Implementation of Peer Review into a Physical Medicine and Rehabilitation Program and its Effect on Professionalism

A modified Delphi approach to nurturing professionalism in postgraduate medical education in Singapore

INTRODUCTION

Nurturing professional identities instils behavioural standards of physicians, and this in turn facilitates consistent professional attitudes, practice and patient care. Identities are socioculturally constructed efforts; therefore, we must account for the social, cultural and local healthcare factors that shape physicians' roles, responsibilities and expectations. This study aimed to forward a programme to nurture professionalism among physicians in Singapore.

METHODS

A three-phase, evidenced-based approach was used. First, a systematic scoping review (SSR) was conducted to identify professionalism elements. Second, a questionnaire was created based on the findings of the SSR. Third, a modified Delphi approach, which involved local experts to identify socioculturally appropriate elements to nurture professionalism, was used.

RESULTS

A total of 124 articles were identified from the SSR; these articles revealed definitions, knowledge, skills and approaches to nurturing professionalism. Through the modified Delphi approach, we identified professional traits, virtues, communication, ethical, self-care, teaching and assessment methods, and support mechanisms.

CONCLUSION

The results of this study formed the basis for a holistic and longitudinal programme focused on instilling professional traits and competencies over time through personalised and holistic support of physicians. The findings will be of interest to medical communities in the region and beyond.

The Senior Medical Resident's New Role in Assessment in Internal Medicine

PURPOSE

With the introduction of competency-based medical education, senior residents have taken on a new, formalized role of completing assessments of their junior colleagues. However, no prior studies have explored the role of near-peer assessment within the context of entrustable professional activities (EPAs) and competency-based medical education. This study explored internal medicine residents' perceptions of near-peer feedback and assessment in the context of EPAs.

METHOD

Semistructured interviews were conducted from September 2019 to March 2020 with 16 internal medicine residents (8 first-year residents and 8 second- and third-year residents) at the University of Toronto, Toronto, Ontario, Canada. Interviews were conducted and coded iteratively within a constructivist grounded theory approach until sufficiency was reached.

RESULTS

Senior residents noted a tension in their dual roles of coach and assessor when completing EPAs. Senior residents managed the relationship with junior residents to not upset the learner and potentially harm the team dynamic, leading to the documentation of often inflated EPA ratings. Junior residents found senior residents to be credible providers of feedback; however, they were reticent to find senior residents credible as assessors.

CONCLUSIONS

Although EPAs have formalized moments of feedback, senior residents struggled to include constructive feedback comments, all while knowing the assessment decisions may inform the overall summative decision of their peers. As a result, EPA ratings were often inflated. The utility of having senior residents serve as assessors needs to be reexamined because there is concern that this new role has taken away the benefits of having a senior resident act solely as a coach.

Instructor-led vs. peer-led debriefing in preoperative care simulation using standardized patients

BACKGROUND

Debriefing involves the active participation of learners to identify and close gaps in knowledge and skills. Varied debriefing methods are used in simulation, but no empirical studies have examined the effectiveness of peer-led debriefing in simulation using standardized patients. The purpose of this study was to compare the effects of two debriefing methods (instructor-led vs. peer-led) on nursing skills, knowledge, self-confidence, and quality of debriefing among undergraduate nursing students in South Korea.

METHOD

A nonequivalent control group pretest-posttest design was used. Fifty-seven third-year nursing students were randomly assigned to instructor-led (n = 26) or peer-led (n = 31) debriefing groups after a simulation of preoperative care. Structured questions and areas for discussion guided debriefing in both groups. Self-administered questionnaires were used to collect data on students' knowledge and self-confidence in providing preoperative care. Faculty evaluated students' nursing skills during pre- and post-simulation practice. Students evaluated the quality of the debriefings.

RESULTS

Nursing skills for preoperative care (p < .001) and the quality of debriefing (p < .001) were statistically higher in the instructor-led group compared to the peer-led group. There were no statistically significant differences in knowledge (p = .445) and self-confidence (p = .686). Knowledge and self-confidence from pre-test to posttest were improved in both groups.

CONCLUSION

The instructor-led debriefing showed improved nursing skills and higher quality debriefing. However, peer-led debriefing led by a non-trained peer also rendered positive results. Thus, peer-led debriefing may be considered a useful strategy for improving nursing students' self-confidence.

