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Vaillant-Corroy AS, Girard F, Virard F, Corne P, Gerber Denizart C, Wulfman C, Vital S, Gosset M, Naveau A, Delbos Y, Vergnes JN, Thivichon-Prince B, Antoine J, Mainville G, Nader M, Richert R, Charlin B, Ducret M. Concordance of judgement: A tool to foster the development of professionalism in dentistry. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024. [PMID: 38581208 DOI: 10.1111/eje.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 01/25/2024] [Accepted: 02/16/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Developing professionalism notably involves learning how to make professional judgements in ambiguous situations. The Concordance of Judgement Test (CJT) is a learning tool that was proposed to develop professionalism competencies, but it was never performed in dentistry or used with a synchronous methodology. The present study evaluated the feasibility of the use of CJT in the context of dental education, to foster professionalism and stimulate reflexivity and discussion. MATERIALS AND METHODS After different steps of optimization, a questionnaire presenting 12 vignettes was submitted to 33 Canadian students. Second, after an additional optimization, a questionnaire of 7 vignettes was submitted to 87 French students. An immediate educational feedback was proposed after each vignette to promote reflexivity and discussions during the experience. RESULTS The overall experience of the students was reported as good, thanks to the feedback of real-life situations. This promoted reflexivity and stimulated discussion between students and educators regarding professionalism issues. The students considered CJT as a relevant and well-adapted tool, and reported positive feelings regarding the inter-university aspect of the activity. The mean score of the panel members was close to 80/100 and the mean score of the students was 5 to 10 points lower, which is in agreement with docimological performance. CONCLUSION The results suggested that the use of CJT in a synchronous way was a feasible and relevant tool to motivate the students to improve their professionalism, and to stimulate their reflexivity and discussion. The students reported positive experience with CJT, and we believe that this tool can be integrated in the dental curriculum.
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Affiliation(s)
- Anne-Sophie Vaillant-Corroy
- UFR d'odontologie de Lorraine, Université de Lorraine, Vandœuvre-lès-Nancy, France
- Service d'odontologie, Centre Hospitalier Régional Universitaire, Nancy, France
- Laboratoire Lorrain de Psychologie et Neurosciences de la Dynamique des Comportements, Université de Lorraine, Nancy, France
| | - Félix Girard
- Faculté de médecine dentaire, Université de Montréal, Montréal, Québec, Canada
| | - François Virard
- UFR d'Odontologie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service de Consultations et de Traitements Dentaires, Lyon, France
| | - Pascale Corne
- UFR d'odontologie de Lorraine, Université de Lorraine, Vandœuvre-lès-Nancy, France
- Service d'odontologie, Centre Hospitalier Régional Universitaire, Nancy, France
- Laboratoire Lorrain de Psychologie et Neurosciences de la Dynamique des Comportements, Université de Lorraine, Nancy, France
| | | | - Claudine Wulfman
- UFR Odontologie Université Paris Cité, URP 2496, Montrouge, France
- Service de médecine bucco-dentaire, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Sibylle Vital
- UFR Odontologie Université Paris Cité, URP 2496, Montrouge, France
- Service de médecine bucco-dentaire, DMU ESPRIT, Hopital Louis Mourier AP-HP, Colombes, France
| | - Marjolaine Gosset
- Service de Médecine Bucco-Dentaire, AP-HP, Hôpital Charles Foix, Ivry/seine, France
| | - Adrien Naveau
- UFR des Sciences Odontologiques, Université de Bordeaux, Bordeaux, France
- Service de Médecine Bucco-Dentaire, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - Yves Delbos
- UFR des Sciences Odontologiques, Université de Bordeaux, Bordeaux, France
- Service de Médecine Bucco-Dentaire, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - Jean-Noël Vergnes
- UFR d'Odontologie de Toulouse, Université Paul Sabatier, Toulouse, France
- Service d'Odontologie, CHU de Toulouse, Toulouse, France
| | | | - Juliette Antoine
- UFR d'Odontologie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service de Consultations et de Traitements Dentaires, Lyon, France
| | - Gisele Mainville
- Faculté de médecine dentaire, Université de Montréal, Montréal, Québec, Canada
| | - Moussa Nader
- Faculté de médecine dentaire, Université de Montréal, Montréal, Québec, Canada
| | - Raphael Richert
- UFR d'Odontologie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service de Consultations et de Traitements Dentaires, Lyon, France
| | - Bernard Charlin
- Faculté de médecine dentaire, Université de Montréal, Montréal, Québec, Canada
| | - Maxime Ducret
- UFR d'Odontologie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service de Consultations et de Traitements Dentaires, Lyon, France
