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Boyle JG, Walters MR, Jamieson S, Durning SJ. Distributed cognition: Theoretical insights and practical applications to health professions education: AMEE Guide No. 159. MEDICAL TEACHER 2023; 45:1323-1333. [PMID: 37043405 DOI: 10.1080/0142159x.2023.2190479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Distributed cognition (DCog) is a member of the family of situativity theories that widens the lens of cognition from occurring solely inside the head to being socially, materially and temporally distributed within a dynamic system. The concept of extending the view of cognition to outside the head of a single health professional is relatively new in the healthcare system. DCog has been increasingly used by researchers to describe many ways in which health professionals perform in teams within structured clinical environments to deliver healthcare for patients. In this Guide, we expound ten central tenets of the macro (grand) theory of DCog (1. Cognition is decentralized in a system; 2. The unit of analysis is the system; 3. Cognitive processes are distributed; 4. Cognitive processes emerge from interactions; 5. Cognitive processes are interdependent; 6. Social organization is a cognitive architecture; 7. Division of labour; 8. Social organization is a system of communication; 9. Buffering and filtering; 10. Cognitive processes are encultured) to provide theoretical insights as well as practical applications to the field of health professions education.
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Affiliation(s)
- James G Boyle
- Undergraduate Medical School, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Matthew R Walters
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Susan Jamieson
- Health Professions Education Programme, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Steven J Durning
- Center for Health Professions Education, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Santen SA, Hemphill RR, Pusic M, Cico SJ, Wolff M, Merritt C. Our responsibility to patients: Maintain competency or … stop practicing. AEM EDUCATION AND TRAINING 2023; 7:e10916. [PMID: 37997590 PMCID: PMC10664403 DOI: 10.1002/aet2.10916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/06/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Sally A. Santen
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Office of the DeanVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | | | - Martin Pusic
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
- American Board of Medical SpecialtiesChicagoIllinoisUSA
| | - Stephen John Cico
- Department of Emergency Medicine & Pediatrics College of MedicineUniversity of Central FloridaOrlandoFloridaUSA
| | - Meg Wolff
- Department of Emergency Medicine & PediatricsUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Chris Merritt
- Department of Emergency MedicineAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
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Soemantri D, Findyartini A, Mustika R, Felaza E, Arsyaf MA, Alfandy BP, Greviana N. Looking beyond the COVID-19 pandemic: the recalibration of student-teacher relationships in teaching and learning process. MEDICAL EDUCATION ONLINE 2023; 28:2259162. [PMID: 37742211 PMCID: PMC10519258 DOI: 10.1080/10872981.2023.2259162] [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: 06/21/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Given the various novel educational approaches and online interactions following the pandemic, it is timely to identify lessons learned for post-pandemic student and teacher relationships within the 'new normal' teaching learning processes. This study aims to explore the dynamics and to what extent the disruption influences student-teacher relationships in teaching and learning process following the COVID-19 pandemic. MATERIALS AND METHODS A qualitative descriptive approach was employed to explore individual reflections and perspectives from 28 medical teachers and 35 medical students from different institutions who participated in 10 focus groups. Data were analyzed thematically using steps for coding and theorization (SCAT) approach. The emerging themes were then further analyzed and regrouped into the relationship-centered leadership framework based on emotional intelligence. RESULTS The identified themes described three elements representing student-teacher relationships in the teaching learning processes. The self as the center of the diagram consists of the co-existing role of the self as teachers and as students, which to some extent, is related to their personal and professional development, motivation, and struggles to maintain work-life balance. The middle layer represents the dynamic of student-teacher relationship, which showed that despite the increased number of teaching opportunities, the trust among teachers and students was compromised. These changes in the self and the dynamic relationship occurred in a broader and more complex medical education system, pictured as the outer layer. Thorough curriculum improvements, contents, and new skills were emphasized. CONCLUSIONS Our findings emphasized the need to recalibrate student-teacher relationships, taking into account the intrapersonal, interpersonal, and the system factors. The pandemic has reemphasized the aim of teachers' roles, not only to nurture students' competencies, but also to nurture meaningful interpersonal reciprocal relationships through responding towards both teachers' and students' needs as well as supporting both personal and professional development.
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Affiliation(s)
- Diantha Soemantri
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ardi Findyartini
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rita Mustika
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Estivana Felaza
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Athallah Arsyaf
- Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Undergraduate Medical Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Bayu Prasetya Alfandy
- Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Undergraduate Medical Program, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Nadia Greviana
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Clarke SO, Ilgen JS, Regehr G. Fostering Adaptive Expertise Through Simulation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:994-1001. [PMID: 37094295 DOI: 10.1097/acm.0000000000005257] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Technology-enhanced simulation has been used to tackle myriad challenges within health professions education. Recently, work has typically adopted a mastery learning orientation that emphasizes trainees' sequential mastery of increasingly complex material. Doing so has privileged a focus on performance and task completion, as captured by trainees' observable behaviors and actions. Designing simulation in these ways has provided important advances to education, clinical care, and patient safety, yet also placed constraints around how simulation-based activities were enacted and learning outcomes were measured. In tracing the contemporary manifestations of simulation in health professions education, this article highlights several unintended consequences of this performance orientation and draws from principles of adaptive expertise to suggest new directions. Instructional approaches grounded in adaptive expertise in other contexts suggest that uncertainty, struggle, invention, and even failure help learners to develop deeper conceptual understanding and learn innovative approaches to novel problems. Adaptive expertise provides a new lens for simulation designers to think intentionally around how idiosyncrasy, individuality, and inventiveness could be enacted as central design principles, providing learners with opportunities to practice and receive feedback around the kinds of complex problems they are likely to encounter in practice. Fostering the growth of adaptive expertise through simulation will require a fundamental reimagining of the design of simulation scenarios, embracing the power of uncertainty and ill-defined problem spaces, and focusing on the structure and pedagogical stance of debriefing. Such an approach may reveal untapped potential within health care simulation.
