17 Suppl 1:5-17. [PMID: 23581734 DOI: 10.1111/eje.12045] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM To summarise findings from a literature review of dentists' engagement in continuing professional development (CPD) and its effects on improving oral health care for patients. METHOD The search strategy used key terms in a range of databases and an academic literature search engine, complemented by hand searching and citation follow-up. RESULTS One hundred and fourteen papers were reviewed. The majority of dentists engaged in CPD. Factors affecting participation included time since graduation, costs, work and home commitments, postgraduate qualification, interest and convenience. Learning needs identification and reflection on practice were rarely evidenced. Common modes of CPD were courses and journal reading; no one delivery method proved more effective. Few papers directly explored recommendations for topics although suggestions related to common areas of error and gaps in knowledge or skill. Studies of CPD effectiveness and impact-on-practice suggested that courses can result in widespread new learning and considerable self-reported change in practice. However, significant barriers to implementing change in workplace practice were noted and included availability of materials, resources and support from colleagues. CONCLUSION To ensure high standards of care, alongside recommending core or mandatory topics, more attention should be given to reflection on learning needs, the learner's readiness to engage with education and training and the influence of the workplace environment.
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Affiliation(s)
- E Barnes
- School of Postgraduate Medical and Dental Education, University Dental Hospital and School, Cardiff University, Heath Park, Cardiff, UK
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Norcini JJ, Lipner RS, Grosso LJ. Assessment in the context of licensure and certification. TEACHING AND LEARNING IN MEDICINE 2013; 25 Suppl 1:S62-S67. [PMID: 24246109 DOI: 10.1080/10401334.2013.842909] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Over the past 25 years, three major forces have had a significant influence on licensure and certification: the shift in focus from educational process to educational outcomes, the increasing recognition of the need for learning and assessment throughout a physician's career, and the changes in technology and psychometrics that have opened new vistas for assessment. These forces have led to significant changes in assessment for licensure and certification. To respond to these forces, licensure and certification programs have improved the ways in which their examinations are constructed, scored, and delivered. In particular, we note the introduction of adaptive testing; automated item creation, scoring, and test assembly; assessment engineering; and data forensics. Licensure and certification programs have also expanded their repertoire of assessments with the rapid development and adoption of simulation and workplace-based assessment. Finally, they have invested in research intended to validate their programs in four ways: (a) the acceptability of the program to stakeholders, (b) the extent to which stakeholders are encouraged to learn and improve, (c) the extent to which there is a relationship between performance in the programs and external measures, and (d) the extent to which there is a relationship between performance as measured by the assessment and performance in practice. Over the past 25 years, changes in licensure and certification have been driven by the educational outcomes movement, the need for lifelong learning, and advances in technology and psychometrics. Over the next 25 years, we expect these forces to continue to exert pressure for change which will lead to additional improvement and expansion in examination processes, methods of assessment, and validation research.
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Affiliation(s)
- John J Norcini
- a Foundation for Advancement of International Medical Education and Research , Philadelphia , Pennsylvania , USA
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Miceli A, Sebuyira LM, Crozier I, Cooke M, Naikoba S, Omwangangye AP, Rayko-Farrar L, Ronald A, Tumwebaze M, Willis KS, Weaver MR. Advances in clinical education: a model for infectious disease training for mid-level practitioners in Uganda. Int J Infect Dis 2012; 16:e708-13. [PMID: 22906682 DOI: 10.1016/j.ijid.2012.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 05/23/2012] [Accepted: 07/02/2012] [Indexed: 11/30/2022] Open
Abstract
Advances in health professional education have been slow to materialize in many developing countries over the past half-century, contributing to a widening gap in quality of care compared to developed countries. Recent calls for reform in global health professional education have stressed, among other priorities, the need for approaches that strengthen clinical reasoning skills. While the development of these skills is critical to enhance health systems, little research has been carried out on the effectiveness of applying these strategies in the context of severe human resource shortages and complex disease presentations. Integrated Infectious Disease Capacity Building Evaluation (IDCAP) based at the Infectious Diseases Institute at Makerere University created a training program using current best practices in clinical education to support the development of complex reasoning skills among clinicians in rural Uganda. Over a period of 9 months, the program integrated classroom and clinic-based training approaches and measured indicators of success with particular reference to common infectious diseases. This article describes in detail the IDCAP approach to integrating advances in health professional education theory in the context of an overburdened, inadequately resourced primary health care system; results from the evaluation are expected in 2012.
