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Smith LE, McBride ME, Henschen B, Bierman J, Uchida T, Eppich W. Mechanisms of Near-Peer Learning in a Longitudinal Clerkship: A Grounded Theory Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:771-777. [PMID: 38527027 DOI: 10.1097/acm.0000000000005715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE Many medical schools incorporate longitudinal clerkships, which promote continuity and may offer early clinical exposure during the preclinical curriculum. However, the mechanisms of near-peer learning and how it contributes to the development of clinical skills in longitudinal clinical experiences are less clear. The authors explored how peer-to-peer interactions among medical students influenced their developmental trajectories from nascent clinicians to more seasoned practitioners capable of juggling dual roles of clinical care and clinical supervision within longitudinal clerkships. METHOD The Education-Centered Medical Home (ECMH) at Northwestern University Feinberg School of Medicine is a longitudinal clerkship that represents an ideal setting to explore peer learning. At ECMH, continuity is established across all 4 years of medical school among small groups of students from each year, a preceptor, and a panel of outpatients. The authors conducted 6 focus groups and 9 individual interviews between March 2021 and February 2023 with medical students from all years. Using constructivist grounded theory, the authors collected and analyzed data iteratively using constant comparison to identify themes and explore their relationships. RESULTS Within ECMH, peer relationships fostered an informal learning culture that enabled meaningful peer interactions while reinforcing the established culture. The authors identified 3 essential learning practices between senior and junior medical students: preparing for patient encounters, shifting roles dynamically during the joint encounter, and debriefing encounters afterward. These practices strengthened learning relationships and supported students' developmental trajectories. CONCLUSIONS Longitudinal peer learning relationships enabled meaningful peer interaction that influenced medical students' clinical development and capability for clinical supervision. Mutual trust, familiarity, and continuity facilitate targeted feedback practices and growth at the edge of junior students' capabilities. Optimizing this peer learning environment and seeking new opportunities to use longitudinal peer learning in clinical environments could promote psychological safety and professional identity formation for medical students.
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Matschl J, Gembruch U, Strizek B, Recker F. Shaping the future of obstetric/gynecological ultrasound training. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:717-722. [PMID: 38031232 DOI: 10.1002/uog.27554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Affiliation(s)
- J Matschl
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - B Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - F Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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Umesh M, Singaravelu V, M K, Gaur A, Ganji V, Taranikanti M, John N, Saileshkumar S. Transition From Observational to Collaborative Learning to Augment Practical Skill Training in First-Year Medical Students. Cureus 2023; 15:e41899. [PMID: 37581151 PMCID: PMC10423650 DOI: 10.7759/cureus.41899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
Introduction Students exhibit less interest in hematology demonstration experiments as they are not expected to do it during their examination. Adopting a different strategy, like collaborative learning, might spark interest, motivate them to work together towards a shared objective, and help further learning and understanding. The current study aimed to assess the effectiveness of collaborative learning in comparison with traditional practical demonstration. Methodology First MBBS students were divided into two groups of 50 each (1 - collaborative learning, 2 - traditional demonstration). In the traditional demonstration, the experiment was demonstrated by faculty using the required materials. In the collaborative learning method, 50 students were divided into groups (seven of seven each) and each group was provided with procedural details of the experiment and requisite materials. At the end of the experiment, assessment was done. In collaborative learning groups, the team cohesion scale (TCS) was employed to analyze group dynamics. Students' perceptions, and feedback regarding collaborative learning as a tool in practical experiments were collected using a five-point Likert scale. Results Post-experiment assessment scores in collaborative learning (8.65±1.54) were significantly higher than the traditional demonstration group (7.06±1.46). High scorers in TCS consistently belonged to groups that completed the experiment on time (positive outcome), whereas students with low scores often belonged to groups that did not complete the experiment (negative outcome). Conclusion Collaborative learning may be used for practical teaching in medical education as it fosters good communication, enables problem-solving, aiding the Indian medical graduate in fulfilling the role of a team member.
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Affiliation(s)
- Madhusudhan Umesh
- Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Vidya Singaravelu
- Pediatrics, Malla Reddy Institute of Medical Sciences, Hyderabad, IND
| | - Kalpana M
- Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Archana Gaur
- Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Vidya Ganji
- Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Madhuri Taranikanti
- Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Nitin John
- Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
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Dargue A, Richards C, Fowler E. An exploration of the impact of working in pairs on the dental clinical learning environment: Students' views. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2023; 27:87-100. [PMID: 35100467 PMCID: PMC10078664 DOI: 10.1111/eje.12780] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/29/2021] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The aims of this study were to explore the undergraduate dental clinical students' experiences and perspectives of paired working in the clinical learning environment. MATERIALS AND METHODS An interpretivist methodological approach with a socio-cultural lens was used. A stratified purposeful sampling strategy was chosen. Students digitally recorded three audio-diaries using Gibbs' cycle to guide reflection on collaborating clinically with a peer. 1:1 semi-structured interviews were held using a topic guide. Inductive thematic data analysis was undertaken. RESULTS Eight participants were recruited. Main themes related to individual characteristics (motivation, professionalism, knowledge and experience) and relational features (feeling safe, attaching value, positive working relationships) that contributed to effective collaborative partnerships. The social setting is important for learning in the dental clinical environment. Benchmarking is used by students to motivate and reassure. Students learnt from their peers, particularly when they felt safe and supported and had developed good relationships. A lesser quality learning experience was highlighted in the assistant role. CONCLUSION Paired working for clinical training was viewed mostly positively. Working with a variety of peers was beneficial and enabled development of interpersonal skills and professionalism. More effective collaborative learning partnerships were described when students felt they belonged and had affective support. Disadvantages of paired working were noted as reduced hands-on experience, particularly for senior students and when working in the assistant role. Ground rules and setting learning goals to change the mind-set about the assistant role were recommended. Emotional and practical support of students is needed in the clinical setting.
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Affiliation(s)
- Anna Dargue
- University Hospitals Bristol and Weston NHS Foundation TrustBristol Dental HospitalBristolUK
| | - Charlotte Richards
- University Hospitals Bristol and Weston NHS Foundation TrustBristol Dental HospitalBristolUK
| | - Ellayne Fowler
- Teaching and Learning for Health ProfessionalsUniversity of BristolBristolUK
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Ding J, Xiao X, Biagi S, Varkey T. Dyad learning versus individual learning under medical simulation conditions: a systematic review. MEDEDPUBLISH 2022. [DOI: 10.12688/mep.19285.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Dyad learning is a two-person learning dynamic in which one student observes the other performing tasks, with their roles then being reversed such that both students experience the observer and the performer role. The efficacy of dyad learning has been tested in medical education contexts, such as in medical simulation. To our knowledge, this is the first systematic review that has evaluated the efficacy of dyad learning in a medical simulation context. Methods: PubMed, Google Scholar, Cochrane Library databases were searched in September 2021 and January 2022. Prospective studies of randomized design that compared dyad learning to a single medical student or physician learning in a medical simulation were included. Non-English language studies, secondary literature papers, non-human based studies, and papers that were published prior to 2000 were excluded. The methodological quality of these studies was assessed using the Medical Education Research Study Quality Instrument (MERSQI). The Kirkpatrick model was used to conceptualize study outcomes. Results: The identified papers included eight studies from four countries that totaled 475 participants. Students reported positively on their experiences as dyads, especially regarding the social aspects of it. Studies showed non-inferior learning outcomes for dyads. As most studies were one or two days long, there is limited evidence that this non-inferiority extends to longer term training modules. There is some evidence to suggest that dyad learning outcomes may be replicable in a clinical context following simulation training. Conclusions: Dyad learning in medical simulation is a pleasant experience for students and may be as effective as conventional learning. These findings set the foundation for future studies of longer duration, which is needed to determine the efficacy of dyad learning in lengthier curriculums and long-term knowledge retention. While cost-reduction is an implied benefit, studies that explicate cost reduction are needed to formalize this.
