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Cecilio-Fernandes D, Carvalho DRDS, Sandars J, Santos TM. Self-regulated learning microanalysis feedback for developing clinical skills: A pilot study. MEDICAL TEACHER 2024:1-6. [PMID: 38295519 DOI: 10.1080/0142159x.2024.2308060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION The development of clinical skills requires the appropriate use of self-regulated learning (SRL). Students' use of key SRL processes as they perform a clinical skill can be identified by SRL microanalysis and used to provide feedback. SRL-microanalysis feedback only on students' key SRL processes has not been previously researched for developing clinical skills. The aim of this study was to investigate whether SRL-microanalysis feedback only on students' key SRL processes can improve both their use of SRL and their clinical skill performance. METHODS Twenty-three final year medical students with no experience in the clinical skill required for mechanical ventilation participated in this study. Key SRL processes and clinical skill performance were measured before and after SRL microanalysis feedback. RESULTS Overall, we found an improvement in the key SRL processes of planning and monitoring of performance, with a significant difference in monitoring. We also found an increase in students' clinical skill performance. DISCUSSION This study, which is the first in clinical skills, demonstrated that SRL microanalysis feedback only on key SRL processes can improve both students' SRL and their clinical skill performance. studies are recommended with a great number of students and across a variety of clinical skills.
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Affiliation(s)
- Dario Cecilio-Fernandes
- Department of Medical Psychology and Psychiatry, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - John Sandars
- Edge Hill University Medical School, Edge Hill University, Ormskirk, UK
| | - Thiago Martins Santos
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Cecilio-Fernandes D, Medina-Ramírez R, Sandars J, Costa MJ. Self-regulated learning processes across different physiotherapy clinical procedural skills and time intervals: A SRL microanalysis study. MEDICAL TEACHER 2023; 45:1170-1176. [PMID: 37036188 DOI: 10.1080/0142159x.2023.2198096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE OF THE STUDY The performance of a clinical procedural skill by an individual student is associated with their use of Self-Regulated Learning (SRL) processes. However, previous research has not identified if an individual student has a similarity in their use of SRL processes across different clinical procedural skill tasks and at a time interval. The aim of this pilot study was to explore the similarity in the use of SRL processes by individual students across different clinical procedural skill tasks and at a time interval. METHODS SRL-microanalysis was used to collect within-subject data on undergraduate physiotherapy students' use of the two key SRL processes (planning and monitoring) during their performance of different goniometry clinical procedural skills tasks and also at a fourth month interval. RESULTS An individual student's use of key SRL processes across different clinical procedural skill tasks and at a time interval was similar. Also, this similarity was identified for students with initial successful and unsuccessful performances. CONCLUSION Our findings have implications for the future wider practical implementation of SRL microanalysis to inform personalised SRL feedback for developing the clinical procedural skills of individual students. Further research with a greater number of students and across a wider range of clinical procedural skills will be required to confirm our findings, and also its effectiveness on feedback and future performance.
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Affiliation(s)
- Dario Cecilio-Fernandes
- Department of Medical Psychology and Psychiatry, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - John Sandars
- Edge Hill University Medical School, Edge Hill University, Ormskirk, UK
| | - Manuel João Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
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Javadi A, Keshmiri F. Surgical Nursing Students' Perception of Feedback in Clinical Education: A Mixed-method Study. EDUCATION FOR HEALTH (ABINGDON, ENGLAND) 2023; 36:131-134. [PMID: 38133129 DOI: 10.4103/efh.efh_55_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/18/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Feedback is a critical component of education but may not always be delivered in a useful manner. This study assessed surgical nursing students' perception of the feedback they received on a clinical rotation. METHODS This is a sequential mixed-method study. The first stage surveyed surgical nursing students in surgical units about the feedback they received. In the second stage, participants' experiences receiving feedback were explored in interviews, and analyzed by a conventional content analysis approach. RESULTS The majority of nurses found that feedback was not helpful, citing a lack of constructive feedback. Negative feedback was often delivered in a public setting. Comments were frequently based on secondary information rather than direct observation. DISCUSSION Feedback to nurses on the surgical unit is not perceived by students as constructive. Clinical teachers did not appear to be aware of the educational effect of the feedback on the learning process of students. In addition, the setting for feedback often undermined its effectiveness. Staff development on effective feedback for teachers on the surgical unit is recommended.