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Affiliation(s)
- Antonina Miceli
- University of Washington, I-TECH, Department of Global Health, University of Washington, Seattle, USA.
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Barnes E, Bullock AD, Bailey SER, Cowpe JG, Karaharju-Suvanto T. A review of continuing professional development for dentists in Europe. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2012; 16:166-178. [PMID: 22783843 DOI: 10.1111/j.1600-0579.2012.00737.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To summarise findings from a literature review of dentists' engagement in continuing professional development (CPD) and its effects on improving oral health care for patients. METHOD The search strategy used key terms in a range of databases and an academic literature search engine, complemented by hand searching and citation follow-up. RESULTS One hundred and fourteen papers were reviewed. The majority of dentists engaged in CPD. Factors affecting participation included time since graduation, costs, work and home commitments, postgraduate qualification, interest and convenience. Learning needs identification and reflection on practice were rarely evidenced. Common modes of CPD were courses and journal reading; no one delivery method proved more effective. Few papers directly explored recommendations for topics although suggestions related to common areas of error and gaps in knowledge or skill. Studies of CPD effectiveness and impact-on-practice suggested that courses can result in widespread new learning and considerable self-reported change in practice. However, significant barriers to implementing change in workplace practice were noted and included availability of materials, resources and support from colleagues. CONCLUSION To ensure high standards of care, alongside recommending core or mandatory topics, more attention should be given to reflection on learning needs, the learner's readiness to engage with education and training and the influence of the workplace environment.
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Affiliation(s)
- E Barnes
- School of Postgraduate Medical and Dental Education, Cardiff University, University Dental Hospital and School, Heath Park, Cardiff, UK
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Brydges R, Butler D. A reflective analysis of medical education research on self-regulation in learning and practice. MEDICAL EDUCATION 2012; 46:71-9. [PMID: 22150198 DOI: 10.1111/j.1365-2923.2011.04100.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES In the health professions we expect practitioners and trainees to engage in self-regulation of their learning and practice. For example, doctors are responsible for diagnosing their own learning needs and pursuing professional development opportunities; medical residents are expected to identify what they do not know when caring for patients and to seek help from supervisors when they need it, and medical school curricula are increasingly called upon to support self-regulation as a central learning outcome. Given the importance of self-regulation in both health professions education and ongoing professional practice, our aim was to generate a snapshot of the state of the science in medical education research in this area. METHODS To achieve this goal, we gathered literature focused on self-regulation or self-directed learning undertaken from multiple perspectives. Then, with support from a multi-component theoretical framework, we created an overarching map of the themes addressed thus far and emerging findings. We built from that integrative overview to consider contributions, connections and gaps in research on self-regulation to date. RESULTS AND CONCLUSIONS Based on this reflective analysis, we conclude that the medical education community's understanding about self-regulation will continue to advance as we: (i) consider how learning is undertaken within the complex social contexts of clinical training and practice; (ii) think of self-regulation within an integrative perspective that allows us to combine disparate strands of research and to consider self-regulation across the training continuum in medicine, from learning to practice; (iii) attend to the grain size of analysis both thoughtfully and intentionally, and (iv) most essentially, extend our efforts to understand the need for and best practices in support of self-regulation.
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Affiliation(s)
- Ryan Brydges
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Byrne A. Measurement of mental workload in clinical medicine: a review study. Anesth Pain Med 2011; 1:90-4. [PMID: 25729663 PMCID: PMC4335734 DOI: 10.5812/kowsar.22287523.2045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 08/10/2011] [Accepted: 08/15/2011] [Indexed: 11/16/2022] Open
Abstract
Background: Measures of mental workload are now commonly used in industries to identify sources of error and to improve performance. Objectives: This study aimed to review the evidence for the use of this technique within medicine. Patients and Methods: We used search engines and the internet to identify experimental studies that included a measure of mental workload in medical practitioners or trainees/students. Studies that aimed to measure mental “stress” as a disorder, or “productivity” were excluded. Each abstract and then the full paper were appraised prior to inclusion. Results: Thirty-three studies were identified that matched the inclusion criteria. Although these covered a variety of settings, common methods were identifiable. The results support the concept of mental workload measurement as an important factor in medical performance. Conclusions: The limited number of studies and the variety of definitions and measurement techniques used in these studies, make direct comparisons difficult. However, the utility of this methodology in medical education appears to have been established, and guidelines for further research methods are proposed.
