Measuring faculty reflection on adverse patient events: development and initial validation of a case-based learning system

Developing a model to promote caretaker confidence and communication in treatment decisions for dairy cattle through case studies

The significant role of dairy caretakers in maintaining animal welfare on dairy farms emphasizes the necessity of appropriate training and education to ensure the implementation of practices that promote good animal welfare. This study explored the potential of case-based learning as a novel approach to training for dairy caretakers by investigating dairy caretakers' perspectives on case study discussions. Additionally, this study sought to understand thoughts and feelings of caretakers during case study discussions to help identify information that caretakers use to evaluate cases and make decisions. Two case studies were developed and presented to participants, and thematic analysis of case study discussion transcripts was performed. Pre- and post-training questionnaires for 21 caretakers (n = 21) were summarized. The study found that caretaker reactions to case studies were generally positive. Thematic analysis revealed that caretakers use previous knowledge to make treatment decisions for cattle, and valued discussion with coworkers. The results of this study suggest the need for further investigation into the use of case studies and other activities that provide opportunities for critical thinking as training opportunities on dairy farms.

Does Online Interprofessional Case-Based Learning Facilitate Collaborative Knowledge Construction?

Introduction

COVID-19 pandemic has caused an impact on various sectors of life, including the education sector. During the COVID-19 pandemic, education from various levels could only be carried out online by utilizing various on-line media. In Health professional education context, one of the learning activities that must be shifted in online format was interprofessional education (IPE) program. This study aimed to evaluate students' collaborative knowledge construction to evaluate the effectiveness of online interprofessional case-based learning (CBL) activities.

Methods

This interventional study using quantitative and qualitative method involved a total of 476 students; consisted of 204 medical students, 39 midwifery students and 233 nursing students; who took part online interprofessional CBL. All students were divided into 34 mixed profession groups with 14 students each. To evaluate students' collaborative knowledge construction during CBL, data were collected using the Maastricht Peer Activity Rating Scale (MPARS). Qualitative data exploring students' perception regarding online IPE activity and their online CBL process were collected using Focus Group Discussion (FGD). Quantitative data were analysed using statistical tests, and the qualitative data were analysed using thematic analysis.

Results

Students' scores for constructive, collaborative, and motivational activities evaluated using MPARS were considered as average to high. However, nursing students scored the lowest compared to the other two fellow professions: medical and midwifery students, on all items of the MPARS. Medical students had the highest MPARS scores. Several themes could be explored during the FGD.

Discussion

This study revealed that students could engage in collaborative knowledge construction in interprofessional education implementing online interprofessional CBL. However, students thought that offline collaborative practice will better improve team bonding which is considered as prominent aspect for collaboration. This thought gives idea to the implementation of hybrid online offline learning for IPE.

Evaluation of an online case-based learning module that integrates basic and clinical sciences

OBJECTIVE

Case-based online modules can be created to integrate basic science and clinical science knowledge. An integrated module was designed, implemented, and evaluated for student performance and perception.

METHODS

Five faculty members from both basic science and clinical education departments developed an integrative, online, case-based learning module. The case involved a patient with facial asymmetry, and the student was led to a diagnosis of Bell's palsy. Material on Bell's palsy was presented in an integrated module in addition to traditional lecture for a fall cohort of students and was presented only in traditional lecture format to a winter cohort of students. Both cohorts were given the same 5 multiple-choice questions on Bell's palsy as part of a midterm exam, and the scores of these test questions were compared between cohorts. A 13-question, mixed-methods survey was given to the fall cohort to determine their perceptions of the module and their learning.

RESULTS

Multiple-choice test question performance was equivalent between cohorts for the Bell's palsy questions (fall 2018: mean = 3.68, SD = 0.99; winter 2019: mean = 3.51, SD = 0.92). Perception survey responses indicated that students felt positively about the integrated module and that it was applicable and helpful with improving, reinforcing, and integrating basic science and clinical knowledge.

CONCLUSION

This study provides evidence that case-based integrated modules are perceived favorably by students and result in similar exam question performance. They can be a useful tool to help students connect information throughout the chiropractic curriculum.

Teaching Professionalism: Comparing Written and Video Case-Studies

PURPOSE

Professionalism is a difficult concept to teach to healthcare professionals. Case-studies in written and video format have demonstrated to be effective teaching tools to improve a student's knowledge, but little is known about their impact on student behaviour. The purpose of this research study was to investigate and compare the impact of the 2 teaching tools on a student's behaviour during a simulation.

