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Tsusaki R, Mullassery D, Ramaswamy P. Stress, Grit, Satisfaction With Life, and Remediation of Prelicensure Nursing Students. Nurse Educ 2024; 49:19-24. [PMID: 37442120 DOI: 10.1097/nne.0000000000001481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND Stress and poor academic performance often lead to high levels of nursing school attrition. PURPOSE To explore nursing students' perceived stress, grit, and satisfaction with life, and assess the effectiveness of a remediation program for students at risk for poor academic performance. METHODS Perceived stress, grit, and satisfaction with life were measured, and the effect of remediation given to at-risk students was studied. Examination and psychometric scores were compared between remediation and nonremediation groups. RESULTS The remediation group had higher levels of perceived stress and a lower satisfaction with life compared with the rest of the cohort. Remediation significantly improved examination scores of at-risk students although scores remained lower than those among nonremediation students. CONCLUSIONS Perceived stress and grit scores were high in nursing students, and satisfaction varied among age groups. Remediation based on metacognitive theory significantly improved at-risk students' examination scores.
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Affiliation(s)
- Rebecca Tsusaki
- Assistant Professor (Drs Tsusaki, Mullassery, and Ramaswamy), Department of Graduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston
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Lees AF, Beni C, Lee A, Wedgeworth P, Dzara K, Joyner B, Tarczy-Hornoch P, Leu M. Uses of Electronic Health Record Data to Measure the Clinical Learning Environment of Graduate Medical Education Trainees: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1326-1336. [PMID: 37267042 PMCID: PMC10615720 DOI: 10.1097/acm.0000000000005288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE This study systematically reviews the uses of electronic health record (EHR) data to measure graduate medical education (GME) trainee competencies. METHOD In January 2022, the authors conducted a systematic review of original research in MEDLINE from database start to December 31, 2021. The authors searched for articles that used the EHR as their data source and in which the individual GME trainee was the unit of observation and/or unit of analysis. The database query was intentionally broad because an initial survey of pertinent articles identified no unifying Medical Subject Heading terms. Articles were coded and clustered by theme and Accreditation Council for Graduate Medical Education (ACGME) core competency. RESULTS The database search yielded 3,540 articles, of which 86 met the study inclusion criteria. Articles clustered into 16 themes, the largest of which were trainee condition experience (17 articles), work patterns (16 articles), and continuity of care (12 articles). Five of the ACGME core competencies were represented (patient care and procedural skills, practice-based learning and improvement, systems-based practice, medical knowledge, and professionalism). In addition, 25 articles assessed the clinical learning environment. CONCLUSIONS This review identified 86 articles that used EHR data to measure individual GME trainee competencies, spanning 16 themes and 6 competencies and revealing marked between-trainee variation. The authors propose a digital learning cycle framework that arranges sequentially the uses of EHR data within the cycle of clinical experiential learning central to GME. Three technical components necessary to unlock the potential of EHR data to improve GME are described: measures, attribution, and visualization. Partnerships between GME programs and informatics departments will be pivotal in realizing this opportunity.
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Affiliation(s)
- A Fischer Lees
- A. Fischer Lees is a clinical informatics fellow, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Catherine Beni
- C. Beni is a general surgery resident, Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Albert Lee
- A. Lee is a clinical informatics fellow, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Patrick Wedgeworth
- P. Wedgeworth is a clinical informatics fellow, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Kristina Dzara
- K. Dzara is assistant dean for educator development, director, Center for Learning and Innovation in Medical Education, and associate professor of medical education, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Byron Joyner
- B. Joyner is vice dean for graduate medical education and a designated institutional official, Graduate Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Peter Tarczy-Hornoch
- P. Tarczy-Hornoch is professor and chair, Department of Biomedical Informatics and Medical Education, and professor, Department of Pediatrics (Neonatology), University of Washington School of Medicine, and adjunct professor, Allen School of Computer Science and Engineering, University of Washington, Seattle, Washington
| | - Michael Leu
- M. Leu is professor and director, Clinical Informatics Fellowship, Department of Biomedical Informatics and Medical Education, and professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Lin JJ, Klopfenstein J, Maldonado A, McCall T, Tsung A, Dinh DH. We Tabulated and Organized American Board of Neurological Surgeons Primary Exam Keywords (2015-2023) so You Don't Have to. Cureus 2023; 15:e39402. [PMID: 37362538 PMCID: PMC10287027 DOI: 10.7759/cureus.39402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Background Passing the American Board of Neurological Surgeons (ABNS) Primary Exam is required for residents in training. Both the program directors and residents are given keywords of the exam afterward in the hope to help program directors determine their relative strengths and weakness. We have organized and tabulated these keywords for neurosurgery residents' benefit. Methodology We collected and analyzed ABNS Primary Exam keywords (2015-2023) in each of the exam's main categories for trends and recurrences. We examined the overall passing rates among first-time credit test takers. The frequency of each subcategory was calculated as a percentage within its corresponding category. Recurrent keywords were grouped together with their corresponding years and categorized as once, twice, or thrice and greater occurrences; the last category was considered to be high-yield keywords. Results The number of questions in Neurosciences and Neurology has decreased over the years while Neurosurgery and Critical Care questions have increased. Similarly, there are fewer keyword repeats in Neurosciences and Neurology. The most repeated keywords are in Neuroimaging. The most common keywords are presented and listed along with the years of occurrences. Overall, the passing rate among first-time credit test takers is over 90%. Conclusions Neurosurgery residents can consider the common keywords as a guide in preparation for the ABNS Primary Exam.
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Affiliation(s)
- Julian J Lin
- Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Jeffrey Klopfenstein
- Neurological Surgery, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Andres Maldonado
- Neurological Surgery, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Todd McCall
- Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Andrew Tsung
- Neurosurgery, OSF Saint Francis Medical Center, Peoria, USA
| | - Dzung H Dinh
- Neurosurgery, University of Illinois College of Medicine, Peoria, USA
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Tarras S, White MT, Toloff K, Cooley D, Edelman D. Just Do It: Participation in Structured Online Curricula Reliably Improves Low ABSITE Scores. JOURNAL OF SURGICAL EDUCATION 2022; 79:e166-e172. [PMID: 35902350 DOI: 10.1016/j.jsurg.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/03/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We hypothesized residents enrolled in an Accelerated Clinical Education in Surgery (ACES) program would improve their scores to above the 30th percentile. We analyzed which components of ACES correlated with improvement. DESIGN AND SETTING A retrospective review of three academic cycles (2018-2021) at an academic general surgery residency. PARTICIPANTS Residents scoring ≤30th percentile on the ABSITE were enrolled in ACES. Baseline demographics including STEP scores were collected. ACES included: (1) SCORE and DeckerMed assignments (2) Weekly faculty review sessions and (3) Monthly meeting with assigned mentor. Data were analyzed by Student's t-test, one-way ANOVA and Fisher's exact test. RESULTS Twenty-six surgical residents enrolled in ACES. Compared to residents not in ACES, there was no significant difference females (15 vs. 15; p = 0.19) and STEP 2 scores (241 vs. 246; p = 0.06). Residents in ACES had significantly lower STEP 1 (225 vs. 237; p < 0.001) and STEP 3 (212 vs. 223; p < 0.001) scores. Demographics of ACES residents who subsequently scored >30th percentile were similar to those who didn't, except for STEP 3 scores (216 vs. 204; p = 0.008). For residents in ACES, the completion of assignments between July and January was significantly higher for those who subsequently achieved an ABSITE score >30th percentile: TWIS, 77% vs. 53% (p = 0.022), Decker WC, 80% vs. 49% (p = 0.009) and Decker MR, 53% vs. 29% (p = 0.016). Completion of an online practice exam prior to ABSITE also correlated with score >30th percentile (57% vs. 13%, p = 0.007). There was also no correlation between the number of faculty review sessions and ABSITE (11.5 vs.11.9, p = 0.931). CONCLUSIONS Participation in a structured online program of reading and quizzes was durably effective in improving ABSITE scores >30th percentile. Completion of online assignments, rather than scores on practice tests or review sessions, appeared to be the most important factor for success.