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Kojich L, Miller SA, Axman K, Eacret T, Koontz JA, Smith C. Evaluating clinical reasoning in first year DPT students using a script concordance test. BMC MEDICAL EDUCATION 2024; 24:329. [PMID: 38519915 DOI: 10.1186/s12909-024-05281-w] [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: 10/20/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND A script concordance test (SCT) provides a series of clinical vignettes to assess clinical reasoning in uncertainty. Appraised throughout health education literature, SCTs are cognitive assessments of clinical reasoning, though their use in Doctor of Physical Therapy (DPT) entry-level education has not been investigated. The purpose of this study was to develop and explore the reliability and validity of a SCT for first year DPT students. METHODS The SCT was developed and implemented over four phases. During phases one and two, DPT program faculty consulted on course content from the first-year curriculum. Thirty clinical vignettes with three follow-up questions each were constructed. The SCT was pilot tested with five clinicians in phase three to assess question clarity. During phase four, the SCT was administered to students and a reference panel via Qualtrics. First year DPT students (n = 44) and reference panel physical therapists with at least two years of experience and advanced certification (n = 15) completed the SCT. Internal consistency was analyzed using Cronbach's Alpha. Differences between student and reference panel percent-correct scores were analyzed with a t-test. Relationships between student SCT scores and academic records were explored with Spearman's Rho. RESULTS The SCT had an internal consistency of 0.74. A significant difference in scores was found between the students [mean 58.5 (+/-5.31)] and reference panel [65.8 (+/-4.88), p < .01]. No significant correlations between student SCT scores and academic records were found. CONCLUSIONS The developed SCT was reliable and demonstrated satisfactory internal consistency among test items. The SCT successfully differentiated between groups, with the reference panel demonstrating statistically significant higher percent-correct scores compared to students. SCTs may provide means to measure clinical reasoning in DPT students and lead to novel pedagogical approaches to enhance clinical reasoning.
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Affiliation(s)
- Lindsey Kojich
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA.
| | - Stephanie A Miller
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
| | - Katelyn Axman
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
| | - Timothy Eacret
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
| | - J Atticus Koontz
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
| | - Caroline Smith
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
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Charton L, Lahmar A, Hernandez E, Rougerie F, Lorenzo M. Impact of an online learning by concordance program on reflection. BMC MEDICAL EDUCATION 2023; 23:822. [PMID: 37915022 PMCID: PMC10621083 DOI: 10.1186/s12909-023-04799-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Learning by concordance (LbC) is a recent approach that introduces learners to the complexity and uncertainty of clinical practice. Some data on LbC suggest that it stimulates reflection in future clinicians. We developed an online LbC training program on electrocardiogram (ECG) interpretation in general practice at the University of Strasbourg, France, and conducted an exploratory qualitative study to document the impact of this ECG learning-by-concordance training program on reflection in participants. METHODS We created 18 clinical vignettes on ECG interpretation based on a review of the literature on frequent and serious cardiovascular diseases that can be identified using an ECG in general practice. The training program was delivered online to postgraduate general practice students in two faculties of medicine. We conducted a qualitative study based on thematic analysis of two focus groups and six individual interviews. Inductive and deductive coding were performed. The five major components of reflection in the Nguyen model were used in the deductive coding: (i) thoughts and actions, (ii) attentive, critical, exploratory, and iterative processes (ACEI), (iii) underlying conceptual frame, (iv) change and (v) self. RESULTS Two focus groups and six individual interviews were conducted. The qualitative analysis indicated 203 codes in the focus groups and 206 codes in the individual interviews, which were divided into five groups based on the components of reflection in the Nguyen model: (i) the self; (ii) attentive, critical, exploratory, and iterative interactions with (iii) one's thoughts and actions; and (iv) a view on both the change itself and (v) the underlying conceptual frame. Inductive coding revealed interesting insights into the impact of the identity of the panel members, the absence of a scoring system and the question of uncertainty in ECG reading. CONCLUSIONS This study supports the claim that the use of LbC in the context of ECG interpretation could foster reflection in future general practitioners. We discuss future research avenues on instructional design of LbC and reflection.