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Archer RM. Expert Veterinarians Should Be Trained Expertly: Fostering the Development of Adaptive Expertise in Veterinary Students through Faculty Development for Veterinary Educators. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022; 50:e20220018. [PMID: 36036570 DOI: 10.3138/jvme-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The field of health professions education is rapidly evolving, and with it the field of veterinary education. This discussion piece amalgamates literature across health professions education to provide a picture of what a veterinary clinician-educator is, why there is a need for veterinary clinician-educators when developing learners with adaptive expertise, and how faculty development can support the growth of clinicians into clinician-educators. It is intended to outline the best practices for fostering the development of adaptive expertise in veterinary students through faculty development for veterinary educators.
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Boggs ZD, Regalado LE, Makary MS. Procedural Fundamentals for Medical Students: Institutional Outcomes of a Novel Multimodal Course. Acad Radiol 2022; 29:1095-1107. [PMID: 34801346 DOI: 10.1016/j.acra.2021.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES There is a gap in current medical student education pertaining to procedural skills' exposure and acquisition. The aim of this study is to evaluate the institutional experience of a novel medical student procedural course and its impact on procedural confidence. MATERIALS AND METHODS This is a single-center prospective study performed at a public medical school and its associated tertiary care medical center between June 2020 and January 2021. This study was deemed exempt by our Institutional Review Board and was performed with participant consent. The multimodal course developed by the radiology department consisted of four didactic lectures, four simulation sessions, and a minimum of 16 clinical rotation hours with the department's vascular access team. Primary outcomes were assessed by comparing participant pre and post course surveys including twenty-five 5-point Likert scaled questions. RESULTS Twenty-five self-selected students completed the course in its entirety. The curriculum and the corresponding survey analysis were stratified into sections by procedure modality. An increase in participant confidence to a moderate or greater level was observed when comparing pre and post course survey data for each procedure: vascular access (4% vs 52%, p < 0.01), thoracentesis (8% vs 48%, p < 0.01), paracentesis (8% vs 72%, p < 0.01), lumbar puncture (4% vs 44%, p < 0.01), and bone marrow biopsy (0% vs 48%, p < 0.01). CONCLUSIONS The creation of a medical-student-centric procedural course is feasible and fills a potential gap in undergraduate medical education. This study demonstrated that a comprehensive multimodal course, designed to include didactic, simulation and clinical experiences, increases participant exposure to, participation with, and confidence in bedside procedural performance abilities.
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Affiliation(s)
- Zak D Boggs
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, 4th floor, Columbus, Ohio, 43210
| | - Luis E Regalado
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, 4th floor, Columbus, Ohio, 43210
| | - Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, 4th floor, Columbus, Ohio, 43210.
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Noerholk LM, Morcke AM, Kulasegaram K, Nørgaard LN, Harmsen L, Andreasen LA, Pedersen NG, Johnsson V, Vamadevan A, Tolsgaard MG. Does group size matter during collaborative skills learning? A randomised study. MEDICAL EDUCATION 2022; 56:680-689. [PMID: 35262226 PMCID: PMC9313549 DOI: 10.1111/medu.14791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/21/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Collaborative skills learning in the form of dyad learning compared with individual learning has been shown to lead to non-inferior skills retention and transfer. However, we have limited knowledge on which learning activities improve collaborative skills training and how the number of collaborators may impact skills transfer. We explored the effects of skills training individually, in dyads, triads or tetrads on learning activities during training and on subsequent skills transfer. METHODS In a randomised, controlled study, participants completed a pre-post-transfer-test set-up in groups of one to four. Participants completed 2 hours of obstetric ultrasound training. In the dyad, triad and tetrad group participants took turns actively handling the ultrasound probe. All performances were rated by two blinded experts using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale and a Global Rating Scale (GRS). All training was video recorded, and learning activities were analysed using the Interactive-Constructive-Active-Passive (ICAP) framework. RESULTS One hundred one participants completed the simulation-based training, and ninety-seven completed the transfer test. Performance scores improved significantly from pre- to post-test for all groups (p < 0.001, ηp2 = 0.55). However, group size did not affect transfer test performance on OSAUS scores (p = 0.13, ηp2 = 0.06) or GRS scores (p = 0.23, ηp2 = 0.05). ICAP analyses of training activities showed that time spent on non-learning and passive learning activities increased with group size (p < 0.001, ηp2 = 0.31), whereas time spent on constructive and interactive learning activities was constant between groups compared with singles (p < 0.001, ηp2 = 0.72). CONCLUSION Collaborative skills learning in groups of up to four did not impair skills transfer despite less hands-on time. This may be explained by a compensatory shift towards constructive and interactive learning activities that outweigh the effect of shorter hands-on time.
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Affiliation(s)
- Laerke Marijke Noerholk
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | | | | | - Lone N. Nørgaard
- Center of Fetal Medicine, Department of ObstetricsCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Lotte Harmsen
- Center of Fetal Medicine, Department of ObstetricsCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Lisbeth Anita Andreasen
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
- Department of Gynecology and ObstetricsCopenhagen University Hospital ‐ HvidovreCopenhagenDenmark
| | - Nina Gros Pedersen
- Fetal Medicine Unit, Department of Obstetrics and GynaecologyCopenhagen University Hospital ‐ HerlevCopenhagenDenmark
| | - Vilma Johnsson
- Center of Fetal Medicine, Department of ObstetricsCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Martin Grønnebæk Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
- Center of Fetal Medicine, Department of ObstetricsCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Chan E, Botelho MG, Wong GTC. A flipped classroom, same-level peer-assisted learning approach to clinical skill teaching for medical students. PLoS One 2021; 16:e0258926. [PMID: 34679098 PMCID: PMC8535182 DOI: 10.1371/journal.pone.0258926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background Clinical procedural skills are vital components of medical education. Increased student intake and limited capacity of medical schools necessitate more efficient ways to deliver clinical skill teaching. This study employed a flipped classroom, peer-assisted learning approach to deliver clinical skill teaching. It aimed to determine the influence of pre-class demonstration video watching and in-class student-student interactions on clinical skill acquisition. Methods In 2017, a cohort of 205 medical students in their penultimate year of undergraduate medical study were recruited, and they learned bag mask ventilation and intravenous cannulation during this study. The participants watched a demonstration video before class, and then underwent self-directed practice as triads. Afterwards, each participant video-recorded their skill performance and completed post-class questionnaires. The videos were evaluated by two blinded assessors. Results A hundred and thirty-one participants (63.9%) completed the questionnaire. For bag mask ventilation, participants who claimed to have watched the corresponding demonstration video before class achieved higher performance scores (those who watched before class: 7.8 ± 1.0; those who did not: 6.3 ± 1.7; p < 0.01). For intravenous cannulation, while there is no significant difference in performance scores (those who watched before class: 14.3 ± 1.3; those who did not: 14.1 ± 1.4; p = 0.295), those who watched the video before class received less interventions from their peers during triad practice (those who watched before class: 2.9 ± 1.8; those who did not: 4.3 ± 2.9; p < 0.05). The questionnaire results showed that most participants preferred the new approach of clinical skill teaching and perceived it to be useful for skill acquisition. Conclusion The flipped classroom, same-level peer-assisted learning model is potentially an effective way to address the current challenges and improve the efficiency of clinical procedural skill teaching in medical schools.
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Affiliation(s)
- Enoch Chan
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Michael George Botelho
- Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Gordon Tin Chun Wong
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Anaesthesiology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- * E-mail:
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Abbott EF, Laack TA, Licatino LK, Wood-Wentz CM, Warner PA, Torsher LC, Newman JS, Rieck KM. Comparison of dyad versus individual simulation-based training on stress, anxiety, cognitive load, and performance: a randomized controlled trial. BMC MEDICAL EDUCATION 2021; 21:367. [PMID: 34225722 PMCID: PMC8256490 DOI: 10.1186/s12909-021-02786-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 06/03/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND Dyad learning has been shown to be an effective tool for teaching procedural skills, but little is known about how dyad learning may impact the stress, anxiety, and cognitive load that a student experiences when learning in this manner. In this pilot study, we investigate the relationship between dyad training on stress, anxiety, cognitive load, and performance in a simulated bradycardia scenario. METHODS Forty-one fourth-year medical school trainees were randomized as dyads (n = 24) or individuals (n = 17) for an education session on day 1. Reassessment occurred on day 4 and was completed as individuals for all trainees. Primary outcomes were cognitive load (Paas scale), stress (Cognitive Appraisal Ratio), and anxiety levels (abbreviated State-Trait Anxiety Inventory). Secondary outcomes were time-based performance metrics. RESULTS On day 1 we observed significant differences for change in anxiety and stress measured before and after the training scenario between groups. Individuals compared to dyads had larger mean increases in anxiety, (19.6 versus 7.6 on 80-point scale, p = 0.02) and stress ratio (1.8 versus 0.9, p = 0.045). On the day 4 post-intervention assessment, no significant differences were observed between groups. Secondary outcomes were significant for shorter time to diagnosis of bradycardia (p = 0.01) and time to initiation of pacing (p = 0.04) in the dyad group on day 1. On day 4, only time to recognizing the indication for pacing was significantly shorter for individual training (hazard ratio [HR] = 2.26, p = 0.02). CONCLUSIONS Dyad training results in lower stress and anxiety levels with similar performance compared to individual training.
