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Valentine J, Jung J. Nurse perspectives on the assessment of emergency medicine residents: A qualitative study. AEM EDUCATION AND TRAINING 2024; 8:e11016. [PMID: 39165859 PMCID: PMC11331246 DOI: 10.1002/aet2.11016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 08/22/2024]
Abstract
Background Multisource and 360-degree feedback are emerging methods in the medical education assessment literature. Nursing feedback in particular has been identified as a point of emphasis regarding what medical education leadership would most value for incorporating into their evaluations. There is no currently accepted tool for multisource feedback in the emergency department (ED). To answer this call, we conducted a qualitative study to elucidate nurse perspectives on evaluation of emergency medicine residents. Methods We conducted individual semistructured interviews of ED nurses with experience working alongside residents via volunteer recruitment. Transcripts were coded independently by each author and then reviewed collaboratively to resolve differences. Codes were created by inductive thematic analysis and subsequently underwent constant comparison and classical content analysis. Recruitment continued until analysis of transcripts showed thematic saturation. Results We organized the interview transcript into chunks of information, arranging 407 quotes from the 10 interview transcripts into 17 codes and six themes regarding observable resident behaviors. Representative quotes and exemplar cases added detailed description to the meaning of these codes. The identified themes for observable resident behaviors included "general communication style," "medical knowledge," "efficiency," "patient communication," "nurse communication," and "professionalism." An additional 13 codes addressed the themes of barriers and catalysts for feedback. Conclusions The identified themes on observable resident behaviors aligned well with prior literature and with the Accreditation Council for Graduate Medical Education (ACGME) Milestones. The interviews also highlighted nurse perspectives on barriers and catalysts for feedback that would be useful to incorporate into the design of an assessment tool.
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Affiliation(s)
- Jake Valentine
- Department of Emergency MedicineHCA Houston Healthcare KingwoodKingwoodTexasUSA
- Department of Clinical SciencesUniversity of Houston College of MedicineHoustonTexasUSA
| | - Julianna Jung
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Bryant JM, Madey KC, Rosenberg SA, Frakes JM, Hoffe SE. Radiation Oncology Resident Education: Is Change Needed? JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02455-4. [PMID: 38761305 DOI: 10.1007/s13187-024-02455-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
Leading successful change efforts first requires assessment of the "before change" environment and culture. At our institution, the radiation oncology (RO) residents follow a longitudinal didactic learning program consisting of weekly 1-h lectures, case conferences, and journal clubs. The resident didactic education series format has not changed since its inception over 10 years ago. We evaluated the perceptions of current residents and faculty about the effectiveness of the curriculum in its present form. Two parallel surveys were designed, one each for residents and attendings, to assess current attitudes regarding the effectiveness and need for change in the RO residency curriculum, specifically the traditional didactic lectures, the journal club sessions, and the case conferences. We also investigated perceived levels of engagement among residents and faculty, whether self-assessments would be useful to increase material retention, and how often the content of didactic lectures is updated. Surveys were distributed individually to each resident (N = 10) and attending (N = 24) either in-person or via Zoom. Following completion of the survey, respondents were informally interviewed about their perspectives on the curriculum's strengths and weaknesses. Compared to 46% of attendings, 80% of RO residents believed that the curriculum should be changed. Twenty percent of residents felt that the traditional didactic lectures were effective in preparing them to manage patients in the clinic, compared to 74% of attendings. Similarly, 10% of residents felt that the journal club sessions were effective vs. 42% of attendings. Finally, 40% of residents felt that the case conferences were effective vs. 67% of attendings. Overall, most respondents (56%) favored change in the curriculum. Our results suggest that the perceptions of the residents did not align with those of the attending physicians with respect to the effectiveness of the curriculum and the need for change. The discrepancies between resident and faculty views highlight the importance of a dedicated change management effort to mitigate this gap. Based on this project, we plan to propose recommended changes in structure to the residency program directors. Main changes would be to increase the interactive nature of the course material, incorporate more ways to increase faculty engagement, and consider self-assessment questions to promote retention. Once we get approval from the residency program leadership, we will follow Kotter's "Eight steps to transforming your organization" to ensure the highest potential for faculty to accept the expectations of a new curriculum.