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Affiliation(s)
- Samuel O Clarke
- S.O. Clarke is associate professor, Department of Emergency Medicine, University of California, Davis, Sacramento, California; ORCID: https://orcid.org/my-orcid?orcid=0000-0003-3762-1727
| | - Jonathan S Ilgen
- J.S. Ilgen is professor, Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington; ORCID: https://orcid.org/0000-0003-4590-6570
| | - Glenn Regehr
- G. Regehr is professor, Department of Surgery, and senior scientist, Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002-3144-331X
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Chaukos D, Genus S, Maunder R, Mylopoulos M. Preparing future physicians for complexity: a post-graduate elective in HIV psychiatry. BMC MEDICAL EDUCATION 2023; 23:269. [PMID: 37081455 PMCID: PMC10116745 DOI: 10.1186/s12909-023-04233-0] [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: 12/16/2022] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Patients with complex care needs have multiple concurrent conditions (medical, psychiatric, social vulnerability or functional impairment), interfering with achieving desired health outcomes. Their care often requires coordination and integration of services across hospital and community settings. Physicians feel ill-equipped and unsupported to navigate uncertainty and ambiguity caused by multiple problems. A HIV Psychiatry resident elective was designed to support acquisition of integrated competencies to navigate uncertainty and disjointed systems of care - necessary for complex patient care. METHODS Through qualitative thematic analysis of pre- and post-interviews with 12 participants - residents and clinic staff - from December 2019 to September 2022, we explored experiences of this elective. RESULTS This educational experience helped trainees expand their understanding of what makes patients complex. Teachers and trainees emphasize the importance of an approach to "not knowing" and utilizing integrative competencies for navigating uncertainty. Through perspective exchange and collaboration, trainees showed evidence of adaptive expertise: the ability to improvise while drawing on past knowledge. CONCLUSIONS Postgraduate training experiences should be designed to facilitate skills for caring for complex patients. These skills help residents fill in practice gaps, improvise when standardization fails, and develop adaptive expertise. Going forward, findings will be used to inform this ongoing elective.
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Affiliation(s)
- Deanna Chaukos
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- Department of Psychiatry, Sinai Health System, 600 University Avenue, Toronto, M5G1X5, Canada.
| | - Sandalia Genus
- Department of Psychiatry, Sinai Health System, 600 University Avenue, Toronto, M5G1X5, Canada
- Department of Anthropology, University of Toronto, Toronto, Canada
| | - Robert Maunder
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, Sinai Health System, 600 University Avenue, Toronto, M5G1X5, Canada
| | - Maria Mylopoulos
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The Wilson Centre, University of Toronto, Toronto, Canada
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Santen SA, Hemphill RR. Embracing our responsibility to ensure trainee competency. AEM EDUCATION AND TRAINING 2023; 7:e10863. [PMID: 37013132 PMCID: PMC10066499 DOI: 10.1002/aet2.10863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Sally A. Santen
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Virginia Commonwealth University School of MedicineRichmondVirginiaUSA
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Cupido N, Fowler N, Sonnenberg LK, Karwowska A, Richardson D, Snell L, Thoma B, Mylopoulos M. Adaptive Expertise in CanMEDS 2025. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:18-21. [PMID: 36998497 PMCID: PMC10042796 DOI: 10.36834/cmej.75445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Nathan Cupido
- The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | - Nancy Fowler
- College of Family Physicians of Canada, Ontario, Canada
- McMaster University, Ontario, Canada
| | - Lyn K Sonnenberg
- University of Alberta, Alberta, Canada
- Glenrose Rehabilitation Hospital, Alberta, Canada
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| | - Anna Karwowska
- University of Ottawa, Ontario, Canada
- Association of Faculties of Medicine of Canada, Ontario, Canada
| | - Denyse Richardson
- University of Toronto, Ontario, Canada
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
| | - Linda Snell
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- McGill University, Quebec, Canada
| | - Brent Thoma
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- University of Saskatchewan, Saskatchewan, Canada
| | - Maria Mylopoulos
- The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
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Pusic MV, Birnbaum RJ, Thoma B, Hamstra SJ, Cavalcanti RB, Warm EJ, Janssen A, Shaw T. Frameworks for Integrating Learning Analytics With the Electronic Health Record. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:52-59. [PMID: 36849429 PMCID: PMC9973448 DOI: 10.1097/ceh.0000000000000444] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The information systems designed to support clinical care have evolved separately from those that support health professions education. This has resulted in a considerable digital divide between patient care and education, one that poorly serves practitioners and organizations, even as learning becomes ever more important to both. In this perspective, we advocate for the enhancement of existing health information systems so that they intentionally facilitate learning. We describe three well-regarded frameworks for learning that can point toward how health care information systems can best evolve to support learning. The Master Adaptive Learner model suggests ways that the individual practitioner can best organize their activities to ensure continual self-improvement. The PDSA cycle similarly proposes actions for improvement but at a health care organization's workflow level. Senge's Five Disciplines of the Learning Organization, a more general framework from the business literature, serves to further inform how disparate information and knowledge flows can be managed for continual improvement. Our main thesis holds that these types of learning frameworks should inform the design and integration of information systems serving the health professions. An underutilized mediator of educational improvement is the ubiquitous electronic health record. The authors list learning analytic opportunities, including potential modifications of learning management systems and the electronic health record, that would enhance health professions education and support the shared goal of delivering high-quality evidence-based health care.