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Affiliation(s)
- Eduardo F. Abbott
- Multidisciplinary Simulation Center, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
- Department of Internal Medicine, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, 5th Floor, 8330077 Santiago, Chile
| | - Torrey A. Laack
- Multidisciplinary Simulation Center, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN USA
| | - Lauren K. Licatino
- Department of Anesthesia and Perioperative Medicine, 200 First Street SW, Rochester, MN 55905 USA
| | - Christina M. Wood-Wentz
- Division of Clinical Trials and Biostatistics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Paul A. Warner
- Department of Anesthesia and Perioperative Medicine, 200 First Street SW, Rochester, MN 55905 USA
| | - Laurence C. Torsher
- Department of Anesthesia and Perioperative Medicine, 200 First Street SW, Rochester, MN 55905 USA
| | - James S. Newman
- Division of Hospital Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Katie M. Rieck
- Division of Hospital Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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Noerholk LM, Morcke AM, Bader Larsen KS, Tolsgaard MG. Is two a crowd? A qualitative analysis of dyad learning in an OBGYN clinical clerkship. MEDICAL EDUCATION 2021; 55:724-732. [PMID: 33368489 DOI: 10.1111/medu.14444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Dyad learning occurs when two students work together to acquire new skills and knowledge. Several studies have provided evidence to support the educational rationale for dyad learning in the controlled simulated setting. However, the role of dyad learning in the clinical setting remains uncertain. Unlike the simulated setting, learning in the clinical setting depends on a complex interplay between medical students, doctors, nurses and patients potentially making dyad learning less valuable in clerkships. The objective of this study was to explore how key stakeholders perceive the value of implementing dyad learning during medical students' clinical clerkships. METHODS In a constructivist qualitative study, we conducted 51 semi-structured interviews with 36 key stakeholders involved in dyad learning, including 10 medical students, 12 doctors, five nurses and nine patients. Data were coded inductively using thematic analysis, then coded deductively using stakeholder theory as a theoretical framework. RESULTS We found that stakeholders generally perceived the educational impact of dyad learning in the clinical setting similarly but disagreed on its value. Students emphasised that dyad learning made them participate more actively during patient encounters and patients did not mind having two students present. Doctors and nurses considered dyad learning disruptive to the balance between service and training and reported that it did not resonate with their perception of good patient care. CONCLUSION Dyad learning enables students to be more active during their clinical clerkships, but it easily disrupts the balance between service and training. This disruption may be exacerbated by the shifted balance in priorities and values between different stakeholder groups, as well as by making implicit teaching obligations more explicit for supervising doctors and nurses. Consequently, implementing dyad learning may not be perceived as valuable by doctors and nurses in the clinical setting, regardless of its pedagogical rationale.
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Affiliation(s)
- Laerke Marijke Noerholk
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Anne Mette Morcke
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Karlen S Bader Larsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Martin G Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for Fetal Medicine, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
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Berg H, Steinsbekk A. The effect of self-practicing systematic clinical observations in a multiplayer, immersive, interactive virtual reality application versus physical equipment: a randomized controlled trial. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:667-682. [PMID: 33511505 PMCID: PMC8041677 DOI: 10.1007/s10459-020-10019-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 12/13/2020] [Indexed: 06/01/2023]
Abstract
This study aimed to investigate whether group self-practice of systematic clinical observation using the airway, breathing, circulation, disability and exposure (ABCDE) approach in a multiplayer, immersive, interactive virtual reality (VR) application provided a non-inferior learning outcome compared to practicing with physical equipment in first-year medical and nursing students. The study was a non-inferior, parallel-group randomized controlled trial. After a 15-min introduction session on the ABCDE approach, all students were randomly allocated to practice ABCDE in groups of three for 20 min either in a fully immersive, interactive, multiplayer virtual reality application (the VR group) or with physical equipment (the TP group). The primary outcome was the number of students who documented all predefined observations in the correct order of the ABCDE approach on a practical test performed immediately after group practice. A total of 84% of all eligible students participated, with 146 students in the VR group and 143 in the TP group. On the primary outcome, 20% in the VR group and 21% in the TP group got everything correct (absolute difference 1% point, one-sided 95% confidence interval 1.0-8.8% points), showing non-inferiority of the virtual reality application. For other outcomes, the results were mostly similar between the groups. Group self-practice of the ABCDE approach in multiplayer, immersive, interactive virtual reality application was non-inferior to practice with physical equipment.
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Affiliation(s)
- Helen Berg
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491, Trondheim, Norway
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Gilligan C, Powell M, Lynagh MC, Ward BM, Lonsdale C, Harvey P, James EL, Rich D, Dewi SP, Nepal S, Croft HA, Silverman J. Interventions for improving medical students' interpersonal communication in medical consultations. Cochrane Database Syst Rev 2021; 2:CD012418. [PMID: 33559127 PMCID: PMC8094582 DOI: 10.1002/14651858.cd012418.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be trained to communicate effectively has seen the emergence of interpersonal communication skills as core graduate competencies in medical training around the world. Medical schools have adopted a range of approaches to develop and evaluate these competencies. OBJECTIVES To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations. SEARCH METHODS We searched five electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and ERIC (Educational Resource Information Centre) in September 2020, with no language, date, or publication status restrictions. We also screened reference lists of relevant articles and contacted authors of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-RCTs (C-RCTs), and non-randomised controlled trials (quasi-RCTs) evaluating the effectiveness of interventions delivered to students in undergraduate or graduate-entry medical programmes. We included studies of interventions aiming to improve medical students' interpersonal communication during medical consultations. Included interventions targeted communication skills associated with empathy, relationship building, gathering information, and explanation and planning, as well as specific communication tasks such as listening, appropriate structure, and question style. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed all search results, extracted data, assessed the risk of bias of included studies, and rated the quality of evidence using GRADE. MAIN RESULTS We found 91 publications relating to 76 separate studies (involving 10,124 students): 55 RCTs, 9 quasi-RCTs, 7 C-RCTs, and 5 quasi-C-RCTs. We performed meta-analysis according to comparison and outcome. Among both effectiveness and comparative effectiveness analyses, we separated outcomes reporting on overall communication skills, empathy, rapport or relationship building, patient perceptions/satisfaction, information gathering, and explanation and planning. Overall communication skills and empathy were further divided as examiner- or simulated patient-assessed. The overall quality of evidence ranged from moderate to very low, and there was high, unexplained heterogeneity. Overall, interventions had positive effects on most outcomes, but generally small effect sizes and evidence quality limit the conclusions that can be drawn. Communication skills interventions in comparison to usual curricula or control may improve both overall communication skills (standardised mean difference (SMD) 0.92, 95% confidence interval (CI) 0.53 to 1.31; 18 studies, 1356 participants; I² = 90%; low-quality evidence) and empathy (SMD 0.64, 95% CI 0.23 to 1.05; 6 studies, 831 participants; I² = 86%; low-quality evidence) when assessed by experts, but not by simulated patients. Students' skills in information gathering probably also improve with educational intervention (SMD 1.07, 95% CI 0.61 to 1.54; 5 studies, 405 participants; I² = 78%; moderate-quality evidence), but there may be little to no effect on students' rapport (SMD 0.18, 95% CI -0.15 to 0.51; 9 studies, 834 participants; I² = 81%; low-quality evidence), and effects on information giving skills are uncertain (very low-quality evidence). We are uncertain whether experiential interventions improve overall communication skills in comparison to didactic approaches (SMD 0.08, 95% CI -0.02 to 0.19; 4 studies, 1578 participants; I² = 4%; very low-quality evidence). Electronic learning approaches may have little to no effect on students' empathy scores (SMD -0.13, 95% CI -0.68 to 0.43; 3 studies, 421 participants; I² = 82%; low-quality evidence) or on rapport (SMD 0.02, 95% CI -0.33 to 0.38; 3 studies, 176 participants; I² = 19%; moderate-quality evidence) compared to face-to-face approaches. There may be small negative effects of electronic interventions on information giving skills (low-quality evidence), and effects on information gathering skills are uncertain (very low-quality evidence). Personalised/specific feedback probably improves overall communication skills to a small degree in comparison to generic or no feedback (SMD 0.58, 95% CI 0.29 to 0.87; 6 studies, 502 participants; I² = 56%; moderate-quality evidence). There may be small positive effects of personalised feedback on empathy and information gathering skills (low quality), but effects on rapport are uncertain (very low quality), and we found no evidence on information giving skills. We are uncertain whether role-play with simulated patients outperforms peer role-play in improving students' overall communication skills (SMD 0.17, 95% CI -0.33 to 0.67; 4 studies, 637 participants; I² = 87%; very low-quality evidence). There may be little to no difference between effects of simulated patient and peer role-play on students' empathy (low-quality evidence) with no evidence on other outcomes for this comparison. Descriptive syntheses of results that could not be included in meta-analyses across outcomes and comparisons were mixed, as were effects of different interventions and comparisons on specific communication skills assessed by the included trials. Quality of evidence was downgraded due to methodological limitations across several risk of bias domains, high unexplained heterogeneity, and imprecision of results. In general, results remain consistent in sensitivity analysis based on risk of bias and adjustment for clustering. No adverse effects were reported. AUTHORS' CONCLUSIONS: This review represents a substantial body of evidence from which to draw, but further research is needed to strengthen the quality of the evidence base, to consider the long-term effects of interventions on students' behaviour as they progress through training and into practice, and to assess effects of interventions on patient outcomes. Efforts to standardise assessment and evaluation of interpersonal skills will strengthen future research efforts.