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Affiliation(s)
- Léa Charton
- Département de Médecine Générale et de la Formation Territoriale, Faculté de Médecine, Maïeutique et Sciences de la Santé, 4 rue Kirschleger, Strasbourg, 67085, France
| | - Abdelkader Lahmar
- Département de Médecine Générale et de la Formation Territoriale, Faculté de Médecine, Maïeutique et Sciences de la Santé, 4 rue Kirschleger, Strasbourg, 67085, France
| | - Elodie Hernandez
- Département de Médecine Générale, Faculté de Médecine, Besançon, France
| | - Fabien Rougerie
- Département de Médecine Générale et de la Formation Territoriale, Faculté de Médecine, Maïeutique et Sciences de la Santé, 4 rue Kirschleger, Strasbourg, 67085, France
| | - Mathieu Lorenzo
- Département de Médecine Générale et de la Formation Territoriale, Faculté de Médecine, Maïeutique et Sciences de la Santé, 4 rue Kirschleger, Strasbourg, 67085, France.
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Belhomme N, Lescoat A, Launey Y, Jégo P, Cavalin C, Pottier P. [Tolerating uncertainty: Towards a competence-based approach]. Rev Med Interne 2023; 44:27-30. [PMID: 36371326 DOI: 10.1016/j.revmed.2022.10.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022]
Abstract
Uncertainty in inherent to every aspects of medical practice. As the concept of uncertainty in healthcare is still to explore, deciphering the determinants and the roots of this uncertainty would benefit from the insights of various disciplines, such as epistemology, sociology, mathematics, or philosophy. The urgent need to improve physician's ability to cope with uncertainty, has been recently highlighted by the COVID-19 pandemic. Besides, the concept of uncertainty tolerance has been proposed, and could serve as a relevant basis for approaching uncertainty, in medical education. Thus, we propose at first to discuss the uncertainty tolerance framework from Hillen et al. Then, from an educational perspective, we outline some avenues regarding how uncertainty tolerance could be thought, in a competence-based approach, and discuss several educational activities, which have proven efficient in promoting uncertainty tolerance among medical practitioners abroad.
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Affiliation(s)
- N Belhomme
- Service de médecine interne et immunologie clinique, CHU de Rennes, université Rennes 1, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France.