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Pusic MV, Hall E, Billings H, Branzetti J, Hopson LR, Regan L, Gisondi MA, Cutrer WB. Educating for adaptive expertise: case examples along the medical education continuum. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1383-1400. [PMID: 36414880 DOI: 10.1007/s10459-022-10165-z] [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: 05/25/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Adaptive expertise represents the combination of both efficient problem-solving for clinical encounters with known solutions, as well as the ability to learn and innovate when faced with a novel challenge. Fostering adaptive expertise requires careful approaches to instructional design to emphasize deeper, more effortful learning. These teaching strategies are time-intensive, effortful, and challenging to implement in health professions education curricula. The authors are educators whose missions encompass the medical education continuum, from undergraduate through to organizational learning. Each has grappled with how to promote adaptive expertise development in their context. They describe themes drawn from educational experiences at these various learner levels to illustrate strategies that may be used to cultivate adaptive expertise.At Vanderbilt University School of Medicine, a restructuring of the medical school curriculum provided multiple opportunities to use specific curricular strategies to foster adaptive expertise development. The advantage for students in terms of future learning had to be rationalized against assessments that are more short-term in nature. In a consortium of emergency medicine residency programs, a diversity of instructional approaches was deployed to foster adaptive expertise within complex clinical learning environments. Here the value of adaptive expertise approaches must be balanced with the efficiency imperative in clinical care. At Mayo Clinic, an existing continuous professional development program was used to orient the entire organization towards an adaptive expertise mindset, with each individual making a contribution to the shift.The different contexts illustrate both the flexibility of the adaptive expertise conceptualization and the need to customize the educational approach to the developmental stage of the learner. In particular, an important benefit of teaching to adaptive expertise is the opportunity to influence individual professional identity formation to ensure that clinicians of the future value deeper, more effortful learning strategies throughout their careers.
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Affiliation(s)
- Martin V Pusic
- Division of Pediatric Emergency Medicine, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, CH3306, USA.
| | - Elissa Hall
- Learning and Technology Innovation, Education Science, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Heather Billings
- Academy of Educational Excellence, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Laura R Hopson
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Linda Regan
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Gisondi
- The Precision Education and Assessment Research Lab, Department of Emergency Medicine, Stanford School of Medicine, Palo Alto, CA, USA
| | - William B Cutrer
- Undergraduate Medical Education, Vanderbilt University School of Medicine, Nashville, TN, USA
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Cupido N, Ross S, Lawrence K, Bethune C, Fowler N, Hess B, van der Goes T, Schultz K. Making sense of adaptive expertise for frontline clinical educators: a scoping review of definitions and strategies. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1213-1243. [PMID: 36302908 DOI: 10.1007/s10459-022-10176-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
Adaptive expertise has been promoted as an emerging model of expertise in health professions education in response to the inherent complexities of patient care; however, as the concept increasingly influences the structure of professional training and practice, it creates the potential for misunderstandings of the definition and implications of adaptive expertise. To foster a common understanding of the concept, we conducted a scoping review to explore how adaptive expertise has been discussed within health professions education literature. Five databases-MedLine, PubMed, ERIC, CINAHL, and PsycINFO-were searched using the exact term "adaptive expertise", producing 212 unique articles. Fifty-eight articles met inclusion criteria. In the included articles, authors discussed the conceptual implications of adaptive expertise for health professions education, strategies for training for adaptive expertise, and research findings aimed at supporting the development of adaptive expertise or utilizing adaptive expertise as a theoretical framework. The goal of this scoping review is to establish a resource for frontline educators tasked with fostering the development of adaptive expertise in learners through education initiatives. A common understanding of adaptive expertise is essential to ensuring effective implementation in training programs.