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Affiliation(s)
- Conor Gilligan
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | - Martine Powell
- Centre for Investigative Interviewing, Griffith Criminology Institute, Griffith University, Brisbane, Australia
| | - Marita C Lynagh
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | | | - Chris Lonsdale
- Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, Australia
| | - Pam Harvey
- School of Rural Health, Monash University, Bendigo, Australia
| | - Erica L James
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | - Dominique Rich
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Sari P Dewi
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Smriti Nepal
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Darlington, Australia
| | - Hayley A Croft
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
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Hansen TB, Pape B, Thiesen PS, Jakobsen F. Interprofessional versus uniprofessional dyad learning for medical students in a clinical setting. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:191-200. [PMID: 32986616 PMCID: PMC7882129 DOI: 10.5116/ijme.5f50.bc76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The aim of the present study was to explore and compare medical students' perceived learning outcomes when treating patients under supervision in two different learning settings: a uniprofessional or an interprofessional dyad. METHODS The design of the study is a qualitative interview study. Data were collected from October 2016 to June 2017 via semi-structured group interviews performed at the end of the clinical placement in an orthopaedic outpatient clinic for medical students in the last semester of the curriculum. In the placement, the students worked by turns in either a uniprofessional dyad with two medical students or an interprofessional dyad with a nursing student. The data from the interviews were analysed using Systematic Text Analysis. RESULTS Overall, 21 students were interviewed. The students appreciated the authenticity of dealing with real patient problems. Both dyads provided the possibility of working as a professional, but the interprofessional dyad had a more authentic setting. In both dyads, the students' interdependence and mutual support promoted the acquisition of knowledge and skills. Working in the interprofessional dyad facilitated relationships between the professions, and the medical students became aware of some of their own profession's strengths and weaknesses. The interprofessional collaboration contributed to different perspectives on the patients' course of treatment and led to a more holistic understanding of the treatment. CONCLUSIONS Interprofessional dyads have the potential to improve learning outcomes in the clinical training of medical students. Further studies are needed to explore the benefits across medical specialities and settings.
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Affiliation(s)
- Torben Bæk Hansen
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Denmark
| | - Britta Pape
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Denmark
| | - Pernille Staal Thiesen
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Denmark
| | - Flemming Jakobsen
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Denmark
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Gardner AL, Clementz L, Lawrence RH, Dolansky MA, Heilman AM, Rusterholtz AR, Singh S, Sparks M, Singh MK. The Dyad Model for Interprofessional Academic Patient Aligned Care Teams. Fed Pract 2019; 36:88-93. [PMID: 30867629 PMCID: PMC6411364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Combining interprofessional education, clinical or workplace learning, and physician resident teachers in the ambulatory setting, the dyad model enhances teamwork skills and increases nurse practitioner students' clinical competence.
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Affiliation(s)
- Annette L Gardner
- is the Assistant Professor, Department of Behavioral Sciences Philip R. Lee Institute for Health Policy Studies, University of California in San Francisco. is a Training Administrator; A is the Nurse Practitioner Associate Director; and are Faculty; was previously the Evaluation Associate Director; was previously Interprofessional Associate Director; was previously Faculty; and was previously Director; all at the Center of Excellence in Primary Care Education at the Louis Stokes Cleveland Veterans Affairs Medical Center in Ohio. Mary Dolansky is an Associate Professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University, Simran Singh is an Assistant Professor, and Mamta Singh is the Assistant Dean for Health Systems Science, both at Case Western Reserve University School of Medicine
| | - Laura Clementz
- is the Assistant Professor, Department of Behavioral Sciences Philip R. Lee Institute for Health Policy Studies, University of California in San Francisco. is a Training Administrator; A is the Nurse Practitioner Associate Director; and are Faculty; was previously the Evaluation Associate Director; was previously Interprofessional Associate Director; was previously Faculty; and was previously Director; all at the Center of Excellence in Primary Care Education at the Louis Stokes Cleveland Veterans Affairs Medical Center in Ohio. Mary Dolansky is an Associate Professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University, Simran Singh is an Assistant Professor, and Mamta Singh is the Assistant Dean for Health Systems Science, both at Case Western Reserve University School of Medicine
| | - Renée H Lawrence
- is the Assistant Professor, Department of Behavioral Sciences Philip R. Lee Institute for Health Policy Studies, University of California in San Francisco. is a Training Administrator; A is the Nurse Practitioner Associate Director; and are Faculty; was previously the Evaluation Associate Director; was previously Interprofessional Associate Director; was previously Faculty; and was previously Director; all at the Center of Excellence in Primary Care Education at the Louis Stokes Cleveland Veterans Affairs Medical Center in Ohio. Mary Dolansky is an Associate Professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University, Simran Singh is an Assistant Professor, and Mamta Singh is the Assistant Dean for Health Systems Science, both at Case Western Reserve University School of Medicine
| | - Mary A Dolansky
- is the Assistant Professor, Department of Behavioral Sciences Philip R. Lee Institute for Health Policy Studies, University of California in San Francisco. is a Training Administrator; A is the Nurse Practitioner Associate Director; and are Faculty; was previously the Evaluation Associate Director; was previously Interprofessional Associate Director; was previously Faculty; and was previously Director; all at the Center of Excellence in Primary Care Education at the Louis Stokes Cleveland Veterans Affairs Medical Center in Ohio. Mary Dolansky is an Associate Professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University, Simran Singh is an Assistant Professor, and Mamta Singh is the Assistant Dean for Health Systems Science, both at Case Western Reserve University School of Medicine
| | - Alli M Heilman
- is the Assistant Professor, Department of Behavioral Sciences Philip R. Lee Institute for Health Policy Studies, University of California in San Francisco. is a Training Administrator; A is the Nurse Practitioner Associate Director; and are Faculty; was previously the Evaluation Associate Director; was previously Interprofessional Associate Director; was previously Faculty; and was previously Director; all at the Center of Excellence in Primary Care Education at the Louis Stokes Cleveland Veterans Affairs Medical Center in Ohio. Mary Dolansky is an Associate Professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University, Simran Singh is an Assistant Professor, and Mamta Singh is the Assistant Dean for Health Systems Science, both at Case Western Reserve University School of Medicine
| | - Anne R Rusterholtz