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Affiliation(s)
- J M Bryant
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
| | - Kara C Madey
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Stephen A Rosenberg
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jessica M Frakes
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Sarah E Hoffe
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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van Keulen SG, de Raad T, Raymakers-Janssen P, Ten Cate O, Hennus MP. Exploring Interprofessional Development of Entrustable Professional Activities For Pediatric Intensive Care Fellows: A Proof-of-Concept Study. TEACHING AND LEARNING IN MEDICINE 2024; 36:154-162. [PMID: 37071751 DOI: 10.1080/10401334.2023.2200760] [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: 07/14/2022] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
Phenomenon: Entrustable professional activities (EPAs) delineate major professional activities that an individual in a given specialty must be "entrusted" to perform, ultimately without supervision, to provide quality patient care. Until now, most EPA frameworks have been developed by professionals within the same specialty. As safe, effective, and sustainable health care ultimately depends on interprofessional collaboration, we hypothesized that members of interprofessional teams might have clear and possibly additional insight into which activities are essential to the professional work of a medical specialist. Approach: We recently employed a national modified Delphi study to develop and validate a set of EPAs for Dutch pediatric intensive care fellows. In this proof-of-concept study, we explored what pediatric intensive care physicians' non-physician team members (physician assistants, nurse practitioners, and nurses) constitute as essential professional activities for PICU physicians and how they regarded the newly developed set of nine EPAs. We compared their judgments with the PICU physicians' opinions. Findings: This study shows that non-physician team members share a mental model with physicians about which EPAs are indispensable for pediatric intensive care physicians. Despite this agreement however, descriptions of EPAs are not always clear for non-physician team members who have to work with them on a daily basis. Insights: Ambiguity as to what an EPA entails when qualifying a trainee can have implications for patient safety and trainees themselves. Input from non-physician team members may add to the clarity of EPA descriptions. This finding supports the involvement of non-physician team members in the developmental process of EPAs for (sub)specialty training programs.
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Affiliation(s)
- Sabrina G van Keulen
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Timo de Raad
- Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paulien Raymakers-Janssen
- Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Olle Ten Cate
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marije P Hennus
- Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Caretta‐Weyer HA, Sebok‐Syer SS, Morris AM, Schnapp BH, Fant AL, Scott KR, Pirotte M, Gisondi MA, Yarris LM. Better together: A multistakeholder approach to developing specialty-wide entrustable professional activities in emergency medicine. AEM EDUCATION AND TRAINING 2024; 8:e10974. [PMID: 38532740 PMCID: PMC10962124 DOI: 10.1002/aet2.10974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/28/2024]
Abstract
Purpose Entrustable professional activities (EPAs) are a widely used framework for curriculum and assessment, yet the variability in emergency medicine (EM) training programs mandates the development of EPAs that meet the needs of the specialty as a whole. This requires eliciting and incorporating the perspectives of multiple stakeholders (i.e., faculty, residents, and patients) in the development of EPAs. Without a shared understanding of what a resident must be able to do upon graduation, we run the risk of advancing ill-prepared residents that may provide inconsistent care. Methods In an effort to address these challenges, beginning in February 2020, the authors assembled an advisory board of 25 EM faculty to draft and reach consensus on a final list of EPAs that can be used across all training programs within the specialty of EM. Using modified Delphi methodology, the authors came to consensus on an initial list of 22 EPAs. The authors presented these EPAs to faculty supervisors, residents, and patients for refinement. The authors collated and analyzed feedback from focus groups of residents and patients using thematic analysis. The EPAs were subsequently refined based on this feedback. Results Stakeholders in EM residency training endorsed a final revised list of 22 EPAs. Stakeholder focus groups highlighted two main thematic considerations that helped shape the finalized list of EM EPAs: attention to the meaningful nuances of EPA language and contextualizing the EPAs and viewing them developmentally. Conclusions To foreground all key stakeholders within the EPA process for EM, the authors chose within the development process to draft; come to consensus; and refine EPAs for EM in collaboration with relevant faculty, patient, and resident stakeholders. Each stakeholder group contributed meaningfully to the content and intended implementation of the EPAs. This process may serve as a model for others in developing stakeholder-responsive EPAs.
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Affiliation(s)
- Holly A. Caretta‐Weyer
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Stefanie S. Sebok‐Syer
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Amanda M. Morris
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Benjamin H. Schnapp
- Berbee Walsh Department of Emergency MedicineUniversity of WisconsinMadisonWisconsinUSA
| | - Abra L. Fant
- Department of Emergency Medicine, Northwestern University Feinberg School of MedicineMcGaw Medical Center at Northwestern UniversityChicagoIllinoisUSA
| | - Kevin R. Scott
- Department of Emergency MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Matthew Pirotte
- Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Michael A. Gisondi
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Lalena M. Yarris
- Department of Emergency MedicineOregon Health & Science UniversityPortlandOregonUSA
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Edmiston N, Hu W, Tobin S, Bailey J, Joyce C, Reed K, Mogensen L. "You're actually part of the team": a qualitative study of a novel transitional role from medical student to doctor. BMC MEDICAL EDUCATION 2023; 23:112. [PMID: 36793053 PMCID: PMC9930018 DOI: 10.1186/s12909-023-04084-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Optimizing transitions from final year of medical school and into first post graduate year has important implications for students, patients and the health care system. Student experiences during novel transitional roles can provide insights into potential opportunities for final year curricula. We explored the experiences of medical students in a novel transitional role and their ability to continue learning whilst working as part of a medical team. METHODS Novel transitional role for final year medical students were created in partnership by medical schools and state health departments in 2020 in response to the COVID-19 pandemic and the need for a medical surge workforce. Final year medical students from an undergraduate entry medical school were employed as Assistants in Medicine (AiMs) in urban and regional hospitals. A qualitative study with semi-structured interviews at two time points was used to obtain experiences of the role from 26 AiMs. Transcripts were analyzed using deductive thematic analysis with Activity theory as a conceptual lens. RESULTS This unique role was defined by the objective of supporting the hospital team. Experiential learning opportunities in patient management were optimized when AiMs had opportunities to contribute meaningfully. Team structure and access to the key instrument, the electronic medical record, enabled participants to contribute meaningfully, whilst contractual arrangements and payments formalized the obligations to contribute. CONCLUSIONS The experiential nature of the role was facilitated by organizational factors. Structuring teams to involve a dedicated medical assistant position with specific duties and access to the electronic medical record sufficient to complete duties are key to successful transitional roles. Both should be considered when designing transitional roles as placements for final year medical students.
