Twenty years of experience using trigger films as a teaching tool

A cinenurducation activity using Call the Midwife to teach about sexually transmitted infections and preeclampsia: design, implementation, and assessment

BACKGROUND

Nursing students need to learn about sexually transmitted infections and preeclampsia. Cinenureducation is a rigorous method that uses materials from commercial movies or television series to teach health sciences students.

OBJECTIVES

Using content analysis of the television series Call the Midwife, design a cinenureducation activity teaching nursing students about sexually transmitted infections and preeclampsia. Evaluate its effectiveness in knowledge acquisition. DESIGN, IMPLEMENTATION, AND PRE-POST ASSESSMENT OF KNOWLEDGE GAIN FOR TEACHING ACTIVITIES: The study comprised three main steps: designing the teaching activity, implementing it, and analyzing its pedagogical effectiveness through a pre-and-post study to assess knowledge acquisition resulting from the teaching activity.

PARTICIPANTS

A six-member panel assessed the suitability of materials for the teaching goals. All second-year undergraduate nursing students in the course "Nursing management and leadership" at a nursing school in the 2022-2023 academic year were invited to participate (N = 160).

METHODS

The panel conducted a content analysis of the first two seasons of the series to determine the usefulness of each episode for teaching the chosen topics. Students were randomly assigned to groups watching episodes emphasizing either sexually transmitted infections or preeclampsia, followed by discussion. Learning was gauged through a pre-post viewing 20-question multiple-choice test. Additionally, students' satisfaction was evaluated.

RESULTS

A total of 142 nursing students participated. Significant differences between mean scores before and after intervention were found [6.90 vs. 6.42 on the preintervention assessment, p < 0.05; mean gain, 0.49 (95 % CI: 0.22-0.76)]. Most students were satisfied with the activity.

CONCLUSIONS

The activity was useful for teaching about sexually transmitted infections and preeclampsia. The use of a television series portraying nurses enables the exploration of these critical topics. This has potential implications for integrating similar methods into nurse education curricula, emphasizing the broader impact of the research on pedagogical practices in healthcare education.

Animating Clinical Ethics: A Structured Method to Teach Ethical Analysis Through Movies

Movies can serve valuable didactic purposes teaching clinical ethics to medical students. However, using film sequences as means to develop critical thinking is not a straightforward task. There is a significant gap in the literature regarding how to analyse the ethical content embedded in these clips systematically, in a way that facilitates the students' transition from anecdotal reflections to abstract thinking. This article offers a pedagogical proposal to approach the ethical analysis of film sequences in a systematic fashion. This structured stepwise method encourages students to identify the main ethical problem of a selected scene and to reflect on the theoretical principles involved, emphasizing the application of these norms and values in a contextually situated analysis. We believe this method in film studies both reinforces the students' comprehension of the theoretical framework of an ethical topic, and casts light on its pertinence and limitations under the circumstances of the scene, thus proving a constructive tool to strengthen the bridge between the theoretical teaching of clinical ethics and clinical practice.

Can Distance Communication Skills Training Increase the Empathy Levels in Medical Students? An Application During the Pandemic Period

Background and Purpose: The aim is to determine the effect of the communication skills training (CST) using interactive synchronous and asynchronous methods, which was applied for the first time on medical students’ empathy levels. Methods: This study is a cross-sectional-analytical, self-controlled intervention. The distance CST program was applied to first-year medical students. The change in students’ empathy levels was measured with the student version of the Jefferson Empathy Scale. Results: 241 students’ forms were included. Empathy mean score increased significantly, this increase was higher in women. Conclusion: The distance CST produced a positive effect on empathy levels. While interactive PowerPoint® presentations, videos, movie clips, cartoons, real-life examples, written/audio question- answer activities, surveys, feedback and, small group work were used in live lessons; in the asynchronous process, student-based techniques (self-assessment, homework, WhatsApp® sharing) were used to support the online learning climate. We believe that all of them support the cognitive and social existence of students throughout the training. We propose our program as a model that can be used during situations where face-to-face education is not possible and to support face-to-face education in medical education.