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Affiliation(s)
| | - Shelley Ross
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
| | | | - Cheri Bethune
- Northern Ontario School of Medicine, Sudbury, Canada
| | - Nancy Fowler
- College of Family Physicians of Canada, Mississauga, Canada
| | - Brian Hess
- College of Family Physicians of Canada, Mississauga, Canada
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Cristancho S, Field E, Lingard L, Taylor T, Hibbert K, Thompson G, Hibbert W. Ecological interchangeability: supporting team adaptive expertise in moments of disruption. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1361-1382. [PMID: 36357657 PMCID: PMC9648894 DOI: 10.1007/s10459-022-10160-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
While undesirable, unexpected disruptions offer unique opportunities to enact adaptive expertise. For adaptive expertise to flourish, individuals and teams must embrace both efficiency and adaptation. While some industries do it readily, others continue to struggle with the tension between efficiency and adaptation, particularly when otherwise stable situations are unexpectedly disrupted. For instance, in healthcare settings, the efficiency mandate for strict compliance with scopes of practice can deter teams from using the adaptive strategy of making their members interchangeable. Yet, interchangeability has been hinted as a key capacity of today' teams that are required to navigate fluid team structures. Because interchangeability - as an adaptive strategy - can generate antagonistic reactions, it has not been well studied in fluid teams. Thus, in this exploratory qualitative study we sought to gain insights into how interchangeability manifests when fluid teams from five different contexts (healthcare, emergency services, orchestras, military, and business) deal with disruptive events. According to our participants, successful interchangeability was possible when people knew how to work within one's role while being aware of their teammates' roles. However, interchangeability included more than just role switching. Interchangeability took various forms and was most successful when teams capitalized on the procedural, emotional, and social dimensions of their work. To reflect this added complexity, we refer to interchangeability in fluid teams as Ecological Interchangeability. We suggest that ecological interchangeability may become a desired feature in the training of adaptive expertise in teams, if its underlying properties and enabling mechanisms are more fully understood.
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Affiliation(s)
- Sayra Cristancho
- Department of Surgery, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
| | - Emily Field
- Centre for Education Research & Innovation (CERI), Western University, London, ON, Canada
| | - Lorelei Lingard
- Department of Medicine, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Taryn Taylor
- Department of Obstetrics and Gynecology, Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kathy Hibbert
- Faculty of Education, Western University, London, ON, Canada
| | - Graham Thompson
- Department of Biology, Western University, London, ON, Canada
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Branzetti J, Gisondi MA, Hopson LR, Regan L. Adaptive expertise: The optimal outcome of emergency medicine training. AEM EDUCATION AND TRAINING 2022; 6:e10731. [PMID: 35368500 PMCID: PMC8908303 DOI: 10.1002/aet2.10731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/08/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Affiliation(s)
| | - Michael A. Gisondi
- Department of Emergency MedicinePrecision Education and Assessment Research LabStanford University School of MedicineStanfordCaliforniaUSA
| | - Laura R. Hopson
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Linda Regan
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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13
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Regan L, Hopson LR, Gisondi MA, Branzetti J. Creating a better learning environment: a qualitative study uncovering the experiences of Master Adaptive Learners in residency. BMC MEDICAL EDUCATION 2022; 22:141. [PMID: 35241060 PMCID: PMC8895544 DOI: 10.1186/s12909-022-03200-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Adaptive expertise is an important physician skill, and the Master Adaptive Learner (MAL) conceptual model describes learner skills and behaviors integral to the acquisition of adaptive expertise. The learning environment is postulated to significantly impact how MALs learn, but it is unclear how these successful learners experience and interact with it. This study sought to understand the authentic experience of MALs within the learning environment and translate those experiences into practical recommendations to improve the learning environment for all trainees. METHODS Following a constructivist paradigm, we conducted a thematic analysis of transcripts from focus groups composed of MALs to identify commonalities in experiences and practices of successful postgraduate trainees in the learning environment. Saturation was achieved after seven focus groups, consisting of thirty-eight participants representing fourteen specialties from four institutions. Researchers coded transcripts using constant comparison analysis, which served as the foundation for our thematic analysis. RESULTS We identified eight themes and situated them within a 4-component model of the learning environment. Four themes were identified within the personal component: (1) patients drive learning; (2) learning has no endpoint; (3) management of emotions is crucial for learning; (4) successful learning requires a structured approach. Two themes were identified in the social component: (5) positive social relationships are leveraged to maximize learning; (6) teaching facilitates personal learning. Two themes were identified in the organizational component: (7) transitions challenge learners to adapt; (8) the learning environment dictates goal setting strategy. No major themes were identified in the physical/virtual component, although participants frequently used technology when learning. CONCLUSIONS Master Adaptive Learners experience similar facilitators of, and barriers to, success in the learning environment. Overall, our data show that acquisition of many successful strategies and skills that support learning are relegated to the hidden curriculum of residency training. Educators could support a more effective learning environment for all trainees by: (1) highlighting patients as the focal point of learning, (2) building a professional 'learner' identity, (3) teaching learning skills, and (4) creating opportunities for collaborative learning.
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Affiliation(s)
- Linda Regan
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 6-100, Baltimore, MD, 21093, USA.
| | - Laura R Hopson
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael A Gisondi
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeremy Branzetti
- Department of Emergency Medicine, New York University School of Medicine, New York City, NY, USA
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Santen SA, Smith J, Shockley J, Cyrus JW, Lomis KD, Pusic M, Mejicano GC, Lawson L, Allen BL, Skochelak S. Social network analysis of publication collaboration of accelerating change in MedEd consortium. MEDICAL TEACHER 2022; 44:276-286. [PMID: 34686101 DOI: 10.1080/0142159x.2021.1985096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The American Medical Association formed the Accelerating Change in Medical Education Consortium through grants to effect change in medical education. The dissemination of educational innovations through scholarship was a priority. The objective of this study was to explore the patterns of collaboration of educational innovation through the consortium's publications. METHOD Publications were identified from grantee schools' semi-annual reports. Each publication was coded for the number of citations, Altmetric score, domain of scholarship, and collaboration with other institutions. Social network analysis explored relationships at the midpoint and end of the grant. RESULTS Over five years, the 32 Consortium institutions produced 168 publications, ranging from 38 papers from one institution to no manuscripts from another. The two most common domains focused on health system science (92 papers) and competency-based medical education (30 papers). Articles were published in 54 different journals. Forty percent of publications involved more than one institution. Social network analysis demonstrated rich publishing relationships within the Consortium members as well as beyond the Consortium schools. In addition, there was growth of the network connections and density over time. CONCLUSION The Consortium fostered a scholarship network disseminating a broad range of educational innovations through publications of individual school projects and collaborations.