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Affiliation(s)
- Natalie Edmiston
- School of Medicine, Western Sydney University, Sydney, Australia.
- University Centre for Rural Health, Lismore, Australia.
| | - Wendy Hu
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Stephen Tobin
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Jannine Bailey
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Caroline Joyce
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Krista Reed
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Lise Mogensen
- School of Medicine, Western Sydney University, Sydney, Australia
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Noerholk LM, Bader‐Larsen KS, Morcke AM, Vamadevan A, Andreasen LA, Svendsen JH, Jørsboe H, Tolsgaard MG. Business as (un)usual: A qualitative study of clerkship experiences during a health crisis. MEDICAL EDUCATION 2022; 56:805-814. [PMID: 35199378 PMCID: PMC9543617 DOI: 10.1111/medu.14787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/07/2022] [Accepted: 02/18/2022] [Indexed: 06/01/2023]
Abstract
INTRODUCTION During a health crisis, hospitals must prioritise activities and resources, which can compromise clerkship-based learning. We explored how health crises affect clinical clerkships using the COVID-19 pandemic as an example. METHODS In a constructivist qualitative study, we conducted 22 semi-structured interviews with key stakeholders (i.e. medical students and doctors) from two teaching hospitals and 10 different departments. We used thematic analysis to investigate our data and used stakeholder theory as a sensitising concept. RESULTS We identified three themes: (1) emotional triggers and reactions; (2) negotiation of legitimacy; and (3) building resilience. Our results suggest that the health crisis accentuated already existing problems in clerkships, such as students' feelings of low legitimacy, constant negotiation of roles, inconsistencies navigating rules and regulations and low levels of active participation. Medical students and doctors adapted to the new organisational demands by developing increased resilience. Students responded by reaching out for guidance and acceptance to remain relevant in the clinical clerkships. Doctors developed a behaviour of closing in and focused on managing themselves and their patients. This created tension between these two stakeholder groups. CONCLUSION A health crisis can critically disrupt the hierarchical structure within the clinical clerkships and exacerbate existing conflicts between stakeholder groups. When medical students are not perceived as legitimate stakeholders in clinical clerkships during a health crisis, their attendance is perceived as unnecessary or even a nuisance. Despite increased student proactiveness and resilience, their roles inevitably shift from being doctors-to-be to students-to-be-managed.
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Affiliation(s)
- Laerke Marijke Noerholk
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Karlen S. Bader‐Larsen
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | | | - Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Lisbeth Anita Andreasen
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of CardiologyCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Hanne Jørsboe
- Nykøbing Falster Sygehus, Region ZealandNykøbing FalsterDenmark
| | - Martin G. Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Centre for Fetal Medicine, Juliane Marie CentreCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
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Chaukos D, Wai A, Genus S, Aulakh G, Maunder R, Mylopoulos M. Involving Multiple Stakeholder Perspectives in a Needs Assessment for a Postgraduate Educational Experience in HIV Psychiatry. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022:10.1007/s40596-022-01665-6. [PMID: 35701711 DOI: 10.1007/s40596-022-01665-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Deanna Chaukos
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada.