Trigger videos: a novel application of a tool for surgical faculty development

BACKGROUND

Trigger videos have occasionally been used in medical education; however, their application to surgical faculty development is novel. We assessed participants' attitudes towards workshops on intraoperative teaching (IOT) that were anchored by trigger videos, and studied whether they could generate discussion-for-learning among surgeons in this workshop setting.

METHODS

Surgeons from multiple specialties attended one of six faculty development workshops where IOT trigger videos were shown and discussed during break-out sessions. Participants completed questionnaires to (1) evaluate videos via survey and feedback, and (2) identify adoptable and discardable IOT techniques. Teaching techniques were collated to identify planned IOT changes and survey data and feedback were analyzed.

RESULTS

A total of 135 surgeons identified 292 adoptable and 202 discardable IOT techniques based on trigger videos and discussions, and 94% of participants reported that the trigger videos were useful and encouraged them to discuss and consider new IOT techniques in their own practice.

CONCLUSIONS

Participants reported that the trigger videos were useful and motivating. Surgeons critically reflected on IOT during the sessions, identifying numerous adoptable and discardable techniques relevant to their own teaching styles. Trigger videos can be a valuable tool for surgical faculty development and can be tailored to other medical specialties.

Changing the channel on medical ethics education: systematic review and qualitative analysis of didactic-icebreakers in medical ethics and professionalism teaching

As medical ethics and professionalism education continues to equip medical students and residents with long-lasting tools, educators should continue to supplement proven teaching strategies with engaging, relatable, and generationally appropriate didactic supplements. However, popular teaching aids have recently been criticized in the literature and summative information on alternatives is absent. The purpose of this review is to evaluate and assess the functional use and application of short form audiovisual didactic supplements or "icebreakers" in medical ethics and professionalism teaching. A systematic review of both the medical and humanities literature (i.e., PubMed/MEDLINE, Cochrane Library, and JSTOR) was conducted from inception to August 1, 2019. Final articles were subjected to a qualitative appraisal and thematic analysis. Thirteen articles were included for final analysis. Sixty-nine percent (n = 9) of the studies were published after 2000. Two studies were qualitative, one study was quantitative, and the remaining articles were commentaries. Short form audiovisual media was most popular outside of the United States (n = 10). Sixty-nine percent (n = 9) of articles advocated for self-contained media in the form of trigger films or short films/videos, while the remaining articles (n = 4) discussed the use of TV/film clips. Producibility of media was exclusive to short/trigger films. Nine themes were identified in the content analysis: adaptability, conversation catalyst, effective, engaging, nuance, practice, producibility, real, and subject diversity. The three most common themes in descending order of frequency were: conversation catalyst, realness, and adaptability. Trigger films represent an effective and unique pedagogical strategy in supplementing current medical ethics and professionalism teaching at the medical school level.

Simulation in Medical Education for the Hospitalist: Moving Beyond the Mock Code

Simulation in medical education has grown due to an evolution in health care. It uses 4 main modalities to re-create a situation from the clinical environment to allow experiential learning and improve patient care. Simulation must be considered as an educational strategy within a larger curriculum. Building an exercise requires first developing goals and objectives and then designing the scenario. There are 4 phases of implementation, wherein the final debrief phase is critical for learning. Educators have used simulation for multiple curricular needs: communication skills, interprofessional education, clinical reasoning, procedural training, and patient safety, which apply to the inpatient setting.

An objective structured teaching exercise for faculty training and assessment of teaching ability in interprofessional collaborative practice and education

OBJECTIVE

Improving clinical teachers' ability to teach interprofessional collaborative practice warrants development in current faculty training programs; in particular, current education training emphasizes experiential learning and multiple teaching strategies. The purpose of this study was to establish a teaching model to apply interdisciplinary collaborative care and to improve clinical teachers' execution of interprofessional practices.

MATERIALS AND METHODS

Health-care faculty members were studied; this study assessed a teacher education curriculum for interprofessional education (IPE) and applied an objective structured teaching exercise (OSTE) to evaluate IPE execution by clinical teachers.

RESULTS

The OSTE improved clinical teachers' IPE execution, verifying the necessity for multistrategy teaching in faculty training programs.

CONCLUSIONS

This study provides different types of interprofessional faculty training and assessments. Development of an OSTE requires long-term planning, and IPE should also be incorporated into formal programs.