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Affiliation(s)
- Sally A Santen
- Senior Associate Dean, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jeff Smith
- School of Business, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeff Shockley
- School of Business, Virginia Commonwealth University, Richmond, VA, USA
| | - John W Cyrus
- Virginia Commonwealth University Medical Center Tomkins-McCaw Library, Richmond, VA, USA
| | | | - Martin Pusic
- Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - George C Mejicano
- Senior Associate Dean for Education, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Luan Lawson
- Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Bradley L Allen
- Clinical Medicine and Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
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Merritt C, Santen S, Cico S, Wolff M, Pusic M. Punctuated Equilibrium: COVID and the Duty to Teach for Adaptive Expertise. West J Emerg Med 2022; 23:56-58. [PMID: 35060863 PMCID: PMC8782136 DOI: 10.5811/westjem.2021.11.55268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/26/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Chris Merritt
- Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | - Sally Santen
- Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, Virginia; University of Cincinnati, Departments of Emergency Medicine and Medical Education, Cincinnati, Ohio
| | - Stephen Cico
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Margaret Wolff
- University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Martin Pusic
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
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16
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Steinert Y, Irby DM, Dolmans D. Reframing faculty development practice and research through the lens of adaptive expertise. MEDICAL TEACHER 2021; 43:865-867. [PMID: 34078230 DOI: 10.1080/0142159x.2021.1931081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Yvonne Steinert
- Institute of Health Sciences Education, Faculty of Medicine & Health Sciences, McGill University, Montreal, Canada
| | - David M Irby
- Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Diana Dolmans
- Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
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Lomis KD, Santen SA, Dekhtyar M, Elliott VS, Richardson J, Hammoud MM, Hawkins R, Skochelak SE. The Accelerating Change in Medical Education Consortium: Key Drivers of Transformative Change. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:979-988. [PMID: 33332909 DOI: 10.1097/acm.0000000000003897] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The American Medical Association's (AMA's) Accelerating Change in Medical Education (ACE) initiative, launched in 2013 to foster advancements in undergraduate medical education, has led to the development and scaling of innovations influencing the full continuum of medical training. Initial grants of $1 million were awarded to 11 U.S. medical schools, with 21 schools joining the consortium in 2016 at a lower funding level. Almost one-fifth of all U.S. MD- and DO-granting medical schools are represented in the 32-member consortium. In the first 5 years, the consortium medical schools have delivered innovative educational experiences to approximately 19,000 medical students, who will provide a potential 33 million patient care visits annually. The core initiative objectives focus on competency-based approaches to medical education and individualized pathways for students, training in health systems science, and enhancing the learning environment. At the close of the initial 5-year grant period, AMA leadership sought to catalogue outputs and understand how the structure of the consortium may have influenced its outcomes. Themes from qualitative analysis of stakeholder interviews as well as other sources of evidence aligned with the 4 elements of the transformational leadership model (inspirational motivation, intellectual stimulation, individualized consideration, and idealized influence) and can be used to inform future innovation interventions. For example, the ACE initiative has been successful in stimulating change at the consortium schools and propagating those innovations broadly, with outputs involving medical students, faculty, medical schools, affiliated health systems, and the broader educational landscape. In summary, the ACE initiative has fostered a far-reaching community of innovation that will continue to drive change across the continuum of medical education.