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Affiliation(s)
- Samantha Tarras
- The Michael and Marian Ilitch Department of Surgery, Wayne State University, Detroit, Michigan.
| | - Michael T White
- The Michael and Marian Ilitch Department of Surgery, Wayne State University, Detroit, Michigan
| | - Katelyn Toloff
- The Michael and Marian Ilitch Department of Surgery, Wayne State University, Detroit, Michigan
| | - Dana Cooley
- The Michael and Marian Ilitch Department of Surgery, Wayne State University, Detroit, Michigan
| | - David Edelman
- The Michael and Marian Ilitch Department of Surgery, Wayne State University, Detroit, Michigan
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Hsiao CY, Wu JC, Lin PC, Yang PY, Liao F, Guo SL, Hou WH. Effectiveness of interprofessional shared decision-making training: A mixed-method study. PATIENT EDUCATION AND COUNSELING 2022; 105:3287-3297. [PMID: 35927112 DOI: 10.1016/j.pec.2022.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study evaluated the learning effects and examined the participants' perceptions of an interprofessional shared decision-making (IP-SDM) training program. METHODS This mixed-method study used a quasi-experimental pretest-posttest design in the quantitative phase and semi-structured interviews in the qualitative phase. The 6-week curriculum design, based on Kolb's experiential learning cycle, consisted of two simulated objective structured clinical examinations with standardized patients and blended teaching methods through various course modules. RESULTS A total of 39 multidisciplinary healthcare personnel completed the 6-week training program, and 32 of them participated in qualitative interviews. The IP-SDM training program effectively improved the SDM process competency of the participants from the perspectives of the participants, standardized patients, and clinical teachers. The interviews illustrated how the curriculum design enhanced learning; the effectiveness results indicated improvements in learners' attitude, knowledge, skills, and teamwork. CONCLUSION This IP-SDM training program improved multidisciplinary healthcare personnel's competency, self-efficacy, and intention to engage in IP-SDM. PRACTICE IMPLICATIONS Applying Kolb's experiential learning cycle and blended teaching methods to develop and implement the IP-SDM training program can improve multidisciplinary healthcare personnel's knowledge, attitude, skills, and teamwork in IP-SDM.
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Affiliation(s)
- Chih-Yin Hsiao
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Jeng-Cheng Wu
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Education, Taipei Medical University Hospital, Taipei, Taiwan; Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan; Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Pi-Chu Lin
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing & Graduate Institute of Nursing, Asia University, Taichung, Taiwan; Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Pang-Yuan Yang
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Faith Liao
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Humanities in Medicine, College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan; Department of Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shu-Liu Guo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wen-Hsuan Hou
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Education, Taipei Medical University Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation & Geriatrics and Gerontology, Taipei Medical University Hospital, Taipei, Taiwan; College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Klein R, Koch J, Snyder ED, Volerman A, Simon W, Jassal SK, Cosco D, Cioletti A, Ufere NN, Burnett-Bowie SAM, Palamara K, Schaeffer S, Julian KA, Thompson V. Association of Gender and Race/Ethnicity with Internal Medicine In-Training Examination Performance in Graduate Medical Education. J Gen Intern Med 2022; 37:2194-2199. [PMID: 35710653 PMCID: PMC9296734 DOI: 10.1007/s11606-022-07597-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Disparities in objective assessments in graduate medical education such as the In-Training Examination (ITE) that disadvantage women and those self-identifying with race/ethnicities underrepresented in medicine (URiM) are of concern. OBJECTIVE Examine ITE trends longitudinally across post-graduate year (PGY) with gender and race/ethnicity. DESIGN Longitudinal analysis of resident ITE metrics at 7 internal medicine residency programs, 2014-2019. ITE trends across PGY of women and URiM residents compared to non-URiM men assessed via ANOVA. Those with ITE scores associated with less than 90% probability of passing the American Board of Internal Medicine certification exam (ABIM-CE) were identified and odds of being identified as at-risk between groups were assessed with chi square. PARTICIPANTS A total of 689 IM residents, including 330 women and URiM residents (48%). MAIN MEASURES ITE score KEY RESULTS: There was a significant difference in ITE score across PGY for women and URiM residents compared to non-URiM men (F(2, 1321) 4.46, p=0.011). Adjusting for program, calendar year, and baseline ITE, women and URiM residents had smaller ITE score gains (adjusted mean change in score between PGY1 and PGY3 (se), non-URiM men 13.1 (0.25) vs women and URiM residents 11.4 (0.28), p<0.001). Women and URiM residents had greater odds of being at potential risk for not passing the ABIM-CE (OR 1.75, 95% CI 1.10 to 2.78) with greatest odds in PGY3 (OR 3.13, 95% CI 1.54 to 6.37). CONCLUSION Differences in ITE over training were associated with resident gender and race/ethnicity. Women and URiM residents had smaller ITE score gains across PGY translating into greater odds of potentially being seen as at-risk for not passing the ABIM-CE. Differences in ITE over training may reflect differences in experiences of women and URiM residents during training and may lead to further disparities.
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Affiliation(s)
- Robin Klein
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Emory University School of Medicine, 49 Jesse Hill Jr Dr, Atlanta, GA, 30303, USA.
| | - Jennifer Koch
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Erin D Snyder
- Department of Medicine, University of Alabama Birmingham School of Medicine, Birmingham, AL, USA
| | - Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, IL, USA
| | - Wendy Simon
- Department of Medicine, University of California, Los Angeles, Los Angeles, USA
| | - Simerjot K Jassal
- Department of Medicine, VA San Diego Healthcare System, University of California, San Diego, San Diego, USA
| | - Dominique Cosco
- Department of Medicine, Washington University St. Louis, St. Louis, USA
| | - Anne Cioletti
- Department of Medicine, University of Utah, Salt Lake City, USA
| | - Nneka N Ufere
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Kerri Palamara
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Schaeffer
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Katherine A Julian
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Vanessa Thompson
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Cheong CWS, Quah ELY, Chua KZY, Lim WQ, Toh RQE, Chiang CLL, Ng CWH, Lim EG, Teo YH, Kow CS, Vijayprasanth R, Liang ZJ, Tan YKI, Tan JRM, Chiam M, Lee ASI, Ong YT, Chin AMC, Wijaya L, Fong W, Mason S, Krishna LKR. Post graduate remediation programs in medicine: a scoping review. BMC MEDICAL EDUCATION 2022; 22:294. [PMID: 35443679 PMCID: PMC9020048 DOI: 10.1186/s12909-022-03278-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the importance of the 'deliberate practice of improving performance through practising beyond one's comfort level under guidance'. However, variations in physician, program, contextual and healthcare and educational systems complicate efforts to create a consistent approach to remediation. Balancing the inevitable disparities in approaches and settings with the need for continuity and effective oversight of the remediation process, as well as the context and population specific nature of remediation, this review will scrutinise the remediation of physicians in training to better guide the design, structuring and oversight of new remediation programs. METHODS Krishna's Systematic Evidence Based Approach is adopted to guide this Systematic Scoping Review (SSR in SEBA) to enhance the transparency and reproducibility of this review. A structured search for articles on remediation programs for licenced physicians who have completed their pre-registration postings and who are in training positions published between 1st January 1990 and 31st December 2021 in PubMed, Scopus, ERIC, Google Scholar, PsycINFO, ASSIA, HMIC, DARE and Web of Science databases was carried out. The included articles were concurrently thematically and content analysed using SEBA's Split Approach. Similarities in the identified themes and categories were combined in the Jigsaw Perspective and compared with the tabulated summaries of included articles in the Funnelling Process to create the domains that will guide discussions. RESULTS The research team retrieved 5512 abstracts, reviewed 304 full-text articles and included 101 articles. The domains identified were characteristics, indications, frameworks, domains, enablers and barriers and unique features of remediation in licenced physicians in training programs. CONCLUSION Building upon our findings and guided by Hauer et al. approach to remediation and Taylor and Hamdy's Multi-theories Model, we proffer a theoretically grounded 7-stage evidence-based remediation framework to enhance understanding of remediation in licenced physicians in training programs. We believe this framework can guide program design and reframe remediation's role as an integral part of training programs and a source of support and professional, academic, research, interprofessional and personal development.