Moral discourse in general practitioners' accounts of obesity communication

Obesity is not addressed with a large proportion of patients presenting in general practice. An increasing body of evidence suggests that health professionals view body weight as a sensitive topic to include in routine consultations and face barriers in initiating weight loss discussions. This study examined the discursive power relations that shape how general practitioners (GPs) understand and talk about obesity using a novel methodology to elicit responses from GPs about raising the topic of weight. Twenty GPs from the South West of England reflected upon novel trigger films simulating doctor-patient interactions, in which a doctor either acknowledged or ignored their patient's body weight. Underpinned by a discourse analytic approach, our findings suggest that GPs both reproduce and resist moral discourse surrounding body weight. They construct obesity as an individual behavioural problem whilst simultaneously drawing on socio-cultural discourse which positions body weight as central to social identity, situating obesity within a context of stigma and positioning patients as powerless to lose weight. Our findings highlight a need for increased reflexivity about competing discursive frameworks at play during medical consultations about obesity, which we suggest, contribute to increased tension and powerlessness for GPs. Trigger films are an innovative method to elicit information and discuss competing discourses.

The Creation of Standard-Setting Videos to Support Faculty Observations of Learner Performance and Entrustment Decisions

Entrustable professional activities (EPAs) provide a framework to standardize medical education outcomes and advance competency-based assessment. Direct observation of performance plays a central role in entrustment decisions; however, data obtained from these observations are often insufficient to draw valid high-stakes conclusions. One approach to enhancing the reliability and validity of these assessments is to create videos that establish performance standards to train faculty observers. Little is known about how to create videos that can serve as standards for assessment of EPAs.The authors report their experience developing videos that represent five levels of performance for an EPA for patient handoffs. The authors describe a process that begins with mapping the EPA to the critical competencies needed to make an entrustment decision. Each competency is then defined by five milestones (behavioral descriptors of performance at five advancing levels). Integration of the milestones at each level across competencies enabled the creation of clinical vignettes that were converted into video scripts and ultimately videos. Each video represented a performance standard from novice to expert. The process included multiple assessments by experts to guide iterative improvements, provide evidence of content validity, and ensure that the authors successfully translated behavioral descriptions and vignettes into videos that represented the intended performance level for a learner. The steps outlined are generalizable to other EPAs, serving as a guide for others to develop videos to train faculty. This process provides the level of content validity evidence necessary to support using videos as standards for high-stakes entrustment decisions.

Thoracic surgeons' perception of frail behavior in videos of standardized patients

Background

Frailty is a predictor of poor outcomes following many types of operations. We measured thoracic surgeons' accuracy in assessing patient frailty using videos of standarized patients demonstrating signs of physical frailty. We compared their performance to that of geriatrics specialists.

Methods

We developed an anchored scale for rating degree of frailty. Reference categories were assigned to 31 videos of standarized patients trained to exhibit five levels of activity ranging from “vigorous” to “frail.” Following an explanation of frailty, thoracic surgeons and geriatrics specialists rated the videos. We evaluated inter-rater agreement and tested differences between ratings and reference categories. The influences of clinical specialty, clinical experience, and self-rated expertise were examined.

Results

Inter-rater rank correlation among all participants was high (Kendall's W 0.85) whereas exact agreement (Fleiss' kappa) was only moderate (0.47). Better inter-rater agreement was demonstrated for videos exhibiting extremes of behavior. Exact agreement was better for thoracic surgeons (n = 32) than geriatrics specialists (n = 9; p = 0.045), whereas rank correlation was similar for both groups. More clinical years of experience and self-reported expertise were not associated with better inter-rater agreement.

Conclusions

Videos of standarized patients exhibiting varying degrees of frailty are rated with internal consistency by thoracic surgeons as accurately as geriatrics specialists when referenced to an anchored scale. Ratings were less consistent for moderate degrees of frailty, suggesting that physicians require training to recognize early frailty. Such videos may be useful in assessing and teaching frailty recognition.