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Affiliation(s)
- Kimberly D Lomis
- K.D. Lomis is vice president, Undergraduate Medical Education Innovations, American Medical Association, Chicago, Illinois
| | - Sally A Santen
- S.A. Santen is senior associate dean, Evaluation, Assessment and Scholarship, Virginia Commonwealth University, Richmond, Virginia, and consultant, American Medical Association, Chicago, Illinois
| | - Michael Dekhtyar
- M. Dekhtyar was research associate, American Medical Association, Chicago, Illinois, at the time this work was completed
| | | | - Judee Richardson
- J. Richardson is director of research and program evaluation, American Medical Association, Chicago, Illinois
| | - Maya M Hammoud
- M.M. Hammoud is associate chair for education, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, and senior advisor, American Medical Association, Chicago, Illinois
| | - Richard Hawkins
- R. Hawkins was vice president, Medical Education Outcomes, American Medical Association, Chicago, Illinois, at the time this work was initiated, and is currently president and chief executive officer, American Board of Medical Specialties, Chicago, Illinois
| | - Susan E Skochelak
- S.E. Skochelak is group vice president, Medical Education, American Medical Association, Chicago, Illinois
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18
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Keister D, Omole F, Sepdham D, Anderson S. FAMILY MEDICINE EDUCATORS AS EXEMPLARS OF MASTER ADAPTIVE LEARNING IN RESPONSE TO THE COVID-19 PANDEMIC. Ann Fam Med 2021; 19:373-374. [PMID: 34264847 PMCID: PMC8282284 DOI: 10.1370/afm.2721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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19
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Loftus KV, Schumacher DJ, Mittiga MR, McDonough E, Sobolewski B. A Descriptive Analysis of the Cumulative Experiences of Emergency Medicine Residents in the Pediatric Emergency Department. AEM EDUCATION AND TRAINING 2021; 5:e10462. [PMID: 33796805 PMCID: PMC7995924 DOI: 10.1002/aet2.10462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Most children seeking emergency care are evaluated in general emergency departments (EDs). The cumulative pediatric clinical experiences of emergency medicine (EM) residents are largely unknown. This study examined EM resident pediatric clinical experience through the lens of the Accreditation Council for Graduate Medical Education requirements and the Model of the Clinical Practice of Emergency Medicine. METHODS Retrospective, observational study of the cumulative clinical experience of two classes of EM residents from a 4-year training program at two pediatric EDs of a quaternary care pediatric center. A database of resident patient encounters was generated from the electronic medical record. Experiences classified included: diagnosis categories per the Model of the Clinical Practice of Emergency Medicine, procedures, and resuscitations. Results were stratified by age, acuity, and disposition. RESULTS Twenty-five EM residents evaluated 17,642 patients (median = 723). Most patients (73.5%) were emergent acuity (Emergency Severity Index triage level 2 or 3 or non-intensive care admission); 2% were critical. Residents participated in 598 (median = 22) medical resuscitations and 483 (median = 19) trauma resuscitations. Minor procedures (e.g., laceration repair) were commonly performed; critical procedures (e.g., intubation) were rare. Exposure to neonates was infrequent and pediatric deaths were rare. Abdominal pain (5.7%), asthma exacerbation (4.6%), and fever (3.8%) were the most common diagnoses. CONCLUSIONS Emergency medicine residents encountered a wide array of pediatric diagnoses throughout training and performed a substantial number of common pediatric procedures. Exposure to critical acuity and procedures, neonatal pathology, and certain pediatric-specific diagnoses, such as congenital heart disease, was limited despite training in a large, quaternary care children's hospital. Curriculum development and collaboration should focus on these areas.
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Affiliation(s)
- Kirsten V. Loftus
- From theDepartment of PediatricsNorthwestern University Feinberg School of Medicine & Division of Pediatric Emergency MedicineAnn and Robert H. Lurie Children’s Hospital of ChicagoChicagoILUSA
- theDepartment of PediatricsUniversity of Cincinnati College of Medicine & Division of Emergency MedicineCincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
| | - Daniel J. Schumacher
- theDepartment of PediatricsUniversity of Cincinnati College of Medicine & Division of Emergency MedicineCincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
| | - Matthew R. Mittiga
- and theDepartment of PediatricsUniversity of Colorado School of Medicine & Section of Emergency MedicineChildren's Hospital ColoradoAuroraCOUSA
| | - Erin McDonough
- and theDepartment of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Brad Sobolewski
- theDepartment of PediatricsUniversity of Cincinnati College of Medicine & Division of Emergency MedicineCincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
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20
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Abstract
Adaptive expertise encompasses efficiency and innovation; however little is known about the state of research of adaptive expertise in medical education. Our scoping review summarizes existing evidence in the conceptual frameworks, development, and measurement for adaptive expertise. We searched Pubmed, MEDLINE, ERIC, CINAHL and PsycINFO for original research articles published from 1986 onwards in English. Given the heterogeneity of the studies, no quantitative syntheses were conducted and the articles were summarized qualitatively. Of the 48 articles that met inclusion criteria, 19 examined conceptual frameworks, 24 explored interventions supporting development and 5 examined measurement. Conceptual frameworks are consistent within and beyond health professions education. Factors influencing development include: predisposing factors such as knowledge (ability to integrate knowledge and innovate), beliefs and attitudes (high motivation and humility), enabling factors such as skills (people skills, implementing reflection and scholarly activities), resources such as curricular enablers (providing variability of cases, allowing flexibility to generate solutions, critical appraisal of textbooks) and reinforcing factors such as mentor-guided feedback and constant curricular review. Two validated measurement tools exist for adaptive expertise. Substantial research opportunities exist in studying interventions involving the development of adaptive expertise. Notable gaps exist in the development and validation of measurement tools.
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Affiliation(s)
- Joanne Kua
- Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wee-Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore, Singapore
| | - Winnie Teo
- Group Education, National Healthcare Group, Singapore, Singapore
| | - Roger A Edwards
- Center for Interprofessional Studies and Innovation, MGH Institute of Health Professions, Boston, MA, USA
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21
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Ott M, Apramian T, Lingard L, Roth K, Cristancho S. The embodiment of practice thresholds: from standardization to stabilization in surgical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:139-157. [PMID: 32417985 DOI: 10.1007/s10459-020-09974-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
Surgeons practice their own variations on a procedure. Residents experience shifting thresholds between variations that one surgeon holds firmly as principle and another takes more lightly as preference. Such variability has implications for surgical education, but the impact is not well understood. This is a critical problem to investigate as programs seek to define procedures for competency-based medical education (CBME) and improve learning through deliberate practice. Our study analyzes the emergence of procedural variation in an early-adopter CBME program through a situational analysis of tonsillectomy, a foundation level procedure in this otolaryngology, head and neck surgical program. An earlier phase of the study identified frequent variations (n = 12) on tonsillectomy among co-located surgeons who routinely perform this procedure (n = 6). In the phase reported here we interviewed these surgeons (n = 4) and residents at different stages of training (n = 3) about their experiences of these variations to map the relations of contributing social and material actors. Our results show that even a basic procedure resists standardization. This study contributes a sociomaterial grounded theory of surgical practice as an embodied response to conditions materialized by intra-relations of human and more-than-human actors. Shifting root metaphors about practice in surgical education from standardization to stabilization can help residents achieve stable-for-now embodiments of performance as their practice thresholds continue to emerge.