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Affiliation(s)
- Aidan Byrne
- Clinical Skills and Simulation, School of Medicine, Cardiff University, Cardiff, UK
- Corresponding author: Aidan Byrne, Department of Medical Education, Cardiff University, Heath Park, P O. Box: CF14 4XN, Cardiff, UK. Tel: +44-1792602618, E-mail:
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Abstract
CONTEXT The study of expertise in medical education has a long history of success. Researchers have identified and elaborated on many dimensions of expert performance. In part, this success has derived from researchers' ability to effectively isolate the dimensions and explore each separately. Although this deconstruction of the expert has been successful, the need to recombine the dimensions of expertise as part of an integrated construct of expert practice has recently become an increasingly evident imperative in health professions education. METHODS The aims of this paper are first to explore dimensions of expert practice as they are expressed in the expertise literature; secondly, to describe more recent programmes of research that have tried to elaborate on how experts integrate these various dimensions during daily practice, and, finally, to examine the potential implications of research exploring how experts integrate their own knowledge and skills with the affordances of the environment in which they work. RESULTS AND CONCLUSIONS There are both challenges and opportunities in elaborating an integrated discourse on expertise. Exploring directions for research related to this integrated construction of the practising expert may add an important dimension to our educational repertoire.
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Affiliation(s)
- Maria Mylopoulos
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Eva KW, Regehr G. Exploring the divergence between self-assessment and self-monitoring. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2011; 16:311-29. [PMID: 21113820 PMCID: PMC3139875 DOI: 10.1007/s10459-010-9263-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 11/09/2010] [Indexed: 05/11/2023]
Abstract
Many models of professional self-regulation call upon individual practitioners to take responsibility both for identifying the limits of their own skills and for redressing their identified limits through continuing professional development activities. Despite these expectations, a considerable literature in the domain of self-assessment has questioned the ability of the self-regulating professional to enact this process effectively. In response, authors have recently suggested that the construction of self-assessment as represented in the self-regulation literature is, itself, problematic. In this paper we report a pair of studies that examine the relationship between self-assessment (a global judgment of one's ability in a particular domain) and self-monitoring (a moment-by-moment awareness of the likelihood that one maintains the skill/knowledge to act in a particular situation). These studies reveal that, despite poor correlations between performance and self-assessments (consistent with what is typically seen in the self-assessment literature), participant performance was strongly related to several measures of self-monitoring including: the decision to answer or defer responding to a question, the amount of time required to make that decision to answer or defer, and the confidence expressed in an answer when provided. This apparent divergence between poor overall self-assessment and effective self-monitoring is considered in terms of how the findings might inform our understanding of the cognitive mechanisms yielding both self-monitoring judgments and self-assessments and how that understanding might be used to better direct education and learning efforts.
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Affiliation(s)
- Kevin W Eva
- University of British Columbia, Vancouver, BC, Canada.
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38
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Byrne A, Oliver M, Bodger O, Barnett W, Williams D, Jones H, Murphy A. Novel method of measuring the mental workload of anaesthetists during clinical practice. Br J Anaesth 2010; 105:767-71. [DOI: 10.1093/bja/aeq240] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Moulton CA, Regehr G, Lingard L, Merritt C, MacRae H. Slowing down to stay out of trouble in the operating room: remaining attentive in automaticity. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:1571-7. [PMID: 20881677 DOI: 10.1097/acm.0b013e3181f073dd] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Automaticity is integral to expert performance, but experts must be able to transition from an automatic mode into a more effortful state when required. In this study, the authors identified and characterized the manifestations of the phenomenon of "slowing down when you should" to stay out of trouble in operative practice. METHOD The authors interviewed 28 surgeons (60-minute, semistructured format) from various specialties at four academic medical centers and observed 5 hepatopancreatobiliary surgeons in the operating room (29 cases, 147 hours) during 2007-2009. Using a grounded theory qualitative methodology, they conducted a thematic analysis of transcripts and field notes in an iterative manner. Data collection continued until saturation. They adopted a reflexive approach throughout. RESULTS Surgeons described and the authors observed four phenomenological manifestations of the transition to a more effortful state. In the most extreme manifestation, "stopping," surgeons actually stopped the procedure, whereas in the most subtle manifestation, "fine-tuning," surgeons were able to continue the procedure and focus on minor events simultaneously. A separate phenomenon of "drifting" represented surgeons' failure to transition out of the automatic mode when appropriate, resulting in surgical errors or near misses. CONCLUSIONS The manifestations of the slowing down phenomenon represent acts of cognitive refocusing during the potentially more-critical moments of operative practice. Further, the authors challenge the conception of automaticity as effortless, arguing that automatic behavior can be attentive (fine-tuning) as well as inattentive (drifting).