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Affiliation(s)
- Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Wei Qiang Lim
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Rachelle Qi En Toh
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Christine Li Ling Chiang
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Caleb Wei Hao Ng
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Elijah Gin Lim
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Cheryl Shumin Kow
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Raveendran Vijayprasanth
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Zhen Jonathan Liang
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Yih Kiat Isac Tan
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Javier Rui Ming Tan
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Blk MD6, Centre, 14 Medical Dr, #05-01 for Translational Medicine, Singapore, 117599 Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854 Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA UK
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597 Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436 Singapore
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Mills LM, Boscardin C, Joyce EA, Ten Cate O, O'Sullivan PS. Emotion in remediation: A scoping review of the medical education literature. MEDICAL EDUCATION 2021; 55:1350-1362. [PMID: 34355413 DOI: 10.1111/medu.14605] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Remediation can be crucial and high stakes for medical learners, and experts agree it is often not optimally conducted. Research from other fields indicates that explicit incorporation of emotion improves education because of emotion's documented impacts on learning. Because this could present an important opportunity for improving remediation, we aimed to investigate how the literature on remediation interventions in medical education discusses emotion. METHODS The authors used Arksey and O'Malley's framework to conduct a scoping literature review of records describing remediation interventions in medical education, using PubMed, CINAHL Complete, ERIC, Web of Science and APA PsycInfo databases, including all English-language publications through 1 May 2020 meeting search criteria. They included publications discussing remediation interventions either empirically or theoretically, pertaining to physicians or physician trainees of any level. Two independent reviewers used a standardised data extraction form to report descriptive information; they reviewed included records for the presence of mentions of emotion, described the mentions and analysed results thematically. RESULTS Of 1644 records, 199 met inclusion criteria and were reviewed in full. Of those, 112 (56%) mentioned emotion in some way; others focused solely on cognitive aspects of remediation. The mentions of emotion fell into three themes based on when the emotion was cited as present: during regular coursework or practice, upon referral for remediation and during remediation. One-quarter of records (50) indicated potential intentional incorporation of emotion into remediation programme design, but they were non-specific as to how emotions related to the learning process itself. CONCLUSION Even though emotion is omnipresent in remediation, medical educators frequently do not factor emotion into the design of remediation approaches and rarely explicitly utilise emotion to improve the learning process. Applications from other fields may help medical educators leverage emotion to improve learning in remediation, including strategies to frame and design remediation.
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Affiliation(s)
- Lynnea M Mills
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Christy Boscardin
- Department of Anaesthesia and Perioperative Care and Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth A Joyce
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Patricia S O'Sullivan
- Departments of Medicine and Surgery, University of California, San Francisco, San Francisco, CA, USA
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Price T, Wong G, Withers L, Wanner A, Cleland J, Gale T, Prescott-Clements L, Archer J, Bryce M, Brennan N. Optimising the delivery of remediation programmes for doctors: A realist review. MEDICAL EDUCATION 2021; 55:995-1010. [PMID: 33772829 DOI: 10.1111/medu.14528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 05/15/2023]
Abstract
CONTEXT Medical underperformance puts patient safety at risk. Remediation, the process that seeks to 'remedy' underperformance and return a doctor to safe practice, is therefore a crucially important area of medical education. However, although remediation is used in health care systems globally, there is limited evidence for the particular models or strategies employed. The purpose of this study was to conduct a realist review to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety. METHOD We conducted a realist literature review consistent with RAMESES standards. We developed a programme theory of remediation by carrying out a systematic search of the literature and through regular engagement with a stakeholder group. We searched bibliographic databases (MEDLINE, EMBASE, PsycINFO, HMIC, CINAHL, ERIC, ASSIA and DARE) and conducted purposive supplementary searches. Relevant sections of text relating to the programme theory were extracted and synthesised using a realist logic of analysis to identify context-mechanism-outcome configurations (CMOcs). RESULTS A 141 records were included. The majority of the studies were from North America (64%). 29 CMOcs were identified. Remediation programmes are effective when a doctor's insight and motivation are developed and behaviour change reinforced. Insight can be developed by providing safe spaces, using advocacy to promote trust and framing feedback sensitively. Motivation can be enhanced by involving the doctor in remediation planning, correcting causal attribution, goal setting and destigmatising remediation. Sustained change can be achieved by practising new behaviours and skills, and through guided reflection. CONCLUSION Remediation can work when it creates environments that trigger behaviour change mechanisms. Our evidence synthesis provides detailed recommendations on tailoring implementation and design strategies to improve remediation interventions for doctors.
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Affiliation(s)
- Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Geoff Wong
- Nuffield Department of Primary Care, Health Sciences, University of Oxford, Oxford, UK
| | | | - Amanda Wanner
- NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), Community and Primary Care Research Group, University of Plymouth, Plymouth, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Tom Gale
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Julian Archer
- Faculty of Medicine, Nursing and Healthcare, Monash University, Melbourne, Vic., Australia
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
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To H, Cargill A, Tobin S, Nestel D. Remediation of Underperformance in Surgical Trainees - A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2021; 78:1111-1122. [PMID: 33139216 DOI: 10.1016/j.jsurg.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/14/2020] [Accepted: 10/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Surgical trainees with significant underperformance require formal support to return to an expected standard, termed remediation. The aim of this scoping review was to define remediation interventions, approaches, and contexts. DESIGN Following scoping review protocols, we set out to identify the evidence-base for remediation of surgical trainees, outline key concepts and uncover areas to stimulate further research. RESULTS From a screen of 80 articles, 24 reported on remediation of surgical trainees. Most were from medical journals (n = 21, 88%) and published in the United States (n = 20, 83%). Ten articles (41%) reported outcomes of remediation of a trainee cohort and 7 (19%) were survey reports from surgical directors. The remainder were a mix of commentaries, editorials or reviews. Thirteen articles (54%) described trainees with deficiencies in multiple competencies, 8 articles (33%) had a singular focus on academic performance, and 1 article (3%) on technical skills. All articles used targeted individualized remediation strategies, a range of intervention methods (some multimodal) and recommended a 6- to 12-month period of remediation (n = 7, 29%). The program director was often the only supervisor (n = 12, 50%). One article reported trainees' perspective of the process and one used educational theory to inform remediation. CONCLUSIONS Data with clearly reported outcomes were limited, but we found that targeted, individualized, multimodal and long-term remediation covering a range of competencies have been reported in the literature for surgical trainees. There is a need for development of explicit frameworks, strengthen the support for supervisors and trainees and further apply educational theory to develop better interventions that remediate deficiencies for all competencies.