METHOD

A 3-stage mixed method study was conducted with senior Medical Laboratory Science (MLS) undergraduate students. All students were randomly divided into a Written Group or Video Group to attend a mandatory professionalism workshop focused on bullying and gossip. Twenty-six students completed the voluntary assignment and 21 students participated in the voluntary group simulations. Thematic analysis was performed on the assignments and simulation. Frequencies of themes were calculated. A Group Simulation Assessment Rubric was used to score simulations and calculate an adjusted group performance average (AGPA).

RESULTS

The assignment demonstrates that students from both groups obtained a theoretical understanding of how to resolve gossip and bullying. From the Written Group and Video Group, 70%/18% of students discouraged/resolved gossiping and 80%/63% prevented bullying. The mean AGPA for the Written Group and Video Group was 5.4 and 4.9 respectively (t ₍₅₎ = 1.5, P = .2).

DISCUSSION

Students can successfully apply knowledge they have gained in written and video case-studies focused on the professionalism topics of bullying and gossip to a hypothetical situation. However, a discrepancy in their actions was found during the simulations. The data from the study suggests that written and video case-studies do not have different impacts on a student's behaviour.

Students' perception and learning on case based teaching in anatomy and physiology: An e-learning approach

INTRODUCTION

Case based teaching (CBT) has been accepted as an effective interactive learning strategy. Digital portals allow the students to learn the content at their own pace, explore various resources and finally enable them to discuss within group and build team work approach, which is a prime focus in the health care professional field. The aim of this study was to assess the perception and learning outcome of first year medical students towards CBT using e-learning approach.

METHOD

This is a non-randomized, interventional study on first year undergraduate medical students from 2017-18 batch (43) and 2018-19 batch (41) of Sumandeep Vidyapeeth University. They were divided into a group of 8-10 members, who attended six sessions of case-based teaching via Google group. Learning outcome was analyzed by comparing the students who participated in the sessions and those who did not. Feedback survey questionnaire was analyzed by Mann Whitney ranking test and focus group discussion by thematic analysis for qualitative analysis manually.

RESULT

A p value <0.01 was considered statistically significant for post-test by e-learning tool for CBT. Participants agreed that CBT is a good way to conceptualize applied aspect of basic science, enhance critical thinking, and explore varied resources. Thus, they confirmed that team building approach and leadership qualities for managing the group contributed to better understanding of the course and would be useful to them in near future.

CONCLUSION

Usage of Google group technology for CBT allowed medical students to explore clinical application of basic sciences course from the first year of the program, going beyond the classroom, thus developing self-directed learning and team building approach.

Planning, implementation, and evaluation of multicomponent, case-based learning for first-year Indian medical undergraduates

Didactic lecture is an effective method to quickly pass on a high volume of information to a large number of students. However, if not well designed, lectures can be monotonous and provide only passive learning, with little scope for higher order learning skills. To address this drawback of lectures, we supplemented it with case-based learning (CBL), which has been shown to promote self-learning. After giving an overview of gastrointestinal physiology through lectures, CBL on peptic ulcer disease was implemented for first-year Bachelor of Medicine, Bachelor of Surgery students. The present study aimed to evaluate the students' and teachers' opinions on the notion of supplementing lectures with CBL. In previous reports, discussion using clinical cases was primarily employed as the solitary component for conducting CBL. In the present study, three different but mutually exclusive components, such as case discussion, concept map, and critical thinking exercise on a specific topic in gastrointestinal pathophysiology, were integrated to form the multicomponent CBL (MC-CBL). Students reported that MC-CBL could promote application of the knowledge learned in lectures in a more appropriate context (92.42% positive response), enhance their learning efficiency (98.46% positive response), promote their active participation in the learning process (98.48% positive response), and help them in integrating physiological concepts with clinical science (98.46% positive response). Teachers observed that MC-CBL could promote active learning, analytic, and problem-solving skills of students. In conclusion, MC-CBL appeared to be an effective supplement for the lectures, providing an opportunity for the students to relate the knowledge learned during lectures.

Instruments to measure the ability to self-reflect: A systematic review of evidence from workplace and educational settings including health care

INTRODUCTION

Self-reflection has become recognised as a core skill in dental education, although the ability to self-reflect is valued and measured within several professions. This review appraises the evidence for instruments available to measure the self-reflective ability of adults studying or working within any setting, not just health care.