| | - Alan Wai
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | | | - Gurpreet Aulakh
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Robert Maunder
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Maria Mylopoulos
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
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8
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Edwards C, Thoirs K, Osborne B, Slade D, McDonald S, Lombardo P, Chandler A, Quinton A, Stoodley P, Taylor L, Childs J. Australian sonographer competency—A new framework. SONOGRAPHY 2022. [DOI: 10.1002/sono.12309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Christopher Edwards
- School of Clinical Sciences, Faculty of Health Queensland University of Technology Brisbane Queensland Australia
| | - Kerry Thoirs
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
| | - Brooke Osborne
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
| | - Debbie Slade
- Australasian Society for Ultrasound in Medicine Chatswood New South Wales Australia
| | - Sandra McDonald
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
- Australasian Society for Ultrasound in Medicine Chatswood New South Wales Australia
| | - Paul Lombardo
- Department of Medical Imaging and Radiation Sciences Monash University Clayton Victoria Australia
| | - Amanda Chandler
- Faculty of Science and Health Charles Sturt University Port Macquarie New South Wales Australia
| | - Ann Quinton
- School of Health, Medical and Applied Sciences Central Queensland University Sydney New South Wales Australia
- Sydney Medical School Nepean The University of Sydney Penrith New South Wales Australia
| | - Paul Stoodley
- Blacktown Clinical School and Research Centre, School of Medicine Western Sydney University Blacktown New South Wales Australia
| | - Lucy Taylor
- The Australian Institute of Healthcare Education St Leonards New South Wales Australia
| | - Jessie Childs
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
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Warm EJ, Kinnear B, Lance S, Schauer DP, Brenner J. What Behaviors Define a Good Physician? Assessing and Communicating About Noncognitive Skills. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:193-199. [PMID: 34166233 DOI: 10.1097/acm.0000000000004215] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Once medical students attain a certain level of medical knowledge, success in residency often depends on noncognitive attributes, such as conscientiousness, empathy, and grit. These traits are significantly more difficult to assess than cognitive performance, creating a potential gap in measurement. Despite its promise, competency-based medical education (CBME) has yet to bridge this gap, partly due to a lack of well-defined noncognitive observable behaviors that assessors and educators can use in formative and summative assessment. As a result, typical undergraduate to graduate medical education handovers stress standardized test scores, and program directors trust little of the remaining information they receive, sometimes turning to third-party companies to better describe potential residency candidates. The authors have created a list of noncognitive attributes, with associated definitions and noncognitive skills-called observable practice activities (OPAs)-written for learners across the continuum to help educators collect assessment data that can be turned into valuable information. OPAs are discrete work-based assessment elements collected over time and mapped to larger structures, such as milestones, entrustable professional activities, or competencies, to create learning trajectories for formative and summative decisions. Medical schools and graduate medical education programs could adapt these OPAs or determine ways to create new ones specific to their own contexts. Once OPAs are created, programs will have to find effective ways to assess them, interpret the data, determine consequence validity, and communicate information to learners and institutions. The authors discuss the need for culture change surrounding assessment-even for the adoption of behavior-based tools such as OPAs-including grounding the work in a growth mindset and the broad underpinnings of CBME. Ultimately, improving assessment of noncognitive capacity should benefit learners, schools, programs, and most importantly, patients.
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Affiliation(s)
- Eric J Warm
- E.J. Warm is professor of medicine and program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6088-2434
| | - Benjamin Kinnear
- B. Kinnear is associate professor of medicine and pediatrics and associate program director, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0003-0052-4130
| | - Samuel Lance
- S. Lance is associate professor of plastic surgery and craniofacial surgery and program director of plastic surgery, Division of Plastic Surgery, University of California San Diego, San Diego, California; ORCID: https://orcid.org/0000-0002-5186-2677
| | - Daniel P Schauer
- D.P. Schauer is associate professor of medicine and associate program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0003-3264-8154
| | - Judith Brenner
- J. Brenner is associate professor of science education and medicine and associate dean for curricular integration and assessment, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; ORCID: https://orcid.org/0000-0002-8697-5401
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Kwan C, Weerdenburg K, Pusic M, Constantine E, Chen A, Rempell R, Herman JE, Boutis K. Learning Pediatric Point-of-Care Ultrasound: How Many Cases Does Mastery of Image Interpretation Take? Pediatr Emerg Care 2022; 38:e849-e855. [PMID: 35100784 DOI: 10.1097/pec.0000000000002396] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Using an education and assessment tool, we examined the number of cases necessary to achieve a performance benchmark in image interpretation of pediatric soft tissue, cardiac, lung, and focused assessment with sonography for trauma (FAST) point-of-care ultrasound (POCUS) applications. We also determined interpretation difficulty scores to derive which cases provided the greatest diagnostic challenges. METHODS Pediatric emergency physicians participated in web-based pediatric POCUS courses sponsored by their institution as a credentialing priority. Participants deliberately practiced cases until they achieved diagnostic interpretation scores of combined 90% accuracy, sensitivity, and specificity. RESULTS Of the 463 who enrolled, 379 (81.9%) completed cases. The median (interquartile range) number of cases required to achieve the performance benchmark for soft tissue was 94 (68-128); cardiac, 128 (86-201); lung, 87 (25-118); and FAST, 93 (68-133) (P < 0001). Specifically, cases completed to achieve benchmark were higher for cardiac relative to other applications (P < 0.0001 for all comparisons). In soft tissue cases, a foreign body was more difficult to diagnose than cobblestoning and hypoechoic collections (P = 0.036). Poor cardiac function and abnormal ventricles were more difficult to interpret with accuracy than normal (P < 0.0001) or pericardial effusion cases (P = 0.01). The absence of lung sliding was significantly more difficult to interpret than normal lung cases (P = 0.028). The interpretation difficulty of various FAST imaging findings was not significantly different. CONCLUSIONS There was a significant variation in number of cases required to reach a performance benchmark. We also identified the specific applications and imaging findings that demonstrated the greatest diagnostic challenges. These data may inform future credentialing guidelines and POCUS learning interventions.