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Affiliation(s)
- Henry To
- University of Melbourne, Parkville, Australia.
| | | | - Stephen Tobin
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Debra Nestel
- Department of Surgery (Austin), University of Melbourne, Heidelberg, Australia; Monash Institute for Health & Clinical Education, Monash University, Clayton, Australia
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11
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Price T, Brennan N, Wong G, Withers L, Cleland J, Wanner A, Gale T, Prescott-Clements L, Archer J, Bryce M. Remediation programmes for practising doctors to restore patient safety: the RESTORE realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
An underperforming doctor puts patient safety at risk. Remediation is an intervention intended to address underperformance and return a doctor to safe practice. Used in health-care systems all over the world, it has clear implications for both patient safety and doctor retention in the workforce. However, there is limited evidence underpinning remediation programmes, particularly a lack of knowledge as to why and how a remedial intervention may work to change a doctor’s practice.
Objectives
To (1) conduct a realist review of the literature to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety; and (2) provide recommendations on tailoring, implementation and design strategies to improve remediation interventions for doctors.
Design
A realist review of the literature underpinned by the Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.
Data sources
Searches of bibliographic databases were conducted in June 2018 using the following databases: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Education Resources Information Center, Database of Abstracts of Reviews of Effects, Applied Social Sciences Index and Abstracts, and Health Management Information Consortium. Grey literature searches were conducted in June 2019 using the following: Google Scholar (Google Inc., Mountain View, CA, USA), OpenGrey, NHS England, North Grey Literature Collection, National Institute for Health and Care Excellence Evidence, Electronic Theses Online Service, Health Systems Evidence and Turning Research into Practice. Further relevant studies were identified via backward citation searching, searching the libraries of the core research team and through a stakeholder group.
Review methods
Realist review is a theory-orientated and explanatory approach to the synthesis of evidence that seeks to develop programme theories about how an intervention produces its effects. We developed a programme theory of remediation by convening a stakeholder group and undertaking a systematic search of the literature. We included all studies in the English language on the remediation of practising doctors, all study designs, all health-care settings and all outcome measures. We extracted relevant sections of text relating to the programme theory. Extracted data were then synthesised using a realist logic of analysis to identify context–mechanism–outcome configurations.
Results
A total of 141 records were included. Of the 141 studies included in the review, 64% related to North America and 14% were from the UK. The majority of studies (72%) were published between 2008 and 2018. A total of 33% of articles were commentaries, 30% were research papers, 25% were case studies and 12% were other types of articles. Among the research papers, 64% were quantitative, 19% were literature reviews, 14% were qualitative and 3% were mixed methods. A total of 40% of the articles were about junior doctors/residents, 31% were about practicing physicians, 17% were about a mixture of both (with some including medical students) and 12% were not applicable. A total of 40% of studies focused on remediating all areas of clinical practice, including medical knowledge, clinical skills and professionalism. A total of 27% of studies focused on professionalism only, 19% focused on knowledge and/or clinical skills and 14% did not specify. A total of 32% of studies described a remediation intervention, 16% outlined strategies for designing remediation programmes, 11% outlined remediation models and 41% were not applicable. Twenty-nine context–mechanism–outcome configurations were identified. Remediation programmes work when they develop doctors’ insight and motivation, and reinforce behaviour change. Strategies such as providing safe spaces, using advocacy to develop trust in the remediation process and carefully framing feedback create contexts in which psychological safety and professional dissonance lead to the development of insight. Involving the remediating doctor in remediation planning can provide a perceived sense of control in the process and this, alongside correcting causal attribution, goal-setting, destigmatising remediation and clarity of consequences, helps motivate doctors to change. Sustained change may be facilitated by practising new behaviours and skills and through guided reflection.
Limitations
Limitations were the low quality of included literature and limited number of UK-based studies.
Future work
Future work should use the recommendations to optimise the delivery of existing remediation programmes for doctors in the NHS.
Study registration
This study is registered as PROSPERO CRD42018088779.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Jennifer Cleland
- Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Amanda Wanner
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Thomas Gale
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Julian Archer
- Medicine, Nursing and Health Sciences Education Portfolio, Monash University, Melbourne, VIC, Australia
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
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Cassidy DJ, Chakraborty S, Panda N, McKinley SK, Mansur A, Hamdi I, Mullen J, Petrusa E, Phitayakorn R, Gee D. The Surgical Knowledge "Growth Curve": Predicting ABSITE Scores and Identifying "At-Risk" Residents. JOURNAL OF SURGICAL EDUCATION 2021; 78:50-59. [PMID: 32694087 DOI: 10.1016/j.jsurg.2020.06.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Resident performance on the American Board of Surgery In-Training Examination (ABSITE) is used for evaluation of surgical knowledge and guides resident selection for institutional remediation programs. Remediation thresholds have historically been based on ABSITE percentile scores; however, this does not account for predictors that can impact a resident's exam performance. We sought to identify predictors of yearly ABSITE performance to help identify residents "at-risk" for performing below their expected growth trajectory. DESIGN The knowledge of the residents, as measured by standardized ABSITE scores, was modeled as a function of the corresponding postgraduate year via a linear mixed effects regression model. Additional model covariates included written USMLE-1-3 examination scores, gender, number of practice questions completed, and percentage correct of practice questions. For each resident, the predicted ABSITE standard score along with a 95% bootstrap prediction interval was obtained. Both resident-specific and population-level predictions for ABSITE standard scores were also estimated. SETTING The study was conducted at a single, large academic medical center (Massachusetts General Hospital, Boston, MA). PARTICIPANTS Six years of general surgery resident score reports at a single institution between 2014 and 2019 were deidentified and analyzed. RESULTS A total of 376 score reports from 130 residents were analyzed. Covariates that had a significant effect on the model included USMLE-1 score (PGY1: p = 0.013; PGY2: p = 0.007; PGY3: p = 0.011), USMLE-2 score (PGY1: p < 0.001; PGY2: p < 0.001; PGY3: p < 0.001; PGY4: p < 0.001; PGY5: p = 0.032), male gender (PGY1: p = 0.003; PGY2: p < 0.001; PGY3: p < 0.001; PGY4: p = 0.008), and number of practice questions completed (p=0.003). Five residents were identified as having "fallen off" their predicted knowledge curve, including a single resident on 2 occasions. Population prediction curves were obtained at 7 different covariate percentile levels (5%, 10%, 25%, 50%, 75%, 90%, and 95%) that could be used to plot predicted resident knowledge progress. CONCLUSION Performance on USMLE-1 and -2 examinations, male gender, and number of practice questions completed were positive predictors of ABSITE performance. Creating residency-wide knowledge growth curves as well as individualized predictive ABSITE performance models allows for more efficient identification of residents potentially at risk for poor ABSITE performance and structured monitoring of surgical knowledge progression.