MATERIALS AND METHODS

A systematic review was conducted of 20 electronic databases (including Medline, ERIC, CINAHL and Business Source Complete) from 1975 to 2017, supplemented by citation searches. Data were extracted from each study and the studies graded against quality indicators by at least two independent reviewers, using a coding sheet. Reviewers completed a utility analysis of the assessment instruments described within included studies, appraising their reported reliability, validity, educational impact, acceptability and cost.

RESULTS

A total of 131 studies met the inclusion criteria. Eighteen were judged to provide higher quality evidence for the review and three broad types of instrument were identified, namely: rubrics (or scoring guides), self-reported scales and observed behaviour.

CONCLUSIONS

Three types of instrument were identified to assess the ability to self-reflect. It was not possible to recommend a single most effective instrument due to under reporting of the criteria necessary for a full utility analysis of each. The use of more than one instrument may therefore be appropriate dependent on the acceptability to the faculty, assessor, student and cost. Future research should report on the utility of assessment instruments and provide guidance on what constitutes thresholds of acceptable or unacceptable ability to self-reflect, and how this should be managed.

Relationships Between Reflection and Behavior Change in CME

INTRODUCTION

Reflection exposes performance gaps and is a step in the process of behavior change among adult learners. However, little is known about the relationships between reflection and behavior change in CME. Our objectives were to measure associations between validated reflection scores and behavior change among CME participants and to identify associations between reflection and characteristics of CME presentations.

METHODS

This was a cohort study of attendees at a national hospital medicine CME course. Participants provided reflection scores for each presentation and planned commitment-to-change (CTC) statements at the conclusion of the course. Reflection scores from 1 (strongly disagree) to 5 (strongly agree) were averaged for each presentation. CTC statements were linked to their accompanying presentations. A 3-month postcourse survey was conducted to assess if planned CTCs were successfully implemented.

RESULTS

In all, 223 of 281 participants (79.4%) returned evaluations. Of the 195 planned CTC statements available for postcourse analysis, 128 (65.6%) were implemented. Reflection scores correlated with the number of planned CTC statements across all presentations (Pearson correlation, 0.65; P < .001). In addition, higher reflection scores (mean [SD]) were associated with the presence of audience response opportunities (Yes: 4.13 [0.18] versus No: 3.96 [0.16]; P = .01) and the use of clinical cases (Yes: 4.09 [0.18] versus No: 3.86 [0.12]; P < .01).

DISCUSSION

To our knowledge, this is the first study to show a relationship between participant reflection and CTC in conference-based CME. Presentations that incorporate clinical cases and audience response systems seem to stimulate participant reflection and behavior change.

Use of the pause procedure in continuing medical education: A randomized controlled intervention study

During lectures, a pause procedure (the presenter pauses so students can discuss content) can improve educational outcomes. We aimed to determine whether (1) continuing medical education (CME) presentations with a pause procedure were evaluated more favorably and (2) a pause procedure improved recall. In this randomized controlled intervention study of all participants (N = 214) at the Mayo Clinic Internal Medicine Board Review course, 48 lectures were randomly assigned to an intervention (pause procedure) or control (traditional lecture) group. The pause procedure was a 1-min pause at the middle and end of the presentation. Study outcomes were (1) presentation evaluation instrument scores and (2) number of recalled items per lecture. A total of 214 participants returned 145 surveys (response rate, 68%). Mean presentation evaluation scores were significantly higher for pause procedure than for traditional presentations (70.9% vs 65.8%; 95%CI for the difference, 3.5-6.7; p < .0001). Mean number of rapid recall items was higher for pause procedure presentations (0.68 vs 0.59; 95%CI for the difference, 0.02-0.14; p = .01). In a traditional CME course, presentations with a pause procedure had higher evaluation scores and more content was recalled. The pause procedure could arm CME presenters with an easy technique to improve educational content delivery.

Case-Based Learning and its Application in Medical and Health-Care Fields: A Review of Worldwide Literature

INTRODUCTION

Case-based learning (CBL) is a newer modality of teaching healthcare. In order to evaluate how CBL is currently used, a literature search and review was completed.

METHODS

A literature search was completed using an OVID© database using PubMed as the data source, 1946-8/1/2015. Key words used were "Case-based learning" and "medical education", and 360 articles were retrieved. Of these, 70 articles were selected to review for location, human health care related fields of study, number of students, topics, delivery methods, and student level.