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Affiliation(s)
- Charisse Kwan
- From the Division of Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Sciences Centre, London, Ontario
| | - Kirstin Weerdenburg
- Department of Emergency Medicine, IWK Health and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Pusic
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Boston and Harvard University, Boston, MA
| | - Erika Constantine
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Aaron Chen
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Rachel Rempell
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | | | - Kathy Boutis
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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11
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Lepre B, Palermo C, Mansfield KJ, Beck EJ. Stakeholder Engagement in Competency Framework Development in Health Professions: A Systematic Review. Front Med (Lausanne) 2021; 8:759848. [PMID: 34869461 PMCID: PMC8632936 DOI: 10.3389/fmed.2021.759848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Competency framework development in health professions has downstream implications for all relevant stakeholders, from the professionals themselves, to organisations, and most importantly end users of services. However, there is little guidance related to what stakeholders might be involved in the competency development process, and when. This review aimed to systematically review literature related to competency framework development methodology in health, to identify the breadth and purpose of key stakeholders commonly involved in the process. Studies were identified using five electronic databases (MEDLINE, PubMed, CINAHL, EMBASE, and ERIC) and a search of websites of organisations involved in curriculum or regulation using keywords related to competency frameworks. The total yield from all databases was 10,625 results, with 73 articles included in the final review. Most articles were from Australia (30%) and were conducted in the nursing (34%) profession. Unsurprisingly, practitioners (86%) and academics (75%) were typically engaged as stakeholders in competency framework development. While many competency frameworks were described as patient-focused, only 14 (19%) studies elected to include service users as stakeholders. Similarly, despite the multi-disciplinary focus described in some frameworks, only nine (12%) studies involved practitioners from other professions. Limiting the conceptualisation of competence to that determined by members of the profession itself may not provide the depth of insight required to capture the complexity of healthcare and address the needs of important stakeholder groups. Future methodology should attempt to engage a variety of relevant stakeholders such as external health professions and the community to match professional education to health service demands. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=128350.
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Affiliation(s)
- Breanna Lepre
- School of Medicine, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, VIC, Australia
| | - Kylie J. Mansfield
- School of Medicine, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Eleanor J. Beck
- School of Medicine, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
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Stalmeijer RE, Varpio L. The wolf you feed: Challenging intraprofessional workplace-based education norms. MEDICAL EDUCATION 2021; 55:894-902. [PMID: 33651450 PMCID: PMC8359828 DOI: 10.1111/medu.14520] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/29/2021] [Accepted: 02/26/2021] [Indexed: 05/26/2023]
Abstract
CONTEXT The trajectory towards becoming a medical professional is strongly situated within the clinical workplace. Through participatory engagement, medical trainees learn to address complex health care issues through collaboration with the interprofessional health care team. To help explain learning and teaching dynamics within the clinical workplace, many scholars have relied on socio-cultural learning theories. In the field of medical education, this research has largely adopted a limited interpretation of a crucial dimension within socio-cultural learning theory: the expert who guides the trainee into the community is almost exclusively from the same profession. We contend that this narrow interpretation is not necessary. This limited focus is one we choose to maintain-be that choice intentional or implicit. In this cross-cutting edge paper, we argue that choosing an interprofessional orientation towards workplace learning and guidance may better prepare medical trainees for their future role in health care practice. METHODS By applying Communities of Practice and Landscapes of Practice , and supported by empirical examples, we demonstrate how medical trainees are not solely on a trajectory towards the Community of Physician Practice (CoPP) but also on a trajectory towards various Landscapes of Healthcare Practice (LoHCP). We discuss some of the barriers present within health care organisations and professions that have likely inhibited adoption of the broader LoHCP perspective. We suggest three perspectives that might help to deliberately and meaningfully incorporate the interprofessional learning and teaching dynamic within the medical education continuum. CONCLUSION Systematically incorporating Landscapes of Competence, Assessment, and Guidance in workplace-based education-in addition to our current intraprofessional approach-can better prepare medical trainees for their roles within the LoHCP. By advocating and researching this interprofessional perspective, we can embark on a journey towards fully harnessing and empowering the health care team within workplace-based education.