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Affiliation(s)
- Carol-anne Moulton
- Department of Surgery, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.
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Firmstone VR, Bullock AD, Jackson D, Manning R, Davies-Slowik J, Frame JW. Using Evaluation to Enhance Educational Support for Dental Teams in the UK. J Dent Educ 2010. [DOI: 10.1002/j.0022-0337.2010.74.8.tb04946.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Vickie R. Firmstone
- Centre for Research in Medical and Dental Education; School of Education; University of Birmingham
| | - Alison D. Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education; Cardiff University School of Social Sciences
| | | | | | | | - John W. Frame
- Centre for Research in Medical and Dental Education; School of Education; University of Birmingham
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Dauphinee WD, Tamblyn R, Cruess SR, Cruess RL. Commentary: one strategy for building public trust in changing times. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:941-944. [PMID: 20505389 DOI: 10.1097/acm.0b013e3181dbfb41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Major health care reforms are being debated in the United States. While these debates address issues of access and cost, the systems-based problems of patient safety, continuous quality improvement, and an integrated approach to continuing professional development (CPD) remain traditional opportunities for the profession to directly improve health care and maintain professional accountability. Such challenges can be addressed independently of proposed reforms and offer an opportunity for the profession to build greater public trust. Given recent evidence questioning many assumptions behind individually focused CPD, and as physicians' work shifts into group and team contexts, it is an opportune time to address better CPD strategies within emerging group and team settings.The first strategic change requires a focus on managing the development of the individual physician's educational growth into a systems-oriented approach based on better information and feedback within groups of practitioners and health care teams. Second, the renewal of the linked visions of professional collegiality and accountability with professional regulation needs to be seen as a collective responsibility across key organizations within the profession's normal accountability framework. Thus, the professional colleges, certifying boards, and regulatory authorities need to collaborate with the CDP community in refocusing their collective activities to promote the profession's traditional role of improving the quality of care and maintaining the public's trust in these times of intense policy debate.
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Dekker H, Driessen E, Ter Braak E, Scheele F, Slaets J, Van Der Molen T, Cohen-Schotanus J. Mentoring portfolio use in undergraduate and postgraduate medical education. MEDICAL TEACHER 2009; 31:903-909. [PMID: 19877862 DOI: 10.3109/01421590903173697] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM Mentoring is widely acknowledged as being crucial for portfolio learning. The aim of this study is to examine how mentoring portfolio use has been implemented in undergraduate and postgraduate settings. METHOD The results of interviews with six key persons involved in setting up portfolio use in medical education programmes were used to develop a questionnaire, which was administered to 30 coordinators of undergraduate and postgraduate portfolio programmes in the Netherlands and Flanders. RESULTS The interviews yielded four main aspects of the portfolio mentoring process--educational aims, individual meetings, small group sessions and mentor characteristics. Based on the questionnaire data, 16 undergraduate and 14 postgraduate programmes were described. Providing feedback and stimulating reflection were the main objectives of the mentoring process. Individual meetings were the favourite method for mentoring (26 programmes). Small group sessions to support the use of portfolios were held in 16 programmes, mostly in the undergraduate setting. In general, portfolio mentors were clinically qualified academic staff trained for their mentoring tasks. CONCLUSION This study provides a variety of practical insights into implementing mentoring processes in portfolio programmes.