| | - A Lescoat
- Service de médecine interne et immunologie clinique, CHU de Rennes, université Rennes 1, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Y Launey
- Réanimation chirurgicale, département d'anesthésie-réanimation-médecine Périopératoire, CHU de Rennes, université Rennes 1, Rennes, France
| | - P Jégo
- Service de médecine interne et immunologie clinique, CHU de Rennes, université Rennes 1, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - C Cavalin
- IRISSO, UMR CNRS-INRAE 7170-1427, Université Paris-Dauphine, PSL, Paris, France; Laboratoire interdisciplinaire d'évaluation des politiques publiques (LIEPP), Sciences Po, Paris, France; Centre d'études de l'emploi et du travail (CEET, CNAM), Noisy-le-Grand, France
| | - P Pottier
- Service de médecine interne et immunologie clinique, CHU Nantes, Nantes, France; Faculté de médecine-pôle santé, Nantes Université, Nantes, France
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Zagury-Orly I, Kamin DS, Krupat E, Charlin B, Fernandez N, Fischer K. The Student-Generated Reasoning Tool (SGRT): Linking medical knowledge and clinical reasoning in preclinical education. MEDICAL TEACHER 2022; 44:158-166. [PMID: 34459337 DOI: 10.1080/0142159x.2021.1967904] [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 simultaneous integration of knowledge acquisition and development of clinical reasoning in preclinical medical education remains a challenge. To help address this challenge, the authors developed and implemented the Student-Generated Reasoning Tool (SGRT)-a tool asking students to propose and justify pathophysiological hypotheses, generate findings, and critically appraise information. METHODS In 2019, students in a first-year preclinical course (n = 171; SGRT group) were assigned to one of 20 teams. Students used the SGRT individually, then in teams, and faculty provided feedback. The control group (n = 168) consisted of students from 2018 who did not use SGRT. Outcomes included academic performance, effectiveness of collaborative environments using the SGRT, and student feedback. RESULTS Students were five times more likely to get questions correct if they were in the SGRT group versus control group. Accuracy of pathophysiological hypotheses was significantly lower for individuals than teams. Qualitative analysis indicated students benefited from generating their own data, justifying their reasoning, and working individually as well as in teams. CONCLUSIONS This study introduces the SGRT as a potentially engaging, case-based, and collaborative learning method that may help preclinical medical students become aware of their knowledge gaps and integrate their knowledge in basic and clinical sciences in the context of clinical reasoning.
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Affiliation(s)
- Ivry Zagury-Orly
- Faculty of Medicine, Université de Montréal, Montreal, Canada
- Harvard Medical School, Boston, MA, USA
| | - Daniel S Kamin
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Edward Krupat
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Bernard Charlin
- Centre for Pedagogy Applied to the Health Sciences, Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Nicolas Fernandez
- Centre for Pedagogy Applied to the Health Sciences, Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Krisztina Fischer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Deschênes MF, Charlin B, Phan V, Grégoire G, Riendeau T, Henri M, Fehlmann A, Moussa A. Educators and practitioners' perspectives in the development of a learning by concordance tool for medical clerkship in the context of the COVID pandemic. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:43-54. [PMID: 35003430 PMCID: PMC8740256 DOI: 10.36834/cmej.72461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic has forced medical schools to create educational material to palliate the anticipated and observed decrease in clinical experiences during clerkships. An online learning by concordance (LbC) tool was developed to overcome the limitation of students' experiences with clinical cases. However, knowledge about the instructional design of an LbC tool is scarce, especially the perspectives of collaborators involved in its design: 1- educators who wrote the vignettes' questions and 2- practitioners who constitute the reference panel by answering the LbC questions. The aim of this study was to describe the key elements that supported the pedagogical design of an LbC tool from the perspectives of educators and practitioners. METHODS A descriptive qualitative research design has been used. Online questionnaires were used, and descriptive analysis was conducted. RESULTS Six educators and 19 practitioners participated in the study. Important to the educators in designing the LbC tool were prevalent or high-stake situations, theoretical knowledge, professional situations experienced and perceived difficulties among students, and that the previous workshop promoted peer discussion and helped solidify the writing process. Important for practitioners was standards of practice and consensus among experts. However, they were uncertain of the educational value of their feedback, considering the ambiguity of the situations included in the LbC tool. CONCLUSIONS The LbC tool is a relatively new training tool in medical education. Further research is needed to refine our understanding of the design of such a tool and ensure its content validity to meet the pedagogical objectives of the clerkship.
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Affiliation(s)
- Marie-France Deschênes
- Centre d’innovation en formation infirmière (CIFI) – Center for Innovation in Nursing Education, Université de Montréal, Quebec, Canada
| | | | - Véronique Phan
- Faculté de Médecine, Université de Montréal, Quebec, Canada
| | | | - Tania Riendeau
- Faculté de Médecine, Université de Montréal, Quebec, Canada
| | - Margaret Henri
- Faculté de Médecine, Université de Montréal, Quebec, Canada
| | - Aurore Fehlmann
- Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Switzerland
| | - Ahmed Moussa
- Faculté de Médecine, Université de Montréal, Quebec, Canada
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