Development, implementation, and dissemination of the I-PASS handoff curriculum: A multisite educational intervention to improve patient handoffs

Patient handoffs are a key source of communication failures and adverse events in hospitals. Despite Accreditation Council for Graduate Medical Education requirements for residency training programs to provide formal handoff skills training and to monitor handoffs, well-established curricula and validated skills assessment tools are lacking. Developing a handoff curriculum is challenging because of the need for standardized processes and faculty development, cultural resistance to change, and diverse institution- and unit-level factors. In this article, the authors apply a logic model to describe the process they used from June 2010 to February 2014 to develop, implement, and disseminate an innovative, comprehensive handoff curriculum in pediatric residency training programs as a fundamental component of the multicenter Initiative for Innovation in Pediatric Education-Pediatric Research in Inpatient Settings Accelerating Safe Sign-outs (I-PASS) Study. They describe resources, activities, and outputs, and report preliminary learner outcomes using data from resident and faculty evaluations of the I-PASS Handoff Curriculum: 96% of residents and 97% of faculty agreed or strongly agreed that the curriculum promoted acquisition of relevant skills for patient care activities. They also share lessons learned that could be of value to others seeking to adopt a structured handoff curriculum or to develop large-scale curricular innovations that involve redesigning firmly established processes. These lessons include the importance of approaching curricular implementation as a transformational change effort, assembling a diverse team of junior and senior faculty to provide opportunities for mentoring and professional development, and linking the educational intervention with the direct measurement of patient outcomes.

Promoting professionalism via a video-based educational workshop for academic hospitalists and housestaff

BACKGROUND

Unprofessional behavior can compromise care and detract from the hospital learning environment. Discrepancy between professional behaviors formally taught and what is witnessed has become increasingly evident.

METHODS

With funding from the American Board of Internal Medicine Foundation, a workshop was developed to address unprofessional behaviors related to inpatient care previously identified in a multi-institution survey. The aims were to utilize video-based education to illustrate unprofessional behaviors, how faculty play a role in promoting such behaviors, and facilitate reflection regarding motivation for and prevention of these behaviors. Hospitalists and housestaff at 3 Chicago-area academic hospitals and 1 community teaching affiliate participated. Videos were debriefed, identifying barriers to professional behavior and improvement strategies. A postworkshop survey assessed beliefs on behaviors and intent to change practice.

RESULTS

Forty-four (53%) faculty and 244 (68%) residents (postgraduate year 1 and greater) participated. The workshop was well received, with 89% reporting it "useful and effective." Two-thirds expressed intent to change behavior. Most (86%) believed videos were realistic and effective. Those who perceived videos as "very realistic" were more likely to report intent to change behavior (93% vs 53%, P = 0.01).

CONCLUSIONS

Video-based education is a feasible way to promote reflection and address unprofessional behaviors among providers and may positively impact the learning environment.

Watch and learn: an innovative video trigger curriculum to increase resident screening for social determinants of health

OBJECTIVE

To determine the effectiveness of an innovative curriculum, using trigger videos modeling screening for social determinants of health (SDH), on the comfort and screening practices of pediatric residents during well-child care.

METHODS

A nonrandomized controlled study of an educational intervention was performed. Resident surveys assessing knowledge, comfort, and screening practices for SDH were performed pre- and post-intervention. Subsets of control and intervention residents were observed pre- and post-intervention to determine changes in SDH screening practices.

RESULTS

Thirty-six residents completed the study. Intervention residents spent more time screening (P = .04), and inquired more frequently about family supports (P = .046) and housing conditions (P = .045). Intervention residents were less likely to note lack of knowledge and discomfort as barriers to screening.

CONCLUSIONS

A curriculum incorporating trigger videos modeling SDH screening increased screening time and inquiry for a number of SDH by pediatric residents. Fewer barriers to screening were noted following the curriculum.

Cinemeducation: A pilot student project using movies to help students learn medical professionalism

BACKGROUND

Using movies has been accepted worldwide as a tool to help students learn medical professionalism. In the second year, a group of medical students conducted the "Cinemeducation" project to promote professionalism in the "Medical Ethics and Critical Thinking" course.

METHOD

Five movies with professionalism issues were screened with 20-30 students attending each session. After the show, participants then were asked to reflect on what they had learned in terms of professionalism. Two students led group discussion emphasizing questioning and argumentation for 60 min. Additional learning issues emerging from each session were also explored in more depth and arranged into a report.