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Affiliation(s)
- Hanke Dekker
- Center for Research and Innovation in Medical Education, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
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Billings-Gagliardi S, Mazor KM. Effects of review on medical students' recall of different types of neuroanatomical content. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:S34-S37. [PMID: 19907381 DOI: 10.1097/acm.0b013e3181b36ec6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Review of previously learned content is central to formal medical education and continuing lifelong learning; however, little is known about the review process itself. This study examined ways in which structured review impacted students' recall and use of different types of neuroanatomical information, categorized as general constructs, fundamental content, and advanced content. METHOD Seven months after completing first-year neuroscience, medical students were given equivalent short-answer tests requiring description of pathways and localization of lesions both before and after a review of clinically related neuroanatomy. Scores that reflected the three different types of information were compared. RESULTS Prereview, students recalled General Constructs of neuroanatomy, with little additional Fundamental or Advanced Content. Postreview, Fundamental Content and Advanced Content scores both increased significantly. CONCLUSIONS Reviews appear to enhance recall of related content, not only isolated facts. The review process may thus have unrealized potential as an educational strategy in medical training.
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Affiliation(s)
- Susan Billings-Gagliardi
- University of Massachusetts Medical School, Department of Cell Biology S7-147, 55 Lake Avenue North, Worcester, MA 01655, USA.
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Mylopoulos M, Regehr G. How student models of expertise and innovation impact the development of adaptive expertise in medicine. MEDICAL EDUCATION 2009; 43:127-132. [PMID: 19161482 DOI: 10.1111/j.1365-2923.2008.03254.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES The ability to innovate new solutions in response to daily workplace challenges is an important component of adaptive expertise. Exploring how to optimally develop this skill is therefore of paramount importance to education researchers. This is certainly no less true in health care, where optimal patient care is contingent on the continuous efforts of doctors and other health care workers to provide the best care to their patients through the development and incorporation of new knowledge. Medical education programmes must therefore foster the skills and attitudes necessary to engage future doctors in the systematic development of innovative problem solving. The aim of this paper is to describe the perceptions and experiences of medical students in their third and fourth years of training, and to explore their understanding of their development as adaptive experts. METHODS A sample of 25 medical students participated in individual 45-60-minute semi-structured interviews. Interviews were audiotaped, transcribed and entered into NVivo qualitative data analysis software to facilitate a thematic analysis. The analysis was both inductive, in that themes were generated from the data, and deductive, in that our data were meaningful when interpreted in the context of theories of adaptive expertise. RESULTS Participants expressed a general belief that, as learners in the health care system, exerting any effort to be innovative was beyond the scope of their responsibilities. Generally, students suggested that innovative practice was the prerogative of experts and an outcome of expert development centred on the acquisition of knowledge and experience. CONCLUSIONS Students' perceptions of themselves as having no responsibility to be innovative in their learning process have implications for their learning trajectories as adaptive experts.
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Affiliation(s)
- Maria Mylopoulos
- SickKids Learning Institute, Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada.
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Gagliardi AR, Wright FC, Victor JC, Brouwers MC, Silver IL. Self-directed learning needs, patterns, and outcomes among general surgeons. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2009; 29:269-275. [PMID: 19998451 DOI: 10.1002/chp.20046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION To explore the relationship between self-directed learning (SDL) needs, patterns, barriers, and outcomes among nonacademic general surgeons. METHODS Participants dictated details of SDL episodes associated with cancer patient management from October 2007 to March 2008. Transcripts were coded thematically. Frequencies were calculated for elements of each SDL stage. Statistical significance among subgroups was established with the use of the Pearson chi-square test, adjusted for clustering by surgeon. Participants were interviewed by telephone, and transcripts were analyzed by qualitative methods. RESULTS Of 21 consenting surgeons, 15 submitted 115 cases, and 108 were analyzed. Most involved breast (40.7%), colon (18.5%), or rectal cancer (13.0%); 2 or more clinical tasks (41.7%); and 2 or more questions (89.8%). Information was sought from the Internet (48.1%), colleagues (24.2%), or both (6.8%). Information was partially, or not relevant for 21.3% of cases. Evidence was new for 66.7%, and confirmed knowledge for 10.7% of cases. Learning helped surgeons formulate new (34.2%), or confirm original (16.5%) management plans, or determine that referral was appropriate (39.2%). Use of codified sources was associated with information retrieval (P < .05), and identifying new evidence leading to a change in management from that initially proposed (P < or = .001). DISCUSSION Numerous individual and systemic barriers may prevent practicing physicians from undertaking SDL, but provision of structured guidance prompted SDL and resulted in several beneficial outcomes. Further research is needed to validate these findings, and investigate who should support SDL, and how.
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Affiliation(s)
- Anna R Gagliardi
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada.
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