RESULTS

All major continents had studies on CBL. Education levels were 64% undergraduate and 34% graduate. Medicine was the most frequently represented field, with articles on nursing, occupational therapy, allied health, child development and dentistry. Mean number of students per study was 214 (7-3105). The top 3 most common methods of delivery were live presentation in 49%, followed by computer or web-based in 20% followed by mixed modalities in 19%. The top 3 outcome evaluations were: survey of participants, knowledge test, and test plus survey, with practice outcomes less frequent. Selected studies were reviewed in greater detail, highlighting advantages and disadvantages of CBL, comparisons to Problem-based learning, variety of fields in healthcare, variety in student experience, curriculum implementation, and finally impact on patient care.

CONCLUSIONS

CBL is a teaching tool used in a variety of medical fields using human cases to impart relevance and aid in connecting theory to practice. The impact of CBL can reach from simple knowledge gains to changing patient care outcomes.

Can reflection boost competences development in organizations?

Purpose

– The purpose of this paper is to examine the gaps in some existing competence frameworks and investigate the power of reflection on one’s behavior to improve the process of the competences development.

Design/methodology/approach

– The authors used a correlational design and a quasi-experimental non-equivalent group design involving a baseline assessment (pre-test) of participants’ ability to reflect on their actions instead of applying the standardized competences. Participants were placed in a treatment group and control groups. The treatment group was exposed to a coaching intervention in reflection and operant competence development. Six months later, the authors conducted post-test assessment to assess effect size caused by the coaching intervention regarding the treatment group’s ability to reflect and transform standardized competences into operant competences.

Findings

– The results showed that reflection and operant competences correlates significantly. Second, there was a larger effect size between the pre-test and post-test assessment results for the treatment group implying change in reflective practice and acquisition of operant competences.

Practical implications

– The results demonstrated the need to utilize reflection as a component that will add value to the existing competence frameworks.

Originality/value

– The research adds value to the existing competence development frameworks by introducing reflective practice among managers to create competences that are compatible with the operational context.

Reflective Practice: A Tool for Readmission Reduction

Factors intrinsic to local practice, but not captured by the medical record, contribute to readmissions. Frontline providers familiar with their practice systems can identify these. The objective was to decrease 30-day hospital readmissions. The intervention involved retrospective review by hospitalists of their own patients' readmissions, using reflective practice guided by a chart review tool. Subjects were patients discharged by hospitalists and readmitted to a tertiary care academic medical center. Hospitalists reviewed 193 readmissions of 170 patients. Factors contributing to readmission were grouped under patient characteristics, operational factors, and care transition. After reflection, physicians scheduled earlier follow-up appointments while nurse practitioners and physician assistants improved discharge instructions. Readmissions decreased during the review period, and the decrease sustained for one year after the review period. Hospitalists reflected on and identified local practice factors that contributed to their own patients' 30-day readmissions. Reflective practice may be an effective strategy to decrease hospital readmissions.

Measuring reflection on participation in quality improvement activities for maintenance of certification

PURPOSE

To validate a measure of reflection on participation in quality improvement (QI) activities and to identify associations with characteristics of QI projects, participants, and teams.

METHOD

This was a prospective validation study of all Mayo Clinic team participants who submitted QI projects for maintenance of certification (MOC) credit from 2010 to 2012. The authors developed a measure of reflection on participation in QI activities and explored associations between participants' overall reflection scores and characteristics of projects, participants, and teams.

RESULTS

A total of 922 participants (567 physicians) on 118 teams completed QI projects and reflections. Factor analysis revealed a two-dimensional model with good internal consistency reliabilities (Cronbach alpha) for high (0.85) and low (0.81) reflection. Reflection scores (mean [standard deviation]) were associated with projects that changed practice (yes: 4.30 [0.51]; no: 3.71 [0.57]; P < .0001), changed the health care system (yes: 4.25 [0.54]; no: 4.03 [0.62]; P < .0001), and impacted patient safety (P < .0001). Physicians' reflection scores (4.27 [0.57]) were higher than support staff scores (4.07 [0.55]; P = .0005). A positive association existed between reflection scores and the number of QI roles per participant (P < .0001). There were no associations with participant gender, team size, or team diversity.

CONCLUSIONS

The authors identified associations between participant reflection and the impact of QI projects, participants' professional roles, and participants' involvement with projects. With further study, the authors anticipate that the new measure of reflection will be useful for determining meaningful engagement in MOC.