RESULTS

In the Cinemeducation Project, medical students have learned five main ethical issues in each film, which were the doctor-patient relationship, informed consent and clinical trials in patients, management of genetic disorders, patient management, and brain death and organ transplantation. In addition to issues of professionalism, they also developed critical thinking and moral reasoning skills.

CONCLUSION

Using a case-based scenario in movies has proven to be an effective and entertaining method of facilitating students with learning on professionalism.

How video cases should be used as authentic stimuli in problem-based medical education

PURPOSE

To examine problem-based learning (PBL) students' views on the added value of video cases compared to text-based cases in the pre-clinical phase of undergraduate medical education and on the conditions for productive use of video in tutorial group discussions.

METHOD

Participants were 2nd-year students who had completed a PBL programme featuring video cases. Three groups of 6-8 randomly selected students participated in focus-group interviews guided by a moderator using a 'questioning route'. The interviews were audiotaped, transcribed and analysed. The summary reports were approved by the students.

RESULTS

According to the students, the video cases enabled them to create realistic mental pictures of disorders, provided integrated pictures of patients as people, which challenged them to elaborate the cases seriously and were more memorable than text-based cases. Cases that students perceived as fostering the productive use of video were neither too directive nor too complete, tailored to students' prior knowledge, short, varied in design and complementary to other materials. The cases should be viewed in a structured, purposeful manner, with cues, instructions and prompts to focus attention on essential issues.

CONCLUSION

The video cases were generally perceived as a valuable stimulus for group discussions in PBL. However, productive use depended on specific conditions. Many of the advantages and conditions mentioned are supported by earlier non-empirical claims in the literature or can be explained by theory and empirical studies on symbol systems. Future observational studies should address the effects of specific attributes of video as a medium.

Overcoming barriers to teaching the behavioral and social sciences to medical students

Most U.S. medical schools offer courses in the behavioral and social sciences (BSS), but their implementation is frequently impeded by problems. First, medical students often fail to perceive the relevance of the BSS for clinical practice. Second, the BSS are vaguely defined and the multiplicity of the topics that they include creates confusion about teaching priorities. Third, there is a lack of qualified teachers, because physicians may have received little or no instruction in the BSS, while behavioral and social scientists lack experience in clinical medicine. The authors propose an approach that may be useful in overcoming these problems and in shaping a BSS curriculum according to the institutional values of various medical schools. This approach originates from insights gathered during their attempts to teach various BSS topics at four Israeli medical schools. They suggest that medical faculties (1) adopt an integrative approach to learning the biomedical, behavioral, and social sciences using Engel's "biopsychosocial model" as a link between the BSS and clinical practice, (2) define a hierarchy of learning objectives and assign the highest priority to acquisition of clinically relevant skills, and (3) develop clinical role models through teacher training programs. This approach emphasizes the clinical relevance of the BSS, defines learning priorities, and promotes cooperation between clinical faculty and behavioral scientists.

Introduction of contextual legal issues in an interdisciplinary program for the study of ethical dilemmas in obstetrics and gynecology for third-year medical students

OBJECTIVE

To introduce contextual legal issues, and the role of law in resolving ethical dilemmas, in a women's health ethics curriculum for third-year medical students.

METHODS

Seventeen third-year medical students at Emory University School of Medicine, rotating on an 8-week obstetrics and gynecology clerkship, and 8 third-year law students from the Georgia State University College of Law attended four 1-hour ethics sessions conducted by an obstetrician and gynecologist, a law professor and an ethics fellow. Each student group completed a short survey to evaluate the effectiveness of the sessions.

RESULTS

The overwhelming majority, 20 of 25 (80%) of the combined student group ranked the sessions a level 6 or 7 (the highest level) and suggested continuation of the interdisciplinary group format. The majority of the combined student group, 14 of 25 (56%), also viewed the multidisciplinary nature of the group as the most helpful aspect of the sessions. For the medical students, additional helpful aspects included having the legal perspective from persons who actually study the law. For the law students, other helpful aspects included the informal roundtable discussion format and the structured 4-quadrant model.

CONCLUSION

Incorporation of medical and law students into a discussion group for resolving ethical dilemmas is a satisfying method for discussion of legal issues in the women's health ethics curriculum. It enriches the understanding of students from both disciplines.