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Affiliation(s)
- Alireza Javadi
- Department of Surgical Technology, Paramedical School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Keshmiri
- Department of Medical Education, Education Development Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Ryznar E, Levine RB. Twelve tips for mindful teaching and learning in medical education. MEDICAL TEACHER 2022; 44:249-256. [PMID: 33794736 DOI: 10.1080/0142159x.2021.1901869] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Mindfulness practice has been shown to have many positive benefits for patients, clinicians, and trainees. Mindfulness fosters compassion, connection, and enhanced clinical reasoning and can reduce burnout among clinicians. A primary focus of mindfulness is present-moment awareness and may be achieved through openness, curiosity, perspective-taking, and letting go of judgment. We propose that the core principles of mindfulness can be harnessed by educators to enhance their teaching skills specifically around creating a supportive and safe learning environment, using questions effectively, providing feedback, and serving as role models. Mindful teaching promotes mindful learning, which focuses on context, openness to new possibilities, reflection, and critical thinking, as opposed to rote repetition and memorization. This article describes core mindfulness principles and strategies that can be used to become a more mindful teacher.
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Affiliation(s)
- Elizabeth Ryznar
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Rachel B Levine
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Chang CCJ, Rumrill SM, Phillips A. Clinical Skills Tutoring Program (CSTP): Developing a Curriculum for Medical Student Clinical Skills Peer Tutors. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11225. [PMID: 35243001 PMCID: PMC8841391 DOI: 10.15766/mep_2374-8265.11225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION There are few curriculum materials designed to provide training and support for peer tutors to become effective clinical skills teachers. We designed the Clinical Skills Tutoring Program (CSTP) curriculum to guide tutors to help their students reflect on clinical skills performance, create an individualized learning plan, and engage in improvement based on feedback to achieve clinical skills competencies. METHODS Curriculum content was delivered through an in-person training session, formal curriculum written content, online resources, and longitudinal support from faculty directors. Tutors (fourth-year medical students) received surveys to evaluate the in-person training session, curriculum resources, and overall program experience. Student participants (medical students of any year) completed a survey to rate their satisfaction in working with their tutors. RESULTS There were 12 tutors in cohort 1 and 18 tutors in cohort 2. Survey response rates ranged from 50% to 70% among tutors. The tutors were satisfied with the in-person training session, program experience, curriculum resources, support from directors, development of learning goals with the student, and clinical skills practice with the student (mean Likert ratings greater than 4 out of 5). Student participants were satisfied with their experience creating learning goals and receiving feedback from their tutors. DISCUSSION The tutor curriculum fills a gap by training and supporting tutors before and during their work with students needing further resources and remediation in one or more clinical skills domains. The curriculum can be implemented and further adapted by other tutoring programs locally and nationally.
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Affiliation(s)
| | - Sara-Megumi Rumrill
- Assistant Clinical Professor, Division of VA General Internal Medicine, Department of Medicine, University of California, San Francisco, School of Medicine
| | - Abigail Phillips
- Associate Clinical Professor, Division of VA General Internal Medicine, Department of Medicine, University of California, San Francisco, School of Medicine
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Taha A. Feedback in an Epidemic? Cureus 2022; 14:e22008. [PMID: 35282511 PMCID: PMC8908454 DOI: 10.7759/cureus.22008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/26/2022] Open
Abstract
Undergraduates and postgraduates frequently receive feedback on their clinical and non-clinical performance and progression throughout their studies and career. Good quality feedback has been shown to improve trainees’ confidence and performance. This article discusses the benefits of feedback and reviews the communication, technical, financial, and networking barriers to feedback introduced by coronavirus disease 2019 (COVID-19) and its impact on the quality of medical and dental education in the UK, followed by a critical reflection. In addition, it reviews the pros and cons of self-assessment of clinical learning, and it provides an overview of the most widely accepted feedback models: Pendleton’s rules, SET-GO method, agenda-led, outcome-based analysis (ALOBA) model and Prepare to Ask-Discuss-Ask-Plan Together (Prepare to ADAPT) on the quality of feedback received. The aim is to identify the most suitable feedback method to help trainees with their clinical and professional development during the COVID-19 pandemic and any possible pandemics in the future.