- is the Assistant Professor, Department of Behavioral Sciences Philip R. Lee Institute for Health Policy Studies, University of California in San Francisco. is a Training Administrator; A is the Nurse Practitioner Associate Director; and are Faculty; was previously the Evaluation Associate Director; was previously Interprofessional Associate Director; was previously Faculty; and was previously Director; all at the Center of Excellence in Primary Care Education at the Louis Stokes Cleveland Veterans Affairs Medical Center in Ohio. Mary Dolansky is an Associate Professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University, Simran Singh is an Assistant Professor, and Mamta Singh is the Assistant Dean for Health Systems Science, both at Case Western Reserve University School of Medicine
| | - Simran Singh
- is the Assistant Professor, Department of Behavioral Sciences Philip R. Lee Institute for Health Policy Studies, University of California in San Francisco. is a Training Administrator; A is the Nurse Practitioner Associate Director; and are Faculty; was previously the Evaluation Associate Director; was previously Interprofessional Associate Director; was previously Faculty; and was previously Director; all at the Center of Excellence in Primary Care Education at the Louis Stokes Cleveland Veterans Affairs Medical Center in Ohio. Mary Dolansky is an Associate Professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University, Simran Singh is an Assistant Professor, and Mamta Singh is the Assistant Dean for Health Systems Science, both at Case Western Reserve University School of Medicine
| | - Matthew Sparks
- is the Assistant Professor, Department of Behavioral Sciences Philip R. Lee Institute for Health Policy Studies, University of California in San Francisco. is a Training Administrator; A is the Nurse Practitioner Associate Director; and are Faculty; was previously the Evaluation Associate Director; was previously Interprofessional Associate Director; was previously Faculty; and was previously Director; all at the Center of Excellence in Primary Care Education at the Louis Stokes Cleveland Veterans Affairs Medical Center in Ohio. Mary Dolansky is an Associate Professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University, Simran Singh is an Assistant Professor, and Mamta Singh is the Assistant Dean for Health Systems Science, both at Case Western Reserve University School of Medicine
| | - Mamta K Singh
- is the Assistant Professor, Department of Behavioral Sciences Philip R. Lee Institute for Health Policy Studies, University of California in San Francisco. is a Training Administrator; A is the Nurse Practitioner Associate Director; and are Faculty; was previously the Evaluation Associate Director; was previously Interprofessional Associate Director; was previously Faculty; and was previously Director; all at the Center of Excellence in Primary Care Education at the Louis Stokes Cleveland Veterans Affairs Medical Center in Ohio. Mary Dolansky is an Associate Professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University, Simran Singh is an Assistant Professor, and Mamta Singh is the Assistant Dean for Health Systems Science, both at Case Western Reserve University School of Medicine
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Newsam R. Operating department practitioners and midwives: The undervalued obstetric care collaboration. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/bjom.2018.26.11.714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rebecca Newsam
- Operating department practitioner, Liverpool Heart and Chest Hospital NHS Foundation Trust
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See KC, Chua JW, Verstegen D, Van Merrienboer JJG, Van Mook WN. Focused echocardiography: Dyad versus individual training in an authentic clinical context. J Crit Care 2018; 49:50-55. [PMID: 30366250 DOI: 10.1016/j.jcrc.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE Echocardiography is increasingly being taught to intensive care unit residents. Current training methods require teachers to closely supervise trainees individually, and are time-intensive. To reduce the time burden, dyad training (training in pairs) under simulation conditions has been shown to be non-inferior to individual training. We aimed to validate these preliminary results for focused subcostal echocardiography (FSE), in an authentic clinical context. MATERIALS AND METHODS We conducted a quasi-experimental study within a 20-bed medical intensive care unit from June 2016 to March 2017. For supervised practice, residents were divided into individual versus dyad training groups. Residents then performed at least five FSE examinations, which were remotely scored by a blinded observer for image quality and correct interpretation. The main outcome measure was the mean composite image quality and interpretation score for the first five echoes done under indirect supervision (composite score range 1-8). RESULTS 16 residents received individual training and 17 residents received dyad training. The mean composite score did not differ between the individual and dyad training groups (6.0 ± 0.4 versus 5.9 ± 0.4, 95% CI of difference - 0.2 to 0.4). CONCLUSIONS Assuming a 1-point non-inferiority threshold for the mean composite score, dyad training for FSE was non-inferior to individual training.
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Affiliation(s)
- Kay Choong See
- Division of Respiratory & Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Joo Wei Chua
- Division of Respiratory & Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Danielle Verstegen
- Department of Educational Research and Development, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
| | - Jeroen J G Van Merrienboer
- Department of Educational Research and Development, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
| | - Walther N Van Mook
- Department of Intensive Care Medicine, Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, the Netherlands; School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
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Yang YY, Wang SJ, Yang LY, Lirng JF, Huang CC, Liang JF, Lee FY, Hwang SJ, Huang CC, Kirby R. Effects of a new parallel primary healthcare centre and on-campus training programme on history taking, physical examination skills and medical students' preparedness: a prospective comparative study in Taiwan. BMJ Open 2017; 7:e016294. [PMID: 28951408 PMCID: PMC5623533 DOI: 10.1136/bmjopen-2017-016294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 07/18/2017] [Accepted: 08/03/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The primary healthcarecentre (PHCC) is the first place that medical students experience patient contact. Usually, medical students are frustrated by a lack of proper skills training for on-campus history taking (HT), physical examination (PE) and self-directed learning (SDL) to prepare for their PHCC and inhospital patient contact. For pre-clerks, this study aims to compare the effectiveness of PHCC training and PHCC training in combination with on-campus HT and PE training modules (PHCC+on-campus) on their clerkship preparedness. DESIGN This comparative study utilised prospective, consecutive, end of pre-clerkship group objective structured clinical examination (GOSCE), beginning of clerkship OSCE and self-administered Preparation for Hospital Practice Questionnaire (PHPQ). SETTING/PARTICIPANTS 128 pre-clinical clerk volunteers (64 each year) receiving PHCC training (7 week PHCCtraining in addition to 7 week assignment based group learning, academic year 2014, controls) and PHCC training in combination with on-campus module training (academic year 2015, 7 week PHCCtraining in addition to 7 week on-campus sessions) were sequentially assessed before the module (week 1), at the end of the module (week 14) and at the beginning of clerkship (week 25). RESULTS For overall HT and PE skills, both PHCC and PHCC+on-campus module trained pre-clerks performed better on OSCE than GOSCE. Additionally, the improvement was accompanied by higher self-reported PHPQ scores in 'confidence/coping' and 'SDL' domains. At the end of the pre-clerkship and the beginning of the clerkship stages, the degree of improvement in preparedness in 'confidence/coping' and 'SDL' domains was higher for those in the PHCC+on-campus group than for those in the PHCC group. Among the PHCC+on-campus module participants, a positive association was observed between high mean PHPQ-SDL scores and high OSCE scores. CONCLUSIONS Our study suggests that the PHCC+on-campus module, which is paired faculty led and pre-trained dyad student assisted, is effective in developing a preclinical clerk's HT and PE skills and intensifying SDL/patient management abilities to prepare for hospital practice in clerkship.