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Affiliation(s)
- Douglas J Cassidy
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Saptarshi Chakraborty
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - Nikhil Panda
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Arian Mansur
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Isra Hamdi
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Denise Gee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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13
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Williams TP, Hancock KJ, Klimberg VS, Radhakrishnan RS, Tyler DS, Perez A. Learning to Read: Successful Program-Based Remediation Using the Surgical Council on Resident Education (SCORE) Curriculum. J Am Coll Surg 2020; 232:397-403. [PMID: 33385566 DOI: 10.1016/j.jamcollsurg.2020.11.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Surgical Council on Resident Education (SCORE) curriculum is aligned with the American Board of Surgery (ABS) objectives. Our program adopted the SCORE curriculum in 2015 after poor ABS In-Training Examination (ABSITE) performance and lowest quartile ABS Certifying Exam (CE) and Qualifying Exam (QE) first-time pass rates. We examined the association of SCORE use with ABSITE performance and ABS board exam first-time pass rate. STUDY DESIGN At a single institution, a retrospective review of surgery residents' SCORE metrics and ABSITE percentile was conducted for academic years 2015 to 2019. Metrics analyzed on the SCORE web portal were mean total minutes and total visits per resident for all residents using SCORE that year. First-time pass rates of the ABS QE and CE were examined from 2013 to 2019. Chi-square and linear regression analysis were performed, and a 95% level of confidence was assumed (alpha = 0.05). RESULTS Yearly data from categorical general surgery residents showed a significant increase in total minutes, total visits, and ABSITE percentile. Combined first time pass rates for the ABS QE and CE significant increased from 70.8% in 2013 to 2015 to 93.9% in 2016 to 2019 (p = 0.018). CONCLUSIONS Increased longitudinal use of the SCORE curriculum was associated with programmatic improvements in ABSITE performance and ABS board exam first-time pass rate.
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Affiliation(s)
- Taylor P Williams
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Kevin J Hancock
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - V Suzanne Klimberg
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | | | - Douglas S Tyler
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Alexander Perez
- Department of Surgery, University of Texas Medical Branch, Galveston, TX.
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14
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Cheun TJ, Davies MG. Improving ABSITE scores - A meta-analysis of reported remediation models. Am J Surg 2020; 220:1557-1565. [DOI: 10.1016/j.amjsurg.2020.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
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15
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Dokmak A, Radwan A, Halpin M, Jaber BL, Nader C. Design and implementation of an academic enrichment program to improve performance on the internal medicine in-training exam. MEDICAL EDUCATION ONLINE 2020; 25:1686950. [PMID: 31707925 PMCID: PMC6853221 DOI: 10.1080/10872981.2019.1686950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/20/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Abstract
The internal medicine In-Training Exam (ITE) is administered at residency training programs to assess medical knowledge. Our internal medicine residency program witnessed a performance decline on the ITE between 2011 and 2014. The goal of this quality improvement project was to improve medical knowledge among residents as measured by an improvement in performance on the ITE, through the design and implementation of an Academic Enrichment Program (AEP). The AEP was designed in 2014-2015, and entailed a multipronged approach, including strengthening and tailoring of the didactic curriculum, establishment of a minimum conference attendance rate, and adoption of the New England Journal of Medicine Knowledge-Plus Internal Medicine Board Review platform. Residents performing below a pre-specified percentile rank cutoff on the previous year's ITE in any of the 12 content areas were required to complete a pre-specified percentage of the question bank in that specific topic. We examined a total of 164 residents enrolled in our program under the categorical training track. The mean (± SEM) ITE percentile for the 12 content areas increased significantly from calendar years 2011-2014 to 2015-2018, reflecting implementation of the AEP (p < 0.001). In brief, compared to the AEP-unexposed graduating classes of residents, the AEP-exposed graduating classes of residents displayed a significant improvement in the mean ITE percentile rank. This quality improvement project was carried out at a single institution. The implementation of a structured academic enrichment program significantly improves performance on the ITE.
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Affiliation(s)
- Amr Dokmak
- Department of Medicine, St Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Amr Radwan
- Department of Medicine, St Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Meredith Halpin
- Division of Hematology & Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Bertrand L. Jaber
- Department of Medicine, St Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Claudia Nader
- Department of Medicine, St Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA, USA
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16
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Al-Sheikhly D, Östlundh L, Arayssi T. Remediation of learners struggling with communication skills: a systematic review. BMC MEDICAL EDUCATION 2020; 20:215. [PMID: 32646405 PMCID: PMC7350558 DOI: 10.1186/s12909-020-02074-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Communication skills is a core area of competency for healthcare practitioners. However, trainees deficient in those skills are not identified early enough to address the deficiency. Furthermore, faculty often struggle to identify effective remediation strategies for those who fail to meet expectations. We undertook a systematic review to determine which assessment methods are appropriate to identify learners that struggle with communication skills and the strategies used to remediate them. METHODS The literature was searched from January 1998 through to May 2019 using academic databases and grey literature. Trainees were defined as healthcare practitioners in undergraduate, graduate and continuing education. Characteristics of studies, assessment and intervention strategies and outcomes were synthesized qualitatively and summarized in tables. RESULTS From an initial 1636 records, 16 (1%) studies met the review criteria. Majority of the learners were medical students. A few studies (44%) included students from other disciplines, residents and physicians in practice. The remediation programs, in the studies, ranged from 1 week to 1 year. Around half of the studies focused solely on learners struggling with communication skills. The majority of studies used a format of a clinical OSCE to identify struggling learners. None of the studies had a single intervention strategy with the majority including an experiential component with feedback. CONCLUSIONS A few studies collectively described the diagnosis, remediation intervention and the assessment of the outcomes of remediation of communication skills. For a remediation strategy to be successful it is important to ensure: (i) early identification and diagnosis, (ii) the development of an individualized plan and (iii) providing reassessment with feedback to the learner.
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Affiliation(s)
- Deema Al-Sheikhly
- Division of Continuing Professional Development, Weill Cornell Medicine - Qatar, Doha, Qatar.
| | - Linda Östlundh
- National Medical Library, United Arab Emirates University, Al-Ain, UAE
| | - Thurayya Arayssi
- Medical Education and Continuing Professional Development, Weill Cornell Medicine - Qatar, Doha, Qatar
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Lacasse M, Audétat MC, Boileau É, Caire Fon N, Dufour MH, Laferrière MC, Lafleur A, La Rue È, Lee S, Nendaz M, Paquette Raynard E, Simard C, Steinert Y, Théorêt J. Interventions for undergraduate and postgraduate medical learners with academic difficulties: A BEME systematic review: BEME Guide No. 56. MEDICAL TEACHER 2019; 41:981-1001. [PMID: 31081426 DOI: 10.1080/0142159x.2019.1596239] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background: Clinical teachers often struggle to report unsatisfactory trainee performance, partly because of a lack of evidence-based remediation options. Objectives: To identify interventions for undergraduate (UG) and postgraduate (PG) medical learners experiencing academic difficulties, link them to a theory-based framework and provide literature-based recommendations around their use. Methods: This systematic review searched MEDLINE, CINAHL, EMBASE, ERIC, Education Source and PsycINFO (1990-2016) combining these concepts: medical education, professional competence/difficulty and educational support. Original research/innovation reports describing intervention(s) for UG/PG medical learners with academic difficulties were included. Data extraction employed Michie's Behavior Change Techniques (BCT) Taxonomy and program evaluation models from Stufflebeam and Kirkpatrick. Quality appraisal used the Mixed Methods Appraisal Tool (MMAT). The authors synthesized extracted evidence by adapting the GRADE approach to formulate recommendations. Results: Sixty-eight articles met the inclusion criteria, most commonly addressing knowledge (66.2%), skills (53.9%) and attitudinal problems (26.2%), or learner personal issues (41.5%). The most common BCTs were Shaping knowledge, Feedback/monitoring, and Repetition/substitution. Quality appraisal was variable (MMAT 0-100%). A thematic content analysis identified 109 interventions (UG: n = 84, PG: n = 58), providing 24 strong, 48 moderate, 26 weak and 11 very weak recommendations. Conclusion: This review provides a repertoire of literature-based interventions for teaching/learning, faculty development, and research purposes.