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Affiliation(s)
- Renée E. Stalmeijer
- School of Health Professions EducationFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Lara Varpio
- Center for Health Professions EducationDepartment of MedicineUniformed Services University of the Health SciencesBethesdaMDUSA
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Noerholk LM, Morcke AM, Bader Larsen KS, Tolsgaard MG. Is two a crowd? A qualitative analysis of dyad learning in an OBGYN clinical clerkship. MEDICAL EDUCATION 2021; 55:724-732. [PMID: 33368489 DOI: 10.1111/medu.14444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Dyad learning occurs when two students work together to acquire new skills and knowledge. Several studies have provided evidence to support the educational rationale for dyad learning in the controlled simulated setting. However, the role of dyad learning in the clinical setting remains uncertain. Unlike the simulated setting, learning in the clinical setting depends on a complex interplay between medical students, doctors, nurses and patients potentially making dyad learning less valuable in clerkships. The objective of this study was to explore how key stakeholders perceive the value of implementing dyad learning during medical students' clinical clerkships. METHODS In a constructivist qualitative study, we conducted 51 semi-structured interviews with 36 key stakeholders involved in dyad learning, including 10 medical students, 12 doctors, five nurses and nine patients. Data were coded inductively using thematic analysis, then coded deductively using stakeholder theory as a theoretical framework. RESULTS We found that stakeholders generally perceived the educational impact of dyad learning in the clinical setting similarly but disagreed on its value. Students emphasised that dyad learning made them participate more actively during patient encounters and patients did not mind having two students present. Doctors and nurses considered dyad learning disruptive to the balance between service and training and reported that it did not resonate with their perception of good patient care. CONCLUSION Dyad learning enables students to be more active during their clinical clerkships, but it easily disrupts the balance between service and training. This disruption may be exacerbated by the shifted balance in priorities and values between different stakeholder groups, as well as by making implicit teaching obligations more explicit for supervising doctors and nurses. Consequently, implementing dyad learning may not be perceived as valuable by doctors and nurses in the clinical setting, regardless of its pedagogical rationale.
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Affiliation(s)
- Laerke Marijke Noerholk
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Anne Mette Morcke
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Karlen S Bader Larsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Martin G Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for Fetal Medicine, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
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Pinilla S, Kyrou A, Maissen N, Klöppel S, Strik W, Nissen C, Huwendiek S. Entrustment decisions and the clinical team: A case study of early clinical students. MEDICAL EDUCATION 2021; 55:365-375. [PMID: 33301632 DOI: 10.1111/medu.14432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/16/2020] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE Clinical learning contexts influence how medical students engage with entrustment decisions. However, it is unclear how students and health care team members perceive the entrustment decision process. This study explored which factors students and team members consider relevant to entrustment decisions in early clinical rotations. METHODS The authors conducted a case study at an academic teaching hospital, interviewing 28 medical students and four health care team members during the clerkship year. Within a social constructivist epistemology, we explored students' and health care team members' perceptions of ad hoc entrustment decisions using semi-structured interviews. Transcripts from the interviews and notes from feedback rounds with students were used for analysis. RESULTS Medical students in their core clerkship year perceived clinical residents as critical educational gatekeepers and key facilitators of entrustment decisions. Another important theme emerged around students' motivation, initiative and willingness to engage with the health care team and patients. Students actively engaged in trust formation processes with different health care team members. The entrustment decision process was perceived as multilateral and dynamic, involving all health care team members and patients. Multiple entrusting supervisors for clerkship students, including nurses and psychologists, emerged from our interview data. They assumed an active role in negotiating entrustment decisions both with and for clerkship students, either facilitating or hindering opportunities. The entrustment decisions emerged as a result of a multifaceted supervisor network interaction. CONCLUSIONS Supervising residents' ability to integrate students into clinical teams seems to be a critical factor in facilitating entrustment opportunities for clinical activities. Students' active management of informal supervisor networks of health care team members and these team members' willingness to assume responsibility for the students' education emerged as relevant aspects for ad hoc entrustment. Our data suggest that supervision from different health professionals is beneficial for clinical education of medical students and merits further exploration.
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Affiliation(s)
- Severin Pinilla
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Alexandra Kyrou
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Norina Maissen
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
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Klitgaard TL, Stentoft D, Skipper M, Grønkjær M, Nøhr SB. Struggling to fit the white coat and the role of contextual factors within a hospital organisation - an ethnographic study on the first months as newly graduated doctors. BMC MEDICAL EDUCATION 2021; 21:74. [PMID: 33494741 PMCID: PMC7836569 DOI: 10.1186/s12909-021-02493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/10/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite increased focus on improving the transition from being a medical student to working as a junior doctor, many newly graduated doctors (NGD) report the process of fitting the white coat as stressful, and burnout levels indicate that they might face bigger challenges than they can handle. During this period, the NGDs are in a process of learning how to be doctors, and this takes place in an organisation where the workflow and different priorities set the scene. However, little is known about how the hospital organisation influences this process. Thus, we aimed to explore how the NGDs experience their first months of work in order to understand 1) which struggles they are facing, and 2) which contextual factors within the hospital organisation that might be essential in this transition. METHODS An ethnographic study was conducted at a university hospital in Denmark including 135 h of participant observations of the NGDs (n = 11). Six semi-structured interviews (four group interviews and two individual interviews) were conducted (n = 21). The analysis was divided into two steps: Firstly, we carried out a "close-to-data" analysis with focus on the struggles faced by the NGDs. Secondly, we reviewed the struggles by using the theoretical lens of Cultural Historical Activity Theory (CHAT) to help us explore, which contextual factors within the hospital organisation that seem to have an impact on the NGDs' experiences. RESULTS The NGDs' struggles fall into four themes: Responsibility, local knowhow, time management and collaborators. By using the CHAT lens, we were able to identify significant contextual factors, including a physically remote placement, a missing overlap between new and experienced NGDs, a time limited introduction period, and the affiliation to several departments. These struggles and factors were highly intertwined and influenced by one another. CONCLUSION Contextual factors within the hospital organisation may aggravate the struggles experienced by the NGDs, and this study points to possible elements that could be addressed to make the transition less challenging and overwhelming.