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Affiliation(s)
- Mary Ott
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Canada.
| | - Tavis Apramian
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Kathryn Roth
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Sayra Cristancho
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Canada
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22
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Ten Cate O, Carraccio C, Damodaran A, Gofton W, Hamstra SJ, Hart DE, Richardson D, Ross S, Schultz K, Warm EJ, Whelan AJ, Schumacher DJ. Entrustment Decision Making: Extending Miller's Pyramid. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:199-204. [PMID: 33060399 DOI: 10.1097/acm.0000000000003800] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The iconic Miller's pyramid, proposed in 1989, characterizes 4 levels of assessment in medical education ("knows," "knows how," "shows how," "does"). The frame work has created a worldwide awareness of the need to have different assessment approaches for different expected outcomes of education and training. At the time, Miller stressed the innovative use of simulation techniques, geared at the third level ("shows how"); however, the "does" level, assessment in the workplace, remained a largely uncharted area. In the 30 years since Miller's conference address and seminal paper, much attention has been devoted to procedures and instrument development for workplace-based assessment. With the rise of competency-based medical education (CBME), the need for approaches to determine the competence of learners in the clinical workplace has intensified. The proposal to use entrustable professional activities as a framework of assessment and the related entrustment decision making for clinical responsibilities at designated levels of supervision of learners (e.g., direct, indirect, and no supervision) has become a recent critical innovation of CBME at the "does" level. Analysis of the entrustment concept reveals that trust in a learner to work without assistance or supervision encompasses more than the observation of "doing" in practice (the "does" level). It implies the readiness of educators to accept the inherent risks involved in health care tasks and the judgment that the learner has enough experience to act appropriately when facing unexpected challenges. Earning this qualification requires qualities beyond observed proficiency, which led the authors to propose adding the level "trusted" to the apex of Miller's pyramid.
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Affiliation(s)
- Olle Ten Cate
- O. ten Cate is professor of medical education and senior scientist, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780
| | - Carol Carraccio
- C. Carraccio was vice president of competency-based assessment, American Board of Pediatrics, Chapel Hill, North Carolina, at the time of writing; ORCID: https://orcid.org/0000-0001-5473-8914
| | - Arvin Damodaran
- A. Damodaran is rheumatologist and director of medical education, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; ORCID: https://orcid.org/0000-0002-5067-9483
| | - Wade Gofton
- W. Gofton is professor of surgery, University of Ottawa, Ottawa, Ontario, Canada; ORCID: https://orcid.org/0000-0003-0438-1659
| | - Stanley J Hamstra
- S.J. Hamstra is research consultant, milestone research and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois, professor, Department of Surgery, University of Toronto, Toronto, Ontario, Canada, and adjunct professor, Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-0680-366X
| | - Danielle E Hart
- D.E. Hart is program director, Emergency Medicine, and director of simulation, Interdisciplinary Simulation and Education Center, Hennepin Healthcare, Minneapolis, Minnesota
| | - Denyse Richardson
- D. Richardson is associate professor, Department of Medicine, Division of Physiatry, and a faculty member, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-6113-158X
| | - Shelley Ross
- S. Ross is associate professor, Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada; ORCID: https://orcid.org/0000-0001-9581-3191
| | - Karen Schultz
- K. Schultz is professor and assessment director, Department of Family Medicine, Queens University, Kingston, Ontario, Canada, and chair, Certification Process and Assessment Committee, College of Family Physicians of Canada, Mississauga, Ontario, Canada; ORCID: https://orcid.org/0000-0001-7041-1700
| | - Eric J Warm
- E.J. Warm is Richard W. Vilter Professor of Medicine, director, Internal Medicine Residency Program, and medical director, Resident Ambulatory Practice, University of Cincinnati, College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6088-2434
| | - Alison J Whelan
- A.J. Whelan is chief medical education officer, Association of American Medical Colleges, Washington, DC; ORCID: https://orcid.org/0000-0001-7661-148X
| | - Daniel J Schumacher
- D.J. Schumacher is associate professor of pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-3747-2410
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23
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Bessmann EL, Rasmussen LS, Konge L, Kristensen MS, Rewers M, Østergaard D, Kotinis A, Mitchell AU, Munksgaard ABF, Schousboe BMB, Rosenstock CV, Nielsen J, Frederiksen H, Graeser K, Larsen PB, Pfeiffer P, Lauritsen T. Maintaining competence in airway management. Acta Anaesthesiol Scand 2020; 64:751-758. [PMID: 32034955 DOI: 10.1111/aas.13558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Airway management is a defining skill for anaesthesiologists. Anaesthesiologists must maintain and update these crucial skills throughout their career, but how this is best achieved remains unclear. This study aimed to clarify anaesthesiologists' procedural volume, confidence in airway management and their current and preferred future educational strategies. METHODS A questionnaire was developed consisting of 28 items exploring essential skills in airway management. All anaesthesiologists in the Capital Region of Denmark were invited to participate. RESULTS The response rate was 84% (240/285). Most anaesthesiologists felt competent to a high or very high degree in basic airway management. Anaesthesiologists from anaesthesia felt confident to a significantly higher degree than those working in the intensive care unit (ICU) regarding the practical aspects of airway management in both the anticipated difficult airway (93% vs 73%, P < .001) and the unanticipated difficult airway (81% vs 61%, P = .002). Both groups performed most of the key advanced techniques ≤4 times yearly, whereas anaesthesiologists from the ICU had a lower and less diverse procedural volume than those working in anaesthesia. The anaesthesiologists preferred training through their daily clinical work, hands-on workshops, and scenario-based simulation training. However, a large discrepancy was identified between the current and the desired level of training. CONCLUSION The anaesthesiologists felt competent to a high or very high degree in basic airway management but the current procedural volume in advanced airway management causes concern for skill maintenance. Furthermore, we found a gap between the current and the desired level of supplemental training.