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Affiliation(s)
- Miriam Lacasse
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
| | - Marie-Claude Audétat
- Department of Family Medicine and Emergency Medicine, Université de Montréal , Montreal , Canada
- Family Medicine Unit (UIGP), University of Geneva , Geneva , Switzerland
- Department of Family and Emergency Medicine, Université de Sherbrooke , Sherbrooke , Canada
| | | | - Nathalie Caire Fon
- Department of Family Medicine and Emergency Medicine, Université de Montréal , Montreal , Canada
| | - Marie-Hélène Dufour
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
| | | | | | - Ève La Rue
- Department of Family and Community Medicine, University of Toronto , Toronto , Canada
| | - Shirley Lee
- Unit of Development and Research (UDREM), University of Geneva , Geneva , Switzerland
- Canadian Medical Protective Association , Ottawa , Canada
| | - Mathieu Nendaz
- Family Medicine Unit (UIGP), University of Geneva , Geneva , Switzerland
- Department of Medicine, University Hospitals , Geneva , Switzerland
| | | | - Caroline Simard
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
| | - Yvonne Steinert
- Institute of Health Sciences Education, Faculty of Medicine, McGill University , Montreal , Canada
| | - Johanne Théorêt
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
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Wasicek PJ, Wise ES, Kavic SM. A Structured Remediation Program Results in Durable Improvement of American Board of Surgery In-Training Examination (ABSITE®) Performance. Am Surg 2019. [DOI: 10.1177/000313481908500624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to assess the results of a structured remediation program for surgical residents scoring poorly on the American Board of Surgery In-Training Examination®. Residents scoring below the threshold (<20th percentile) were placed in a remediation program consisting of textbook-based review and mandatory weekly quizzes overseen by the program director. The effects of the program were assessed over a five-year period (2014-2018). Of 168 tests taken, 23 (13.7%) instances of scoring below the threshold occurred (average percentile 11, range 1–19). Postremediation scores in the subsequent year improved with a median (IQR) percentile increase of 29 [23.5, 46] ( P < 0.001). Two residents scored below the threshold twice; all others continued to score above the threshold. Participation in a structured remediation program results in dramatic improvement in American Board of Surgery In-Training Examination® performance, and a single occurrence of poor performance does not necessarily lead to a permanent handicap in academic performance.
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Affiliation(s)
- Philip J. Wasicek
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Eric S. Wise
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Stephen M. Kavic
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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19
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Shah V, Dileep A, Dickens C, Groo V, Welland B, Field J, Baumann M, Flores JD, Shroff A, Zhao Z, Yao Y, Wilkie DJ, Boyd AD. Patient-Centered Tablet Application for Improving Medication Adherence after a Drug-Eluting Stent. Front Public Health 2016; 4:272. [PMID: 28018897 PMCID: PMC5149519 DOI: 10.3389/fpubh.2016.00272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/28/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND/AIMS This study's objective was to evaluate a patient-centered educational electronic tablet application, "My Interventional Drug-Eluting Stent Educational App" (MyIDEA) to see if there was an increase in patient knowledge about dual antiplatelet therapy (DAPT) and medication possession ratio (MPR) compared to treatment as usual. METHODS In a pilot project, 24 elderly (≥50 years old) research participants were recruited after a drug-eluting stent. Eleven were randomized to the control arm and 13 to the interventional arm. All the participants completed psychological and knowledge questionnaires. Adherence was assessed through MPR, which was calculated at 3 months for all participants who were scheduled for second and third follow-up visits. RESULTS Relative to control, the interventional group had a 10% average increase in MPR. As compared to the interventional group, more patients in the control group had poor adherence (<80% MPR). The psychological data revealed a single imbalance in anxiety between the control and interventional groups. On average, interventional participants spent 21 min using MyIDEA. DISCUSSION Consumer health informatics has enabled us to engage patients with their health data using novel methods. Consumer health technology needs to focus more on patient knowledge and engagement to improve long-term health. MyIDEA takes a unique approach in targeting DAPT from the onset. CONCLUSION MyIDEA leverages patient-centered information with clinical care and the electronic health record highlighting the patients' role as a team member in their own health care. The patients think critically about adverse events and how to solve issues before leaving the hospital.
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Affiliation(s)
- Vicki Shah
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago , Chicago, IL , USA
| | - Anandu Dileep
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago , Chicago, IL , USA
| | - Carolyn Dickens
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA; Division of Cardiology, Department of Internal Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Vicki Groo
- Division of Cardiology, Department of Internal Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA; Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Betty Welland
- University of Illinois at Chicago , Chicago, IL , USA
| | - Jerry Field
- University of Illinois at Chicago , Chicago, IL , USA
| | | | - Jose D Flores
- University of Illinois at Chicago , Chicago, IL , USA
| | - Adhir Shroff
- Division of Cardiology, Department of Internal Medicine, College of Medicine, University of Illinois at Chicago , Chicago, IL , USA
| | - Zhongsheng Zhao
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago , Chicago, IL , USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, University of Florida , Gainesville, FL , USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, University of Florida , Gainesville, FL , USA
| | - Andrew D Boyd
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago , Chicago, IL , USA
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Ferrell BT, Tankersley WE, Morris CD. Using an Accountability Program to Improve Psychiatry Resident Scores on In-Service Examinations. J Grad Med Educ 2015; 7:555-9. [PMID: 26692966 PMCID: PMC4675411 DOI: 10.4300/jgme-d-14-00722.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The Psychiatry Resident-In-Training Examination (PRITE) is a standardized examination that measures residents' educational progress during residency training. It also serves as a moderate-to-strong predictor of later performance on the board certification examination. OBJECTIVE This study evaluated the effectiveness of an accountability program used by a public psychiatric hospital to increase its residents' PRITE scores. METHODS A series of consequences and incentives were developed based on levels of PRITE performance. Poor performance resulted in consequences, including additional academic assignments. Higher performance led to residents earning external moonlighting privileges. Standardized PRITE scores for all residents (N = 67) over a 10-year period were collected and analyzed. The PRITE examination consists of 2 subscales-psychiatry and neurology. Change in the overall level of PRITE scores following the implementation of the accountability program was estimated using a discontinuous growth curve model for each subscale. RESULTS Standardized scores on the psychiatry subscale were 51.09 points, approximately 0.50 SD change, which was higher after the accountability program was implemented. Standardized scores on the neurology subscale did not change. CONCLUSIONS An accountability program that assigns consequences based on examination performance may be moderately successful in improving scores on the psychiatry subscale scores of the PRITE. This likely has longer-term benefits for residents due to the relationship between PRITE and board certification examination performance.