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Bransen D, Govaerts MJB, Panadero E, Sluijsmans DMA, Driessen EW. Putting self-regulated learning in context: Integrating self-, co-, and socially shared regulation of learning. MEDICAL EDUCATION 2022; 56:29-36. [PMID: 33988857 PMCID: PMC9291108 DOI: 10.1111/medu.14566] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/03/2021] [Accepted: 05/08/2021] [Indexed: 06/01/2023]
Abstract
Processes involved in the regulation of learning have been researched for decades, because of its impact on academic and workplace performance. In fact, self-regulated learning is the focus of countless studies in health professions education and higher education in general. While we will always need competent individuals who are able to regulate their own learning, developments in healthcare require a shift from a focus on the individual to the collective: collaboration within and between healthcare teams is at the heart of high-quality patient care. Concepts of collaborative learning and collective competence challenge commonly held conceptualisations of regulatory learning and call for a focus on the social embeddedness of regulatory learning and processes regulating the learning of the collective. Therefore, this article questions the alignment of current conceptualisations of regulation of learning with demands for collaboration in current healthcare. We explore different conceptualisations of regulation of learning (self-, co-, and socially shared regulation of learning), and elaborate on how the integration of these conceptualisations adds to our understanding of regulatory learning in healthcare settings. Building on these insights, we furthermore suggest ways forward for research and educational practice.
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Affiliation(s)
- Derk Bransen
- School of Health Professions Education (SHE)Maastricht UniversityMaastrichtThe Netherlands
| | - Marjan J. B. Govaerts
- Department of Educational Development and ResearchFaculty of Health, Medicine and Life ScienceMaastricht UniversityMaastrichtThe Netherlands
| | - Ernesto Panadero
- Facultad de Psicología y EducaciónUniversidad de DeustoBilbaoEspaña
- IKERBASQUEBasque Foundation for ScienceBilbaoSpain
| | | | - Erik W. Driessen
- Department of Educational Development and ResearchFaculty of Health, Medicine and Life ScienceMaastricht UniversityMaastrichtThe Netherlands
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The challenge of understanding, evaluating and providing feedback on regulation during group learning. SCIENTIA MEDICA 2021. [DOI: 10.15448/1980-6108.2021.1.39294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Learning in groups is commonly used in academic and clinical health professions education (HPE). There is growing recognition that regulation during learning is essential for both the individual learner and group learning. The authors in this article propose a practical approach for understanding, evaluating and providing feedback on regulation during group learning. The approach is informed by previous studies conducted in other areas of education. Three varieties of regulation during group learning are discussed: individual, co-regulation and shared regulation. Each variety of regulation has a focus on three essential activities during group learning: task, social and motivation. Illustrative scenarios are presented to describe how the approach can be practically used in HPE. The specific and additional focus on regulation can enhance current approaches for providing feedback on group learning and the authors discuss recommendations for practical implementation and future research.