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Affiliation(s)
- Ying-Ying Yang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling-Yu Yang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiing-Feng Lirng
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Chang Huang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jen-Feng Liang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fa-Yauh Lee
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Chou Huang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ralph Kirby
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
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Abay EŞ, Turan S, Odabaşı O, Elçin M. Who Is the Preferred Tutor in Clinical Skills Training: Physicians, Nurses, or Peers? TEACHING AND LEARNING IN MEDICINE 2017; 29:247-254. [PMID: 28296513 DOI: 10.1080/10401334.2016.1274262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Phenomenon: Clinical skills centers allow structured training of undergraduate medical students for the acquisition of clinical skills in a simulated environment. Physician, nurse, or peer tutors are employed for training in those centers. All tutors should have appropriate training about the methodology used in the clinical skills training. Many of the studies revealed the effectiveness of various types of tutors. The aim of our study was to evaluate medical students' satisfaction with clinical skills training, and their opinions about the differences in coaching skills among the physician, nurse, and peer tutors. APPROACH This study was conducted with third-year students (467 students) in 2013-2014 academic year at Hacettepe University Faculty of Medicine. Participation rate was 85 % (397 students). The students attended the suturing skill training in groups of 40 students. First, a faculty member from the Department of Medical Education delivered a video demonstration and conducted discussion. After the demonstration, the students were divided into groups of 5-6 students. A physician, nurse, or a peer tutor facilitated each group. The students were asked to complete the Coaching Skills Evaluation Form after the practicum session. It contained 13 criteria for assessing the coaching skills. Additionally, the form included a question for rating the student's satisfaction with the tutor. The performance of the tutors at each step was rated on a three-point scale. FINDINGS Kruskal Wallis analysis was used to compare students' scores for their tutors. The students' satisfaction with tutors was high for all of the tutors. However, there was no difference between students' scores in suturing skill, and between physician, nurse, and peer tutors' coaching skills. Insights: In this study, we revealed that physician, nurse, and peer tutors were equally effective on the students' performances. They were also regarded as effective in their teaching role by students. But the most important point was that sufficient tutor training and preparation was crucial for the success of models.
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Affiliation(s)
- Ece Şükriye Abay
- a Medical Education and Informatics, Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Sevgi Turan
- a Medical Education and Informatics, Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Orhan Odabaşı
- a Medical Education and Informatics, Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Melih Elçin
- a Medical Education and Informatics, Hacettepe University Faculty of Medicine , Ankara , Turkey
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Abstract
We investigated the effects of dyadic training on medical students' resuscitation performance during cardiopulmonary resuscitation (CPR) training.We provided students with a 2-hour training session on CPR for simulated cardiac arrest. Student teams were split into double groups (Dyad training groups: Groups A and B) or Single Groups. All groups received 2 CPR simulation rounds. CPR simulation training began with peer demonstration for Group A, and peer observation for Group B. Then the 2 groups switched roles. Single Groups completed CPR simulation without peer observation or demonstration. Teams were then evaluated based on leadership, teamwork, and team member skills.Group B had the highest first simulation round scores overall (P = 0.004) and in teamwork (P = 0.001) and team member skills (P = 0.031). Group B also had the highest second simulation round scores overall (P < 0.001) and in leadership (P = 0.033), teamwork (P < 0.001), and team member skills (P < 0.001). In the first simulation, there were no differences between Dyad training groups with those of Single Groups in overall scores, leadership scores, teamwork scores, and team member scores. In the second simulation, Dyad training groups scored higher in overall scores (P = 0.002), leadership scores (P = 0.044), teamwork scores (P = 0.005), and team member scores (P = 0.008). Dyad training groups also displayed higher improvement in overall scores (P = 0.010) and team member scores (P = 0.022).Dyad training was effective for CPR training. Both peer observation and demonstration for peers in dyad training can improve student resuscitation performance.
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Affiliation(s)
| | - Chin-Chou Huang
- Department of Medical Education
- Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital
- Cardiovascular Research Center
- Institute of Pharmacology
| | - Shing-Jong Lin
- Department of Medical Research
- Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital
- Cardiovascular Research Center
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Jaw-Wen Chen
- Department of Medical Research
- Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital
- Cardiovascular Research Center
- Institute of Pharmacology
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Romeo R, Blasiole B, Chalifoux T, Dalby P, Krohner R, Lyon T, Mahoney J, McIvor WR, Ondecko Ligda K, Patel R. A Clinical Procedures Course for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2016; 12:10524. [PMID: 30984866 PMCID: PMC6440491 DOI: 10.15766/mep_2374-8265.10524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/07/2016] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Doctors perform many clinical procedures throughout their careers. It is important for students to learn these procedures in a nonthreatening environment. This clinical procedures course introduces students to several basic diagnostic and therapeutic procedures, both invasive and noninvasive. These include managing pediatric and adult airways, starting intravenous lines, inserting arterial and central lines, inserting Foley catheters and nasogastric tubes, and performing lumbar punctures and paracentesis. METHODS Small-group teaching is used to achieve these objectives; over the course of 4 weeks, the medical students meet once a week for 4 hours. Each meeting includes teaching and demonstrations of the procedures by faculty instructors and residents. This is followed by practice of the procedures on mannequin simulators and partial task trainers by the students. Feedback is then given to the students by the instructors. RESULTS Based on conversations during the feedback sessions, the students feel that the materials used in the course are helpful in learning these clinical procedures. DISCUSSION The medical students feel that the course familiarizes them with clinical procedures they may be asked to perform on patients during their clinical rotations and postgraduate training.
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Affiliation(s)
- Ryan Romeo
- Anesthesiologist, University of Pittsburgh School of Medicine
| | - Brian Blasiole
- Anesthesiologist, University of Pittsburgh School of Medicine
| | | | - Patricia Dalby
- Anesthesiologist, University of Pittsburgh School of Medicine
| | - Robert Krohner
- Anesthesiologist, University of Pittsburgh School of Medicine
| | - Tim Lyon
- Urology Chief Resident, University of Pittsburgh School of Medicine
| | - John Mahoney
- Emergency Room Physician, University of Pittsburgh School of Medicine
| | | | | | - Rita Patel
- Anesthesiologist, University of Pittsburgh School of Medicine
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Tolsgaard MG, Jepsen RMHG, Rasmussen MB, Kayser L, Fors U, Laursen LC, Svendsen JH, Ringsted C. The effect of constructing versus solving virtual patient cases on transfer of learning: a randomized trial. PERSPECTIVES ON MEDICAL EDUCATION 2016; 5:33-38. [PMID: 26754313 PMCID: PMC4754215 DOI: 10.1007/s40037-015-0242-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to explore the effect of actively constructing virtual patient (VP) cases compared with solving VP cases on knowledge gains, skills transfer and time spent on cases. Forty-five fourth-year medical students were randomized to constructing (VP-construction, n = 23) or solving (VP-solving, n = 22) four cardiopulmonary VP cases. Whereas the VP-solving group solved the cases, the VP-construction group only received the final diagnosis and had to complete the history, physical findings, and lab results. After a week, participants completed a transfer test involving two standardized patients representing cardiopulmonary cases. Performances on the transfer test were video-recorded and assessed by two blinded raters using the Reporter, Interpreter, Manager, Educator (RIME) framework. Thirty-nine participants completed the transfer test. The VP-construction group spent significantly more time on the VP cases compared with the VP-solving group, p = 0.002. There were no significant differences in RIME scores between the VP-construction group and VP-solving group, p = 0.54.In conclusion, engaging novice students in active VP case construction may be more time consuming than solving VP cases, without resulting in superior skills transfer.
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Affiliation(s)
- Martin G Tolsgaard
- Centre for Clinical Education, Capital Region of Denmark and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Obstetrics and Gynaecology, Nordsjælland University Hospital, Hillerød, Denmark.