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Affiliation(s)
| | - William E. Tankersley
- Corresponding author: William E. Tankersley, MD, Children's Recovery Center, 320 12th Avenue NE, Norman, OK 73071, 405.684.7262,
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Boyd AD, Moores K, Shah V, Sadhu E, Shroff A, Groo V, Dickens C, Field J, Baumann M, Welland B, Gutowski G, Flores JD, Zhao Z, Bahroos N, Hynes DM, Wilkie DJ. My Interventional Drug-Eluting Stent Educational App (MyIDEA): Patient-Centered Design Methodology. JMIR Mhealth Uhealth 2015; 3:e74. [PMID: 26139587 PMCID: PMC4526975 DOI: 10.2196/mhealth.4021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 05/11/2015] [Accepted: 05/30/2015] [Indexed: 11/13/2022] Open
Abstract
Background Patient adherence to medication regimens is critical in most chronic disease treatment plans. This study uses a patient-centered tablet app, “My Interventional Drug-Eluting Stent Educational App (MyIDEA).” This is an educational program designed to improve patient medication adherence. Objective Our goal is to describe the design, methodology, limitations, and results of the MyIDEA tablet app. We created a mobile technology-based patient education app to improve dual antiplatelet therapy adherence in patients who underwent a percutaneous coronary intervention and received a drug-eluting stent. Methods Patient advisers were involved in the development process of MyIDEA from the initial wireframe to the final launch of the product. The program was restructured and redesigned based on the patient advisers’ suggestions as well as those from multidisciplinary team members. To accommodate those with low health literacy, we modified the language and employed attractive color schemes to improve ease of use. We assumed that the target patient population may have little to no experience with electronic tablets, and therefore, we designed the interface to be as intuitive as possible. Results The MyIDEA app has been successfully deployed to a low-health-literate elderly patient population in the hospital setting. A total of 6 patients have interacted with MyIDEA for an average of 17.6 minutes/session. Conclusions Including patient advisers in the early phases of a mobile patient education development process is critical. A number of changes in text order, language, and color schemes occurred to improve ease of use. The MyIDEA program has been successfully deployed to a low-health-literate elderly patient population. Leveraging patient advisers throughout the development process helps to ensure implementation success.
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Affiliation(s)
- Andrew Dallas Boyd
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, United States.
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Kim RH, Tan TW. Interventions that affect resident performance on the American Board of Surgery In-Training Examination: a systematic review. JOURNAL OF SURGICAL EDUCATION 2015; 72:418-429. [PMID: 25456409 DOI: 10.1016/j.jsurg.2014.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/10/2014] [Accepted: 09/25/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To systematically review the published literature on the effectiveness of interventions intended to improve residents' American Board of Surgery In-Training Examination (ABSITE) performances. DESIGN A systematic review was conducted by 2 independent investigators to identify all publications that examined the effect of specific interventions on residents' ABSITE performances from 1975 to 2013. RESULTS Overall, 26 published articles met study criteria. Structured reading programs and setting clear expectations with mandatory remedial programs were consistently effective in improving ABSITE performance, whereas the effect of didactic teaching conferences and problem-based learning groups was mixed. There was marked heterogeneity in the usage of study designs and reporting of results. CONCLUSIONS Structured reading programs and mandatory remedial programs appear to be consistently effective measures that can improve residents' ABSITE performances. There is a need for improved study design and reporting in future research conducted in this field.
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Affiliation(s)
- Roger H Kim
- Department of Surgery, Louisiana State University Health Sciences Center in Shreveport, Shreveport, Louisiana.
| | - Tze-Woei Tan
- Department of Surgery, Louisiana State University Health Sciences Center in Shreveport, Shreveport, Louisiana
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Webb TP, Paul J, Treat R, Codner P, Anderson R, Redlich P. Surgery residency curriculum examination scores predict future American Board of Surgery in-training examination performance. JOURNAL OF SURGICAL EDUCATION 2014; 71:743-747. [PMID: 24776858 DOI: 10.1016/j.jsurg.2014.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 01/31/2014] [Accepted: 02/18/2014] [Indexed: 06/03/2023]
Abstract
IMPORTANCE A protected block curriculum (PBC) with postcurriculum examinations for all surgical residents has been provided to assure coverage of core curricular topics. Biannual assessment of resident competency will soon be required by the Next Accreditation System. OBJECTIVE To identify opportunities for early medical knowledge assessment and interventions, we examined whether performance in postcurriculum multiple-choice examinations (PCEs) is predictive of performance in the American Board of Surgery In-Training Examination (ABSITE) and clinical service competency assessments. DESIGN Retrospective single-institutional education research study. SETTING Academic general surgery residency program. PARTICIPANTS A total of 49 surgical residents. INTERVENTION Data for PGY1 and PGY2 residents participating in the 2008 to 2012 PBC are included. Each resident completed 6 PCEs during each year. MAIN OUTCOME MEASURES The results of 6 examinations were correlated to percentage-correct ABSITE scores and clinical assessments based on the 6 Accreditation Council for Graduate Medical Education core competencies. Individual ABSITE performance was compared between PGY1 and PGY2. Statistical analysis included multivariate linear regression and bivariate Pearson correlations. RESULTS A total of 49 residents completed the PGY1 PBC and 36 completed the PGY2 curriculum. Linear regression analysis of percentage-correct ABSITE and PCE scores demonstrated a statistically significant correlation between the PGY1 PCE 1 score and the subsequent PGY1 ABSITE score (p = 0.037, β = 0.299). Similarly, the PGY2 PCE 1 score predicted performance in the PGY2 ABSITE (p = 0.015, β = 0.383). The ABSITE scores correlated between PGY1 and PGY2 with statistical significance, r = 0.675, p = 0.001. Performance on the 6 Accreditation Council for Graduate Medical Education core competencies correlated between PGY1 and PGY2, r = 0.729, p = 0.001, but did not correlate with PCE scores during either years. CONCLUSIONS AND RELEVANCE Within a mature PBC, early performance in a PGY1 and PGY2 PCE is predictive of performance in the respective ABSITE. This information can be used for formative assessment and early remediation of residents who are predicted to be at risk for poor performance in the ABSITE.
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Affiliation(s)
- Travis P Webb
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Jasmeet Paul
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert Treat
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Panna Codner
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rebecca Anderson
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Philip Redlich
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Visconti A, Gaeta T, Cabezon M, Briggs W, Pyle M. Focused Board Intervention (FBI): A Remediation Program for Written Board Preparation and the Medical Knowledge Core Competency. J Grad Med Educ 2013; 5:464-7. [PMID: 24404311 PMCID: PMC3771177 DOI: 10.4300/jgme-d-12-00229.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/08/2013] [Accepted: 02/04/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residents deemed at risk for low performance on standardized examinations require focused attention and remediation. OBJECTIVE To determine whether a remediation program for residents identified as at risk for failure on the Emergency Medicine (EM) Written Board Examination is associated with improved outcomes. INTERVENTION All residents in 8 classes of an EM 1-3 program were assessed using the In-Training Examination. Residents enrolled in the Focused Board Intervention (FBI) remediation program based on an absolute score on the EM 3 examination of <70% or a score more than 1 SD below the national mean on the EM 1 or 2 examination. Individualized education plans (IEPs) were created for residents in the FBI program, combining self-study audio review lectures with short-answer examinations. The association between first-time pass rate for the American Board of Emergency Medicine (ABEM) Written Qualifying Examination (WQE) and completion of all IEPs was examined using the χ(2) test. RESULTS Of the 64 residents graduating and sitting for the ABEM examination between 2000 and 2008, 26 (41%) were eligible for the program. Of these, 10 (38%) residents were compliant and had a first-time pass rate of 100%. The control group (12 residents who matched criteria but graduated before the FBI program was in place and 4 who were enrolled but failed to complete the program) had a 44% pass rate (7 of 16), which was significantly lower (χ(2) = 8.6, P = .003). CONCLUSIONS The probability of passing the ABEM WQE on the first attempt was improved through the completion of a structured IEP.