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Egan R, Chaplin T, Szulewski A, Braund H, Cofie N, McColl T, Hall AK, Dagnone D, Kelley L, Thoma B. A case for feedback and monitoring assessment in competency-based medical education. J Eval Clin Pract 2020; 26:1105-1113. [PMID: 31851772 DOI: 10.1111/jep.13338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/31/2019] [Accepted: 11/29/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Within competency-based medical education, self-regulated learning (SRL) requires residents to leverage self-assessment and faculty feedback. We sought to investigate the potential for competency-based assessments to foster SRL by quantifying the relationship between faculty feedback and entrustment ratings as well as the congruence between faculty assessment and resident self-assessment. MATERIALS AND METHODS We collected comments in (a) an emergency medicine objective structured clinical examination group (objective structured clinical examinations [OSCE] and emergency medicine OSCE group [EMOG]) and (b) a first-year resident multidisciplinary resuscitation "Nightmares" course assessment group (NCAG) and OSCE group (NOG). We assessed comments across five domains including Initial Assessment (IA), Diagnostic Action (DA), Therapeutic Action (TA), Communication (COM), and entrustment. Analyses included structured qualitative coding and (non)parametric and descriptive analyses. RESULTS In the EMOG, faculty's positive comments in the entrustment domain corresponded to lower entrustment score Mean Ranks (MRs) for IA (<11.1), DA (<11.2), and entrustment (<11.6). In NOG, faculty's negative comments resulted in lower entrustment score MRs for TA (<11.8 and <10) and DA (<12.4), and positive comments resulted in higher entrustment score MRs for IA (>15.4) and COM (>17.6). In the NCAG, faculty's positive IA comments were negatively correlated with entrustment scores (ρ = -.27, P = .04). Across programs, faculty and residents made similar domain-specific comments 13% of the time. CONCLUSIONS Minimal and inconsistent associations were found between narrative and numerical feedback. Performance monitoring accuracy and feedback should be included in assessment validation.
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Affiliation(s)
- Rylan Egan
- School of Nursing, Health Quality Programs, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Timothy Chaplin
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Adam Szulewski
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Heather Braund
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Nicholas Cofie
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Tamara McColl
- Educational Scholarship, Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew K Hall
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Damon Dagnone
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Leah Kelley
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Brent Thoma
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Patel R, Green W, Shahzad MW, Church H, Sandars J. Using a self-regulated learning-enhanced video feedback educational intervention to improve junior doctor prescribing. MEDICAL TEACHER 2020; 42:886-895. [PMID: 32301633 DOI: 10.1080/0142159x.2020.1748183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Introduction: Medical school graduates in the UK consistently report feeling underprepared for the task of prescribing when embarking on practice. The effective application of self-regulated learning (SRL) approaches and feedback on complex tasks are associated with improved outcomes in practice-based clinical skills.Aims: This study aimed to investigate the effectiveness of an educational intervention using SRL-enhanced video feedback for improving the prescribing competency of junior doctors.Methods: A prospective cohort study was designed to compare intervention and control cohorts of junior doctors undertaking simulated clinical encounters at the beginning and end of their 4-month rotation through renal medicine.Results: The improvement in prescribing competency for the intervention cohort was significant (p < 0.001) with large effect size (d = 1.42). Self-efficacy improved in both cohorts with large (control cohort p = 0.026, r= 0.64) and medium (intervention cohort p = 0.083, d = 0.55) effect sizes. Goal setting and self-monitoring skills improved in the intervention cohort only with medium effect size (p = 0.096, d = 0.53).Conclusions: SRL-enhanced video feedback is effective for improving prescribing competency and developing SRL processes such as goal setting and self-monitoring skills in simulated clinical encounters. Further research is required to evaluate transferability to other clinical sub-speciality contexts and investigate the effectiveness of the intervention for improving prescribing in non-simulated settings.