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Affiliation(s)
- Tine Lass Klitgaard
- Department of Postgraduate Medical Education, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Diana Stentoft
- Centre for Health Science Education and Problem-Based Learning, Aalborg University, Aalborg, Denmark
| | - Mads Skipper
- Postgraduate Medical Educational Region North, Viborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Grønkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Susanne Backman Nøhr
- Department of Postgraduate Medical Education, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Bobel MC, Branson CF, Chipman JG, Campbell AR, Brunsvold ME. "Who wants me to do what?" varied expectations from key stakeholder groups in the surgical intensive care unit creates a challenging learning environment. Am J Surg 2020; 221:394-400. [PMID: 33303187 DOI: 10.1016/j.amjsurg.2020.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/30/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical intensive care units (SICU) require complex care from a multi-disciplinary team. Frequent changes in team members can lead to shifting expectations for junior general surgical trainees, which creates a challenging working and learning environment. We aim to identify expectations of junior surgery trainee's medical knowledge and technical/non-technical skills at the start of their SICU rotation. We hypothesize that expectations will not be consistent across SICU stakeholder groups. METHODS Twenty-eight individual semi-structured interviews were conducted with six SICU stakeholder groups at a medium-sized academic hospital. Expectations were identified from interview transcripts. Frequency counts were analyzed. RESULTS Forty-one expectations were identified. 4 expectations were identified by a majority of interviewees. Most expectations were identified by 7 or fewer interviewees. 23 (53%) expectations were shared by at least one stakeholder group. 2 (8%) expectations were shared by all groups. CONCLUSIONS SICU stakeholder groups identified ten medical knowledge, ten technical skill, and three non-technical skill expectations. Yet, few expectations were shared among the groups. Thus, SICU stakeholder groups have disparate expectations for surgery trainees in our SICU.
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Affiliation(s)
- Matthew C Bobel
- University of Minnesota, Department of Surgery, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, MN, 55455, USA.
| | - Carolina Fernandez Branson
- University of Minnesota, Department of Surgery, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, MN, 55455, USA
| | - Jeffrey G Chipman
- University of Minnesota, Department of Surgery, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, MN, 55455, USA
| | - Andre R Campbell
- University of California-San Francisco, Department of Surgery, San Francisco, Campus Box 0807, CA, 94143-0807, USA
| | - Melissa E Brunsvold
- University of Minnesota, Department of Surgery, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, MN, 55455, USA
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Kwan C, Pusic M, Pecaric M, Weerdenburg K, Tessaro M, Boutis K. The Variable Journey in Learning to Interpret Pediatric Point-of-care Ultrasound Images: A Multicenter Prospective Cohort Study. AEM EDUCATION AND TRAINING 2020; 4:111-122. [PMID: 32313857 PMCID: PMC7163207 DOI: 10.1002/aet2.10375] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To complement bedside learning of point-of-care ultrasound (POCUS), we developed an online learning assessment platform for the visual interpretation component of this skill. This study examined the amount and rate of skill acquisition in POCUS image interpretation in a cohort of pediatric emergency medicine (PEM) physician learners. METHODS This was a multicenter prospective cohort study. PEM physicians learned POCUS using a computer-based image repository and learning assessment system that allowed participants to deliberately practice image interpretation of 400 images from four pediatric POCUS applications (soft tissue, lung, cardiac, and focused assessment sonography for trauma [FAST]). Participants completed at least one application (100 cases) over a 4-week period. RESULTS We enrolled 172 PEM physicians (114 attendings, 65 fellows). The increase in accuracy from the initial to final 25 cases was 11.6%, 9.8%, 7.4%, and 8.6% for soft tissue, lung, cardiac, and FAST, respectively. For all applications, the average learners (50th percentile) required 0 to 45, 25 to 97, 66 to 175, and 141 to 290 cases to reach 80, 85, 90, and 95% accuracy, respectively. The least efficient (95th percentile) learners required 60 to 288, 109 to 456, 160 to 666, and 243 to 1040 cases to reach these same accuracy benchmarks. Generally, the soft tissue application required participants to complete the least number of cases to reach a given proficiency level, while the cardiac application required the most. CONCLUSIONS Deliberate practice of pediatric POCUS image cases using an online learning and assessment platform may lead to skill improvement in POCUS image interpretation. Importantly, there was a highly variable rate of achievement across learners and applications. These data inform our understanding of POCUS image interpretation skill development and could complement bedside learning and performance assessments.