Coaching the Debriefer: Peer Coaching to Improve Debriefing Quality in Simulation Programs

STATEMENT

Formal faculty development programs for simulation educators are costly and time-consuming. Peer coaching integrated into the teaching flow can enhance an educator's debriefing skills. We provide a practical guide for the who, what, when, where, why, and how of peer coaching for debriefing in simulation-based education. Peer coaching offers advantages such as psychological safety and team building, and it can benefit both the educator who is receiving feedback and the coach who is providing it. A feedback form for effective peer coaching includes the following: (1) psychological safety, (2) framework, (3) method/strategy, (4) content, (5) learner centeredness, (6) co-facilitation, (7) time management, (8) difficult situations, (9) debriefing adjuncts, and (10) individual style and experience. Institutional backing of peer coaching programs can facilitate implementation and sustainability. Program leaders should communicate the need and benefits, establish program goals, and provide assessment tools, training, structure, and evaluation to optimize chances of success.

Resident Perceptions of Giving and Receiving Peer-to-Peer Feedback

BACKGROUND

Peer feedback is increasingly being used by residency programs to provide an added dimension to the assessment process. Studies show that peer feedback is useful, uniquely informative, and reliable compared to other types of assessments. Potential barriers to implementation include insufficient training/preparation, negative consequences for working relationships, and a perceived lack of benefit.

OBJECTIVE

We explored the perceptions of residents involved in peer-to-peer feedback, focusing on factors that influence accuracy, usefulness, and application of the information.

METHODS

Family medicine residents at the University of Michigan who were piloting an online peer assessment tool completed a brief survey to offer researchers insight into the peer feedback process. Focus groups were conducted to explore residents' perceptions that are most likely to affect giving and receiving peer feedback.

RESULTS

Survey responses were provided by 28 of 30 residents (93%). Responses showed that peer feedback provided useful (89%, 25 of 28) and unique (89%, 24 of 27) information, yet only 59% (16 of 27) reported that it benefited their training. Focus group participants included 21 of 29 eligible residents (72%). Approaches to improve residents' ability to give and accept feedback included preparatory training, clearly defined goals, standardization, fewer and more qualitatively oriented encounters, 1-on-1 delivery, immediacy of timing, and cultivation of a feedback culture.

CONCLUSIONS

Residents perceived feedback as important and offered actionable suggestions to enhance accuracy, usefulness, and application of the information shared. The findings can be used to inform residency programs that are interested in creating a meaningful peer feedback process.

A literature review of professionalism in surgical education: suggested components for development of a curriculum

BACKGROUND

While it is evident that a surgeon must master medical knowledge and technical skill, there are other "soft skills" that are essential to a successful surgeon. One of these skills is professionalism. The challenge in surgical education lies in developing an effective professionalism curriculum and a related method of evaluation.

OBJECTIVE

Our review updates the literature and provides recommendations for improving instruction and evaluation of professionalism.

DESIGN

A literature review was conducted using PubMed, Google Scholar, and Web of Knowledge. We restricted our search to documents published from 2009 to 2012 that address methods of teaching and tools for assessing professionalism in surgical education.

RESULTS

Sixty-three documents were reviewed, with 14 fitting our search criteria for professionalism in surgical education completely. Other articles focused on the topics of professionalism in surgery, medical professionalism, and professionalism education in medical specialties other than surgery.

CONCLUSIONS

Development of a professionalism curriculum for surgical residents might begin with defining professionalism in terms of tangible behaviors. The program might also include a precurriculum preparatory course and simulation-based training. Residency programs must also maintain professionalism among its faculty. Assessment in the form of multisource feedback that is consistent with observable behavioral definitions of professionalism should also be considered in evaluating resident professionalism.

Assessing physician competency: an update on the joint commission requirement for ongoing and focused professional practice evaluation

In 2008, the Joint Commission created 2 new hospital standards that revolve around competency assessment of credentialed and privileged healthcare practitioners. These are called Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE). As many pathologists work as members of a hospital medical staff, either through primary employment or contract relationships, pathology departments and groups need to have OPPE and FPPE policies in place and should be using them to evaluate physicians for competency as part of a regular cycle. There are many subtleties in the standards, and careful attention to the details of the policies will be essential. Furthermore, as credentialing and privileging decisions may be made based upon the assessments that are carried out in OPPE and FPPE, it is quite important to follow internal policies consistently. This review describes OPPE and FPPE in detail, with an analysis of the Standards and the Elements of Performance. It also provides scenarios to illustrate the concepts and charts that can be used to create OPPE and FPPE documents for a practice.