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Affiliation(s)
- Rakesh Patel
- School of Medicine, University of Nottingham, Nottingham, UK
| | - William Green
- Innovation, Technology and Operations Division, University of Leicester School of Business, University of Leicester, Leicester, UK
| | - Muhammad Waseem Shahzad
- Innovation, Technology and Operations Division, University of Leicester School of Business, University of Leicester, Leicester, UK
| | - Helen Church
- School of Medicine, University of Nottingham, Nottingham, UK
| | - John Sandars
- Health Research Institute, Faculty of Health, Social Care and Medicine, Edge Hill University Medical School, Ormskirk, UK
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Medina-Ramírez RI, Álamo-Arce DD, Rodriguez-Castro F, Cecilio-Fernandes D, Sandars J, Costa MJ. Self-regulated learning microanalysis for the study of the performance of clinical examinations by physiotherapy students. BMC MEDICAL EDUCATION 2020; 20:233. [PMID: 32698789 PMCID: PMC7374893 DOI: 10.1186/s12909-020-02149-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/13/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND Students require feedback on their self-regulated learning (SRL) processes to improve the performance of clinical examinations. The key SRL processes used by students can be identified by SRL-micro-analysis but, this method has not been previously applied to physiotherapy students. The aim of this pilot study was to test a research design that might allow the evaluation of the potential usefulness of SRL microanalysis for the identification of key SRL processes used by physiotherapy students during the performance of a clinical examination skill. The objectives of the pilot study were: 1) to evaluate whether SRL-microanalysis could identify differences in the use of SRL processes between successful and unsuccessful students; 2) to evaluate the reliability of SRL microanalysis ratings produced by different assessors. METHODS SRL-microanalysis was used with second year physiotherapy students of a Spanish university (n = 26) as they performed a goniometric task. The task required students to obtain a goniometric measurement of the shoulder joint of a peer. Two assessors evaluated student performance and conducted the SRL- microanalysis with all students. An analysis of inter-rater reliability was performed to evaluate the degree of agreement between assessors. RESULTS The SRL-microanalysis revealed differences in the use of key SRL processes between successful (n = 15: 57.0%) and unsuccessful performers (n = 11: 43.0%): The differences were particularly evident in strategic planning and self-monitoring skills. There was good inter-rater reliability for scoring of strategic planning (k = 0.792), self-monitoring (k = 0.946) and self-evaluation (k = 0.846). CONCLUSION The use of SRL microanalysis characterized the key SRL processes of physiotherapy students performing a clinical skill with reliability between the assessors. This pilot study supports the potential usefulness of SRL-microanalysis for the identification of key SRL processes in physiotherapy education. Therefore, this study paves the way to the development of a full study, with a larger number of students and more diverse clinical tasks, to evaluate the SRL processes in successful and unsuccessful students.
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Affiliation(s)
- Raquel I. Medina-Ramírez
- Health Sciences School, University of Las Palmas, Las Palmas, Spain
- Health Science, Blas Cabrera Felipe Street, without number 35016 – Las Palmas of Gran Canaria, Canary Island, Spain
| | | | | | - Dario Cecilio-Fernandes
- Department of Medical Psychology and Psychiatry, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - John Sandars
- Health Research Institute, Faculty of Health, Social Care and Medicine, Edge Hill University, St Helens Road, Ormskirk, UK
| | - Manuel J. Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
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Sandars J, Patel R. Using personalized teaching and learning to improve clinical performance. Br J Hosp Med (Lond) 2018; 79:102-105. [DOI: 10.12968/hmed.2018.79.2.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The intention of personalized teaching and learning to improve clinical performance is the optimization of individual performance across a variety of tasks in different environments. Educational interventions need to have a focus on the assessment and feedback of both outcome and process of performance. An essential component of the assessment and feedback on the process of performance is how ‘the will’ and ‘the skill’ are dynamically adapted by the individual through self-regulated learning processes. Microanalysis can identify the key self-regulated learning processes and the findings used to inform self-regulated learning enhanced feedback for personalized teaching and learning. The experience of the authors in using self-regulated learning enhanced feedback for optimizing performance in prescribing by junior doctors is discussed.
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Affiliation(s)
- John Sandars
- Professor of Medical Education, Postgraduate Medical Institute, Edge Hill University, Ormskirk L39 4QP
| | - Rakesh Patel
- Clinical Associate Professor in Medical Education and Honorary Consultant Nephrologist, Education Centre, School of Medicine, University of Nottingham, Nottingham
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