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Affiliation(s)
- Charisse Kwan
- From the Division of Pediatric Emergency MedicineDepartment of PediatricsHospital for Sick Children and University of TorontoTorontoOntarioCanada
| | - Martin Pusic
- Department of Emergency Medicine and Division of Learning AnalyticsNYU School of MedicineNew YorkNY
| | | | - Kirstin Weerdenburg
- Department of Emergency MedicineIWK Health Centre and Dalhousie UniversityHalifaxNova ScotiaCanada
| | - Mark Tessaro
- From the Division of Pediatric Emergency MedicineDepartment of PediatricsHospital for Sick Children and University of TorontoTorontoOntarioCanada
| | - Kathy Boutis
- From the Division of Pediatric Emergency MedicineDepartment of PediatricsHospital for Sick Children and University of TorontoTorontoOntarioCanada
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Andersen BR, Rasmussen MB, Christensen KB, Engel KG, Ringsted C, Løkkegaard E, Tolsgaard MG. Making the best of the worst: Care quality during emergency cesarean sections. PLoS One 2020; 15:e0227988. [PMID: 32084173 PMCID: PMC7034794 DOI: 10.1371/journal.pone.0227988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/03/2020] [Indexed: 11/18/2022] Open
Abstract
Objective This study aimed to identify factors influencing mothers’ and their partners’ perceptions of care quality, and to identify associated clinical factors. Methods Questionnaires were developed based on eight interviews with couples after emergency Cesarean Sections (ECS). The internal structure of the questionnaires was examined using Rasch analysis. Cronbach’s alpha was calculated to evaluate internal consistency of questionnaire items. Finally, associations between questionnaire scores and ECS characteristics were determined. Results Thematic analysis of interview data demonstrated that team-dynamics, professionalism, information, safety, leadership and mother-child continuity of care are important to patient- perceived quality of care. Questionnaire responses from 119 women and 95 partners were included in the validation and demonstrated satisfying fit to the Rasch model. The questionnaires had acceptable internal consistency with Cronbach’s alpha 0.8 and 0.7 for mothers and partners, respectively. Perceived quality of care was negatively associated with increasing urgency of the CS. Spearman rank correlation coefficients were -0.34 (p <0.001) and -0.32 (p = 0.004) for mothers and partners, respectively. Perceived quality of care differed significantly across CS indications for both mothers (p = 0.0006) and their partners (p<0.0001). Conclusion Team-dynamics, professionalism, information, safety, leadership and mother-child-continuity affect patients’ perceptions of care. Perceptions of care were highly influenced by CS indications and urgency.
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Affiliation(s)
- Betina Ristorp Andersen
- Department of Gynaecology and Obstetrics, Hillerød Hospital, Northzealand Hospital, University of Copenhagen, Hillerød, Denmark.,Copenhagen Academy of Medical Education and Simulation, Rigshospitalet, Capital Region of Denmark, Copenhagen, Denmark
| | | | - Karl Bang Christensen
- Department of Health, Section of Biostatistics, University of Copenhagen, Øster Farimagsgade, Copenhagen, Denmark
| | - Kirsten G Engel
- Copenhagen Academy of Medical Education and Simulation, Rigshospitalet, Capital Region of Denmark, Copenhagen, Denmark
| | - Charlotte Ringsted
- Center for Health Science Education, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Ellen Løkkegaard
- Department of Gynaecology and Obstetrics, Hillerød Hospital, Northzealand Hospital, University of Copenhagen, Hillerød, Denmark
| | - Martin G Tolsgaard
- Copenhagen Academy of Medical Education and Simulation, Rigshospitalet, Capital Region of Denmark, Copenhagen, Denmark.,Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Yarris LM. Defining Trainee Competence: Value Is in the Eye of the Stakeholder. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:760-762. [PMID: 30730366 DOI: 10.1097/acm.0000000000002643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this issue of Academic Medicine, Lundsgaard and colleagues present "Embracing Multiple Stakeholder Perspectives in Defining Trainee Competence," a qualitative exploration of how various stakeholders contribute to the understanding of trainee competence. Drawing on stakeholder theory from business management, the authors of that report explore how the perceptions of key stakeholders (leaders/administrators, nurses/nurse practitioners, trainees, and patients) either confirm, enhance, or complicate the picture of competence that emerges from the perspectives of senior physician supervisors.In this Invited Commentary, the author considers the potential effects of applying stakeholder theory to educational assessment and elaborates on Lundsgaard and colleagues' findings that additional stakeholder perceptions may be redundant in some instances and present conflicting understandings of competence in others. She also emphasizes the importance of a process of defining competence, and ultimately developing assessment programs, that includes measuring and illuminating conflicting perceptions of what constitutes competence. Finally, the author considers potential applications of Lundsgaard and colleagues' results for educators and assessors with comprehensive assessment programs already in place.There are limitations and risks to applying a conceptual framework that aims to increase value for a company to the training of physicians. However, with thoughtful application, incorporating multiple stakeholders into instrument development and workplace-based assessment may provide educators with a more nuanced picture of competence that incorporates the values of those ultimately impacted by trainee performance.
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Affiliation(s)
- Lalena M Yarris
- L.M. Yarris is professor and residency program director, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
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