| | - Rikke M H G Jepsen
- Centre for Clinical Education, Capital Region of Denmark and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Danish Institute for Medical Simulation, Herlev University Hospital, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Maria B Rasmussen
- Centre for Clinical Education, Capital Region of Denmark and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Kayser
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Uno Fors
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Lars C Laursen
- Department of Pulmonary Medicine, Herlev University Hospital, Herlev, Denmark
| | - Jesper H Svendsen
- Department of Cardiology, Department of Clinical Medicine, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen and Danish Arrhythmia Research Centre, University of Copenhagen, Copenhagen, Denmark
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Tolsgaard MG, Kulasegaram KM, Ringsted CV. Collaborative learning of clinical skills in health professions education: the why, how, when and for whom. MEDICAL EDUCATION 2016; 50:69-78. [PMID: 26695467 DOI: 10.1111/medu.12814] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 04/23/2015] [Accepted: 06/16/2015] [Indexed: 05/24/2023]
Abstract
OBJECTIVES This study is designed to provide an overview of why, how, when and for whom collaborative learning of clinical skills may work in health professions education. WHY Collaborative learning of clinical skills may influence learning positively according to the non-medical literature. Training efficiency may therefore be improved if the outcomes of collaborative learning of clinical skills are superior or equivalent to those attained through individual learning. HOW According to a social interaction perspective, collaborative learning of clinical skills mediates its effects through social interaction, motivation, accountability and positive interdependence between learners. Motor skills learning theory suggests that positive effects rely on observational learning and action imitation, and negative effects may include decreased hands-on experience. Finally, a cognitive perspective suggests that learning is dependent on cognitive co-construction, shared knowledge and reduced cognitive load. WHEN AND FOR WHOM The literature on the collaborative learning of clinical skills in health science education is reviewed to support or contradict the hypotheses provided by the theories outlined above. Collaborative learning of clinical skills leads to improvements in self-efficacy, confidence and performance when task processing is observable or communicable. However, the effects of collaborative learning of clinical skills may decrease over time as benefits in terms of shared cognition, scaffolding and cognitive co-construction are outweighed by reductions in hands-on experience and time on task. CONCLUSIONS Collaborative learning of clinical skills has demonstrated promising results in the simulated setting. However, further research into how collaborative learning of clinical skills may work in clinical settings, as well as into the role of social dynamics between learners, is required.
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Affiliation(s)
- Martin G Tolsgaard
- Centre for Clinical Education, Capital Region and University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Nordsjaelland's Hospital Hillerød, Denmark
| | - Kulamakan M Kulasegaram
- Wilson Centre, Department of Family and Community Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Hernández-Irizarry R, Zendejas B, Ali SM, Farley DR. Optimizing training cost-effectiveness of simulation-based laparoscopic inguinal hernia repairs. Am J Surg 2015; 211:326-35. [PMID: 26644038 DOI: 10.1016/j.amjsurg.2015.07.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/23/2015] [Accepted: 07/12/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Motor learning theory suggests that highly complex tasks are probably best trained under conditions of part task (PT), as opposed to whole-task (WT) training. Within PT, random practice of tasks has been shown to lead to improved skill retention and transfer. METHODS General surgery residents were equally randomized to PT vs WT, mastery learning type, and simulation-based training of laparoscopic inguinal hernia repair. Training time and resources used to reach mastery (skill acquisition), performance at 1-month testing (skill retention), and intraoperative time and performance scores (skill transfer) were compared. RESULTS Forty-four general surgery trainees were randomized. All residents achieved mastery benchmarks. Trainees in the PT group achieved mastery on average 17 minutes faster (60.2 ± 23.8 vs 77.1 ± 24.8 minutes, P = .02, saving 6.2 instructor hours), used fewer material resources (curricular cost savings of $2,380 or $121 per learner), and were more likely to retain mastery level performance at 1-month retention testing (59% vs 22.7% P = .03). No differences in intraoperative performance were encountered. CONCLUSIONS For laparoscopic inguinal hernia repair, random PT simulation-based training seems to be more cost-effective, compared with WT training.
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Affiliation(s)
| | - Benjamin Zendejas
- Department of Surgery, College of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Shahzad M Ali
- Department of Surgery, College of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - David R Farley
- Department of Surgery, College of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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For the general internist: a review of relevant 2013 innovations in medical education. J Gen Intern Med 2015; 30:496-502. [PMID: 25650262 PMCID: PMC4370990 DOI: 10.1007/s11606-015-3197-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/11/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
Abstract
We conducted a review of articles published in 2013 to identify high-quality research in medical education that was relevant to general medicine education practice. Our review team consisted of six general internists with expertise in medical education of varying ranks, as well as a professional medical librarian. We manually searched 15 journals in pairs, and performed an online search using the PubMed search engine for all original research articles in medical education published in 2013. From the total 4,181 citations identified, we selected 65 articles considered most relevant to general medicine educational practice. Each team member then independently reviewed and rated the quality of each selected article using the modified Medical Education Research Study Quality Instrument. We then reviewed the quality and relevance of each selected study and grouped them into categories of propensity for inclusion. Nineteen studies were felt to be of adequate quality and were of moderate to high propensity for inclusion. Team members then independently voted for studies they felt to be of the highest relevance and quality within the 19 selected studies. The ten articles with the greatest number of votes were included in the review. We categorized the studies into five general themes: Improving Clinical Skills in UME, Inpatient Clinical Teaching Methods, Advancements in Continuity Clinic, Handoffs/Transitions in Care, and Trainee Assessment. Most studies in our review of the 2013 literature in general medical education were limited to single institutions and non-randomized study designs; we identified significant limitations of each study. Selected articles may inform future research and practice of medical educators.
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Shuid AN, Yaman MN, Abd Kadir RA, Hussain RI, Othman SN, Nawi AM, Ugusman A, Daud F, Manap RA, Mohamed IN. Effect of early clinical skills teaching on 3rd year medical students' learning: The student perspective. J Taibah Univ Med Sci 2015. [DOI: 10.1016/j.jtumed.2014.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bjerrum AS, Morcke AM. Dyad training: effective, efficient and transferable. What are we waiting for? MEDICAL EDUCATION 2015; 49:242-244. [PMID: 25693982 DOI: 10.1111/medu.12667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Tolsgaard MG, Madsen ME, Ringsted C, Oxlund BS, Oldenburg A, Sorensen JL, Ottesen B, Tabor A. The effect of dyad versus individual simulation-based ultrasound training on skills transfer. MEDICAL EDUCATION 2015; 49:286-95. [PMID: 25693988 PMCID: PMC5024026 DOI: 10.1111/medu.12624] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 07/29/2014] [Accepted: 09/11/2014] [Indexed: 05/10/2023]
Abstract
CONTEXT Dyad practice may be as effective as individual practice during clinical skills training, improve students' confidence, and reduce costs of training. However, there is little evidence that dyad training is non-inferior to single-student practice in terms of skills transfer. OBJECTIVES This study was conducted to compare the effectiveness of simulation-based ultrasound training in pairs (dyad practice) with that of training alone (single-student practice) on skills transfer. METHODS In a non-inferiority trial, 30 ultrasound novices were randomised to dyad (n = 16) or single-student (n = 14) practice. All participants completed a 2-hour training programme on a transvaginal ultrasound simulator. Participants in the dyad group practised together and took turns as the active practitioner, whereas participants in the single group practised alone. Performance improvements were evaluated through pre-, post- and transfer tests. The transfer test involved the assessment of a transvaginal ultrasound scan by one of two clinicians using the Objective Structured Assessment of Ultrasound Skills (OSAUS). RESULTS Thirty participants completed the simulation-based training and 24 of these completed the transfer test. Dyad training was found to be non-inferior to single-student training: transfer test OSAUS scores were significantly higher than the pre-specified non-inferiority margin (delta score 7.8%, 95% confidence interval -3.8-19.6%; p = 0.04). More dyad (71.4%) than single (30.0%) trainees achieved OSAUS scores above a pre-established pass/fail level in the transfer test (p = 0.05). There were significant differences in performance scores before and after training in both groups (pre- versus post-test, p < 0.01) with large effect sizes (Cohen's d = 3.85) and no significant interactions between training type and performance (p = 0.59). The dyad group demonstrated higher training efficiency in terms of simulator score per number of attempts compared with the single-student group (p = 0.03). CONCLUSION Dyad practice improves the efficiency of simulation-based training and is non-inferior to individual practice in terms of skills transfer.