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Cleland J, Leggett H, Sandars J, Costa MJ, Patel R, Moffat M. The remediation challenge: theoretical and methodological insights from a systematic review. MEDICAL EDUCATION 2013; 47:242-51. [PMID: 23398010 DOI: 10.1111/medu.12052] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Remediation is usually offered to medical students and doctors in training who underperform on written or clinical examinations. However, there is uncertainty and conflicting evidence about the effectiveness of remediation. The aim of this systematic review was to synthesise the available evidence to clarify how and why remediation interventions may have worked in order to progress knowledge on this topic. METHODS The MEDLINE, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ERIC (Educational Resources Information Centre), Web of Science and Scopus databases were searched for papers published from 1984 to April 2012, using the search terms 'remedial teaching', 'education', 'medical', 'undergraduate'/or 'clinical clerkship'/or 'internship and residency', 'at risk' and 'struggling'. Only studies that included an intervention, then provided retest data, and reported at least one outcome measure of satisfaction, knowledge, skills or effects on patients were eligible for inclusion. Studies of practising doctors were excluded. Data were abstracted independently in duplicate for all items. Coding differences were resolved through discussion. RESULTS Thirty-one of 2113 studies met the review criteria. Most studies were published after 2000 (n=24, of which 12 were published from 2009 onwards), targeted medical students (n=22) and were designed to improve performance on an immediately subsequent examination (n=22). Control or comparison groups, conceptual frameworks, adequate sample sizes and long-term follow-up measures were rare. In studies that included long-term follow-up, improvements were not sustained. Intervention designs tended to be highly complex, but their design or reporting did not enable the identification of the active components of the remedial process. CONCLUSIONS Most remediation interventions in medical education focus on improving performance to pass a re-sit of an examination or assessment and provide no insight into what types of extra support work, or how much extra teaching is critical, in terms of developing learning. More recent studies are generally of better quality. Rigorous approaches to developing and evaluating remediation interventions are required.
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Affiliation(s)
- Jennifer Cleland
- Division of Medical and Dental Education, University of Aberdeen, Aberdeen, UK.
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Wolbrink TA, Burns JP. Internet-based learning and applications for critical care medicine. J Intensive Care Med 2011; 27:322-32. [PMID: 22173562 DOI: 10.1177/0885066611429539] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Recent changes in duty hour allowances and economic constraints are forcing a paradigm shift in graduate medical education in the United States. Internet-based learning is a rapidly growing component of postgraduate medical education, including the field of critical care medicine. Here, we define the key concepts of Internet-based learning, summarize the current literature, and describe how Internet-based learning may be uniquely suited for the critical care provider. METHODS A MEDLINE/PubMed search from January 2000 to July 2011 using the search terms: "e-learning," "Web-based learning," "computer-aided instruction," "adult learning," "knowledge retention," "intensive care," and "critical care." RESULTS The growth of the Internet is marked by the development of new technologies, including more user-derived tools. Nonmedical fields have embraced Internet-based learning as a valuable teaching tool. A recent meta-analysis described Internet-based learning in the medical field as being more effective than no intervention and likely as efficacious as traditional teaching methods. Web sites containing interactive features are aptly suited for the adult learner, complementing the paradigm shift to more learner-centered education. Interactive cases, simulators, and games may allow for improvement in clinical care. The total time spent utilizing Internet-based resources, as well as the frequency of returning to those sites, may influence educational gains. CONCLUSION Internet-based learning may provide an opportunity for assistance in the transformation of medical education. Many features of Web-based learning, including interactivity, make it advantageous for the adult medical learner, especially in the field of critical care medicine, and further work is necessary to develop a robust learning platform incorporating a variety of learning modalities for critical care providers.
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Affiliation(s)
- Traci A Wolbrink
- Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Management, Children's Hospital Boston, Boston, MA 02115, USA.
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Mukhopadhyay S, Smith S, Cresswell J. Lifelong learning in obstetrics and gynaecology: how theory can influence clinical practice. J OBSTET GYNAECOL 2011; 31:476-9. [DOI: 10.3109/01443615.2011.587050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
OBJECTIVE There is a correlation between American Board of Pediatrics In-Training and General Pediatrics Certifying Examination scores. A course targeted mainly for residents "at-risk" based on in-training scores may improve the outcome of the certification exam. The objective of the study was to evaluate the impact of a board review course on pediatric board certification scores, particularly for residents at-risk. METHODS Residents "at-risk" taking the course (Yes) were compared to residents not taking the course who were not at-risk (No) as well as to a cohort of residents predating the onset of the course with mixed risk (Comparison). Analyses compared board exam scores and passing rates in the three groups and in the subcategory of residents who scored </=300 on the in-training exam in each group. RESULTS Standard scores and pass rates were higher for the residents not at risk, middle for residents of mixed risk and lowest for residents at risk. When analyzing the subset of scores for those with in-training score of <300, the scores were higher for the residents in the course than those who never took it. Also, residents with in-training score of <300 achieved higher average point score gains when comparing the certification exam to their last in-training score. Linear regression analysis showed that not delaying board certification, third year in-training scores and taking the board review course were significantly associated with higher board certification scores. CONCLUSIONS Pediatric residents at risk for not passing their Pediatric board certification exams benefited from a board review course.
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Affiliation(s)
- Lita Aeder
- Department of Pediatrics, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY 11219, USA,
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Mukhopadhyay S, China S. Teaching and learning in the operating theatre: A framework for trainers and advanced trainees in obstetrics and gynaecology. J OBSTET GYNAECOL 2010; 30:238-40. [DOI: 10.3109/01443610903585242] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Langenau EE, Fogel J, Schaeffer HA. Correlation between an email based board review program and American Board of Pediatrics General Pediatrics Certifying Examination scores. MEDICAL EDUCATION ONLINE 2009; 14:18. [PMID: 20101279 PMCID: PMC2810095 DOI: 10.3885/meo.2009.res00321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the impact of a weekly email based board review course on individual resident performance on the American Board of Pediatrics (ABP) General Pediatrics Certifying Examination for pediatric residents and, specifically, residents with low ABP In-training Examination (ITE) scores. METHODS Weekly board-type questions were emailed to all pediatric residents from 2004-2007. Responses to board-type questions were tracked, recorded, and correlated with ITE scores and ABP General Pediatrics Certifying Examination Scores. RESULTS With regard to total number of questions answered, only total number of questions answered correctly had a significant positive correlation with standard board scores (n = 71, r = 0.24, p = 0.047). For "at risk" residents with ITE scores <or= 200 (n = 21), number of questions answered in PL 3 year (r = 0.51, p = 0.018) and number of questions answered correctly for all PL years (r = 0.59, p = 0.005) had significant positive correlations with standard board scores. CONCLUSIONS Participating regularly in the email-based board review course, answering board style questions, and answering correctly to board style questions were associated with higher standard board scores. This benefit existed for all but was especially prominent among those with poor in-training examination scores.
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Affiliation(s)
- Erik E Langenau
- Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, USA.
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