Levels of reflective thinking and patient safety: an investigation of the mechanisms that impact on student learning in a single cohort over a 5 year curriculum

Existing research into learning about patient safety focuses on identifying how educational interventions improve educational outcomes but few studies offer evidence that inform educators about the mechanisms involved in learning about patient safety. The current evidence based in undergraduates is also limited to outcomes that relate to knowledge and skills. A realist approach involving three cycles of data collection in a single cohort of students over 5 years used different outcomes in Kirkpatrick's framework to identify the mechanisms that influence students learning about patient safety. Data source 1. Focus groups identified an overarching theoretical model of the mechanisms that influence patient safety learning for medical students. Data source 2 Identified if the mechanisms from data source 1 could be demonstrated at the outcome level of knowledge and attitudes. Data source 3 Established associations between mechanisms and outcomes at skills and behavioural level, in a standardised simulated ward setting. Data source 1: The interpretation of data from seven focus groups involving sixty students identified reflection at two levels of Mezirow's descriptions; reflection and critical reflection as mechanisms that influence learning about error. Data source 2: Sixty-one students participated. The associations found, reflection and knowledge of actions to take for patient safety, r = 0.44 (P = 0.00) and critical reflection and intentions regarding patient safety, r = 0.40 (P = 0.00) Data source 3: Forty-eight students participated. The correlation identified associations between critical reflection and planned changes following feedback was, r = 0.48 (P = 0.00) and reflection and knowledge based errors r = -0.30 (P = 0.03). A realist approach identified two different levels of reflection were associated with different patient safety outcomes for this cohort of students. Critical reflection was associated with attitudes and reflection was associated with knowledge of actions and error behaviours. These findings give educators greater depth of information about the role of reflection in patient safety.

Validation of a method for measuring medical students' critical reflections on professionalism in gross anatomy

Improving professional attitudes and behaviors requires critical self reflection. Research on reflection is necessary to understand professionalism among medical students. The aims of this prospective validation study at the Mayo Medical School and Cleveland Clinic Lerner College of Medicine were: (1) to develop and validate a new instrument for measuring reflection on professionalism, and (2) determine whether learner variables are associated with reflection on the gross anatomy experience. An instrument for assessing reflections on gross anatomy, which was comprised of 12 items structured on five-point scales, was developed. Factor analysis revealed a three-dimensional model including low reflection (four items), moderate reflection (five items), and high reflection (three items). Item mean scores ranged from 3.05 to 4.50. The overall mean for all 12 items was 3.91 (SD = 0.52). Internal consistency reliability (Cronbach's α) was satisfactory for individual factors and overall (Factor 1 α = 0.78; Factor 2 α = 0.69; Factor 3 α = 0.70; Overall α = 0.75). Simple linear regression analysis indicated that reflection scores were negatively associated with teamwork peer scores (P = 0.018). The authors report the first validated measurement of medical student reflection on professionalism in gross anatomy. Critical reflection is a recognized component of professionalism and may be important for behavior change. This instrument may be used in future research on professionalism among medical students.

Measuring faculty reflection on medical grand rounds at Mayo Clinic: associations with teaching experience, clinical exposure, and presenter effectiveness

OBJECTIVES

To develop and validate a new instrument for measuring participant reflection on continuing medical education (CME) and determine associations between the reflection instrument scores and CME presenter, participant, and presentation characteristics.

PARTICIPANTS AND METHODS

This was a prospective validation study of presenters and faculty at the weekly medical grand rounds at Mayo Clinic in Rochester, Minnesota, from January 1, 2011, through June 30, 2011. Eight items (5-point Likert scales) were developed on the basis of 4 reflection levels: habitual action, understanding, reflection, and critical reflection. Factor analysis was performed to account for clustered data. Interrater and internal consistency reliabilities were calculated. Associations between reflection scores and characteristics of presenters, participants, and presentations were determined.

RESULTS

Participants completed a total of 1134 reflection forms. Factor analysis revealed a 2-dimensional model (eigenvalue; Cronbach α): minimal reflection (1.19; 0.77) and high reflection (2.51; 0.81). Item mean (SD) scores ranged from 2.97 (1.17) to 4.01 (0.83) on a 5-point scale. Interrater reliability (intraclass correlation coefficient) for individual items ranged from 0.58 (95% CI, 0.31-0.78) to 0.88 (95% CI, 0.80-0.94). Reflection scores were associated with presenters' speaking effectiveness (P<.001) and prior CME teaching experience (P=.02), participants' prior clinical experiences (P<.001), and presentations that were case based (P<.001) and used the audience response system (P<.001).

CONCLUSION

We report the first validated measure of reflection on CME at medical grand rounds. Reflection scores were associated with presenters' effectiveness and prior teaching experience, participants' clinical exposures, and presentations that were interactive and clinically relevant. Future research should determine whether reflection on CME leads to better patient outcomes.