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Affiliation(s)
- Martin G Tolsgaard
- Department of ObstetricsJuliane Marie CentreRigshospitaletUniversity of CopenhagenCopenhagenDenmark
- Centre for Clinical EducationCapital Region and University of CopenhagenCopenhagenDenmark
| | - Mette E Madsen
- Department of ObstetricsJuliane Marie CentreRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Charlotte Ringsted
- Department of AnaesthesiaUniversity of TorontoTorontoOntarioCanada
- Wilson CentreUniversity Health NetworkTorontoOntarioCanada
| | - Birgitte S Oxlund
- Department of ObstetricsJuliane Marie CentreRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Anna Oldenburg
- Department of ObstetricsJuliane Marie CentreRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Jette L Sorensen
- Department of ObstetricsJuliane Marie CentreRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Bent Ottesen
- Department of ObstetricsJuliane Marie CentreRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Ann Tabor
- Department of ObstetricsJuliane Marie CentreRigshospitaletUniversity of CopenhagenCopenhagenDenmark
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Tolsgaard MG, Rasmussen MB, Bjørck S, Gustafsson A, Ringsted CV. Medical students' perception of dyad practice. PERSPECTIVES ON MEDICAL EDUCATION 2014; 3:500-507. [PMID: 25073865 PMCID: PMC4263787 DOI: 10.1007/s40037-014-0138-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Training in pairs (dyad practice) has been shown to improve efficiency of clinical skills training compared with single practice but little is known about students' perception of dyad practice. The aim of this study was to explore the reactions and attitudes of medical students who were instructed to work in pairs during clinical skills training. A follow-up pilot survey consisting of four open-ended questions was administered to 24 fourth-year medical students, who completed four hours of dyad practice in managing patient encounters. The responses were analyzed using thematic analysis. The students felt dyad practice improved their self-efficacy through social interaction with peers, provided useful insight through observation, and contributed with shared memory of what to do, when they forgot essential steps of the physical examination of the patient. However, some students were concerned about decreased hands-on practice and many students preferred to continue practising alone after completing the initial training. Dyad practice is well received by students during initial skills training and is associated with several benefits to learning through peer observation, feedback and cognitive support. Whether dyad training is suited for more advanced learners is a subject for future research.
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Affiliation(s)
- Martin G Tolsgaard
- The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100-O, Copenhagen, Denmark.
- Centre for Clinical Education, Capital Region of Denmark and Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100-O, Copenhagen, Denmark.
| | - Maria B Rasmussen
- Centre for Clinical Education, Capital Region of Denmark and Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100-O, Copenhagen, Denmark
| | - Sebastian Bjørck
- Department of Orthopaedic Surgery, University Hospital Slagelse, Slagelse, Denmark
| | - Amandus Gustafsson
- Department of Orthopaedic Surgery, University Hospital Hvidovre, Hvidovre, Denmark
| | - Charlotte V Ringsted
- The Wilson Centre and Department of Anesthesia, University of Toronto and University Health Network, Toronto, Canada
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Team Training (Training at Own Facility) versus Individual Surgeon's Training (Training at Trainer's Facility) When Implementing a New Surgical Technique: Example from the ONSTEP Inguinal Hernia Repair. Surg Res Pract 2014; 2014:762761. [PMID: 25506078 PMCID: PMC4258376 DOI: 10.1155/2014/762761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/10/2014] [Indexed: 01/29/2023] Open
Abstract
Background. When implementing a new surgical technique, the best method for didactic learning has not been settled. There are basically two scenarios: the trainee goes to the teacher's clinic and learns the new technique hands-on, or the teacher goes to the trainee's clinic and performs the teaching there. Methods. An informal literature review was conducted to provide a basis for discussing pros and cons. We also wanted to discuss how many surgeons can be trained in a day and the importance of the demand for a new surgical procedure to ensure a high adoption rate and finally to apply these issues on a discussion of barriers for adoption of the new ONSTEP technique for inguinal hernia repair after initial training. Results and Conclusions. The optimal training method would include moving the teacher to the trainee's department to obtain team-training effects simultaneous with surgical technical training of the trainee surgeon. The training should also include a theoretical presentation and discussion along with the practical training. Importantly, the training visit should probably be followed by a scheduled visit to clear misunderstandings and fine-tune the technique after an initial self-learning period.
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Bjerrum AS, Eika B, Charles P, Hilberg O. Dyad practice is efficient practice: a randomised bronchoscopy simulation study. MEDICAL EDUCATION 2014; 48:705-712. [PMID: 24909532 DOI: 10.1111/medu.12398] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/12/2013] [Accepted: 10/16/2013] [Indexed: 06/03/2023]
Abstract
CONTEXT Medical simulation training requires effective and efficient training strategies. Dyad practice may be a training strategy worth pursuing because it has been proven effective and efficient in motor skills learning. In dyad practice two participants collaborate in learning a task they will eventually perform individually. In order to explore the effects of dyad practice in a medical simulation setting, this study examined the effectiveness and efficiency of dyad practice compared with individual practice in the learning of bronchoscopy through simulation-based training. METHODS A total of 36 students of medicine were randomly assigned to either individual practice or dyad practice. The training setting included video-based instruction, 10 bronchoscopy simulator cases and instructor feedback. Participants in the dyad practice group alternated between physical and observational practice and hence physically undertook only half of the training cases undertaken by participants who practised individually. Pre-, post- and delayed (3 weeks) retention tests were used to assess skills according to previously validated simulator measures. Data were analysed using repeated-measures analysis of variance (anova) on each dependent measure. RESULTS A significant main effect of test was found for all measures (F2,67 > 23.32, p < 0.001), indicating improvement in performance from pre-tests to post-tests and retention tests. No interaction was found between test and group (F2,67 < 0.26, p > 0.49), indicating parallel learning curves. Most importantly, no main effect of group was found for any of the measures, indicating no difference between learning curves (F1,34 = 2.08, p < 0.16). CONCLUSIONS Individual practice and dyad practice did not differ in their effectiveness for the acquisition of bronchoscopy skills through supervised simulation training. However, dyad practice proved more efficient than individual practice because two participants practising in dyads learned as much as one participant practising individually but required the same instructor resources and training time as the single learner.
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Affiliation(s)
- Anne Sofie Bjerrum
- Department of Respiratory Diseases, Aarhus University Hospital, Aarhus, Denmark
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Training clinical skills in Pairs. J Gen Intern Med 2014; 29:437. [PMID: 24352636 PMCID: PMC3930781 DOI: 10.1007/s11606-013-2682-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tolsgaard MG, Ringsted C. Using equivalence designs to improve methodological rigor in medical education trials. MEDICAL EDUCATION 2014; 48:220-221. [PMID: 24528405 DOI: 10.1111/medu.12313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Martin G Tolsgaard
- Centre for Clinical Education and Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Shanks D, Brydges R, den Brok W, Nair P, Hatala R. Are two heads better than one? Comparing dyad and self-regulated learning in simulation training. MEDICAL EDUCATION 2013; 47:1215-1222. [PMID: 24206155 DOI: 10.1111/medu.12284] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/08/2013] [Accepted: 06/12/2013] [Indexed: 06/02/2023]
Abstract
CONTEXT The optimal learner to simulator ratio for procedural skills training is not known. Research in motor learning suggests observational training in pairs, termed 'dyad training', may be as effective as directed self-regulated learning (DSRL). OBJECTIVES This study was conducted to compare the relative effectiveness and efficiency of dyad versus DSRL training of simulation-based lumbar puncture (LP). METHODS We conducted a two-group randomised equivalence trial. First-year internal medicine residents (n = 50) were randomly assigned to learn LP either in dyads or as individual learners on a simulator, using a directed self-regulated approach (i.e. the learning sequence was defined for them, but they defined the pace of learning). Participants were videotaped performing a simulated LP on a pre-test, an immediate post-test, and a 6-week delayed retention test. In duplicate, blinded raters independently evaluated all trainee performances using a previously validated 5-point global rating scale (GRS) and 35-item checklist. RESULTS Our analyses showed no significant differences (p = 0.69) on pre-test, post-test or retention test GRS scores between the dyad (mean ± standard deviation [SD] scores by test: 2.39 ± 0.57, 3.48 ± 0.62, 3.12 ± 0.85, respectively) and DSRL (mean ± SD scores by test: 2.67 ± 0.50, 3.34 ± 0.77, 3.21 ± 0.79, respectively) groups. Both groups improved significantly from pre-test to post-test (p < 0.001) and retained that performance following the 6-week delay. Dyad participants experienced significantly greater pre-test to post-test gains than DSRL participants (p = 0.02). There was no significant difference in total practice time between the groups (20.94 minutes for individuals and 24.20 minutes for dyads; p = 0.175). CONCLUSIONS Our results indicate that learning in pairs is as effective as independent DSRL. Dyad training permits the more efficient use of simulators as two learners use the same resources as an individual.
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Affiliation(s)
- David Shanks
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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