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Affiliation(s)
- Ebbe L. Bessmann
- Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Lars S. Rasmussen
- Department of Anaesthesia Centre of Head and Orthopaedics Rigshospitalet Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | | | - Mikael Rewers
- Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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24
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Cook DA, Gas BL, Pankratz VS, Farley DR, Pusic MV. Speed and quality goals in procedural skills learning: A randomized experiment. MEDICAL TEACHER 2020; 42:196-203. [PMID: 31595825 DOI: 10.1080/0142159x.2019.1670342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: Compare time (speed) and product quality goals in a surgical procedural task.Methods: Secondary school students participating in a medical simulation-based training activity participated in a randomized experiment. Each participant completed eight repetitions of a blood vessel ligation. Once, between repetitions four and five, each participant received a randomly-assigned speed goal or quality goal. Outcomes included time and leak-free ligatures.Results: 80 students participated. The speed-goal group performed 18% faster on the final repetition than the quality-goal group, with adjusted fold change (FC) 0.82 (95% confidence interval [CI], 0.71, 0.94; p = 0.01). Conversely, the speed-goal group had fewer high-quality (leak-free) ligatures (odds ratio [OR] 0.36 [95% CI, 0.22, 0.58; p < 0.001]). For the quality-goal group, leaky ligatures took longer post-intervention than leak-free ligatures (FC 1.09 [95% CI, 1.02, 1.17; p = 0.01]), whereas average times for leaky and leak-free ligatures were similar for the speed-goal group (FC 0.97 [95% CI, 0.91, 1.04; p = 0.38]). For a given performance time, the speed-goal group had more leaks post-intervention than the quality-goal group (OR 3.35 [95% CI, 1.58, 7.10; p = 0.002]).Conclusions: Speed and quality goals promote different learning processes and outcomes among novices. Use of both speed and quality goals may facilitate more effective and efficient learning.
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Affiliation(s)
- David A Cook
- Mayo Clinic Multidisciplinary Simulation Center, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Becca L Gas
- Center for Clinical and Translational Sciences, Mayo Clinic, Rochester, MN, USA
| | - V Shane Pankratz
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Martin V Pusic
- Department of Emergency Medicine, NYU Langone Health, New York, NY, USA
- Division of Learning Analytics, Institute for Innovations in Medical Education, NYU School of Medicine, New York, NY, USA
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25
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Regan L, Hopson LR, Gisondi MA, Branzetti J. Learning to learn: A qualitative study to uncover strategies used by Master Adaptive Learners in the planning of learning. MEDICAL TEACHER 2019; 41:1252-1262. [PMID: 31287741 DOI: 10.1080/0142159x.2019.1630729] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background: The ability to adapt expertise to both routine and uncommon situations, termed adaptive expertise, has been suggested as a necessary skill for physicians. The Master Adaptive Learner (MAL) framework proposes four phases necessary to develop adaptive expertise. The first phase, "planning" for learning, includes three stages: identification of gaps, prioritization of gaps, and identification of learning resources. This study explored key strategies used by MALs in "planning" for learning. Methods: Focus groups were used to identify strategies that successful postgraduate trainees use to plan learning. Researchers analyzed transcripts using constant comparison analysis and grounded theory to guide the generation of themes. Results: 38 participants, representing 14 specialties, participated in 7 focus groups. Six key strategies used in the "planning" phase of learning were found. During gap identification, they used performance-driven gap identification and community-driven gap identification. To prioritize gaps, they used the schema of triage and adequacy. To identify resources they used intentional adaptation and weighted curation. Barriers such as lack of time and inexperience were noted. Conclusions: MALs use six strategies to plan learning, using patients, health-care team roles, and clinical questions to guide them. Understanding these strategies can help educators design learning opportunities and overcome barriers.
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Affiliation(s)
- Linda Regan
- Department of Emergency Medicine, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Laura R Hopson
- Department of Emergency Medicine, University of Michigan Medical School , Ann Arbor , MI , USA
| | - Michael A Gisondi
- Department of Emergency Medicine, Stanford University School of Medicine , Stanford , CA , USA
| | - Jeremy Branzetti
- Department of Emergency Medicine, New York University School of Medicine , New York City , NY , USA
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