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Song SL, Yu ZZ, Pavlech L, Scott IU, Greenberg PB. Theoretical Frameworks in Medical Education: Using a Systematic Review of Ophthalmology Education Research to Create a Theory of Change Model. J Grad Med Educ 2022; 14:568-582. [PMID: 36274766 PMCID: PMC9580314 DOI: 10.4300/jgme-d-22-00115.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/25/2022] [Accepted: 07/22/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Theoretical frameworks provide a lens to examine questions and interpret results; however, they are underutilized in medical education. OBJECTIVE To systematically evaluate the use of theoretical frameworks in ophthalmic medical education and present a theory of change model to guide educational initiatives. METHODS Six electronic databases were searched for peer-reviewed, English-language studies published between 2016 and 2021 on ophthalmic educational initiatives employing a theoretical framework. Quality of studies was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach; risk of bias was evaluated using the Medical Education Research Study Quality Instrument (MERSQI) and the Accreditation Council for Graduate Medical Education (ACGME) guidelines for evaluation of assessment methods. Abstracted components of the included studies were used to develop a theory of change model. RESULTS The literature search yielded 1661 studies: 666 were duplicates, 834 studies were excluded after abstract review, and 132 after full-text review; 29 studies (19.2%) employing a theoretical framework were included. The theories used most frequently were the Dreyfus model of skill acquisition and Messick's contemporary validity framework. GRADE ratings were predominantly "low," the average MERSQI score was 10.04, and the ACGME recommendation for all assessment development studies was the lowest recommendation. The theory of change model outlined how educators can select, apply, and evaluate theory-based interventions. CONCLUSIONS Few ophthalmic medical education studies employed a theoretical framework; their overall rigor was low as assessed by GRADE, MERSQI, and ACGME guidelines. A theory of change model can guide integration of theoretical frameworks into educational initiatives.
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Affiliation(s)
- Sophia L. Song
- Sophia L. Song, ScB, is a Medical Student, Warren Alpert Medical School, Brown University
| | - Zane Z. Yu
- Zane Z. Yu, AB, is a Medical Student, Warren Alpert Medical School, Brown University
| | - Laura Pavlech
- Laura Pavlech, DVM, MSLS, is a Research Librarian, University of Maryland School of Pharmacy and University of Maryland Health and Human Services Library
| | - Ingrid U. Scott
- Ingrid U. Scott, MD, MPH, is a Professor of Ophthalmology and Public Health Sciences, Penn State College of Medicine
| | - Paul B. Greenberg
- Paul B. Greenberg, MD, MPH, is Deputy Chief Academic Affiliations Officer, Office of Academic Affiliations, United States Department of Veterans Affairs, and Professor of Surgery (Ophthalmology), Warren Alpert Medical School, Brown University
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Lowater SJ, Grauslund J, Vergmann AS. Modern Educational Simulation-Based Tools Among Residents of Ophthalmology: A Narrative Review. Ophthalmol Ther 2022; 11:1961-1974. [PMID: 36001249 DOI: 10.1007/s40123-022-00559-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION With no specific overview on simulation-based training for educational purposes among residents in ophthalmology, this narrative review attempts to highlight the current literature on modern educational simulation-based tools used to educate residents in ophthalmology. METHODS We searched databases Web of Science and PubMed between March 15 and July 21, 2022. Relevant and accessible articles and abstracts published after 2006 and in English only were included. RESULTS Simulation-based cataract surgery is associated with better outcomes in the operating room and faster surgeries. Construct validity has been established across different procedures and levels in simulation-based cataract surgery and simulation-based vitreoretinal surgery. Other simulation-based procedures indicate promising results but in general lack evidence-based validity. DISCUSSION This narrative review highlights and evaluates the current and relevant literature of modern educational simulation-based tools to train ophthalmology residents in different fundamental skills like simulation-based ophthalmoscopy and complex surgical procedures like simulation-based cataract surgery and vitreoretinal surgery. Some studies attempt to develop simulators for the use in education of ophthalmology residents. Other studies strive to establish validity of the respective procedures or modern education tools and some studies investigate the effect of simulation-based training. The most validated modern educational simulation-based tool is the Eyesi Surgical Simulator (VRmagic, Germany). However, other modern educational simulation-based tools have also been evaluated, including the HelpMeSee Eye Surgery Simulator (HelpMeSee Inc., New York, USA) and the MicroVisTouch Surgical Simulator (ImmersiveTouch, USA). CONCLUSION Simulation-based training has already been established for residents in ophthalmology to benefit the most from skill-demanding procedures resulting in better learning and better patient handling. Future studies should aim to validate more simulation-based procedures for the teaching of ophthalmology residents so that the evidence is kept at a high standard.
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Affiliation(s)
- Simon J Lowater
- Research Unit of Ophthalmology, Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Jakob Grauslund
- Research Unit of Ophthalmology, Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anna S Vergmann
- Research Unit of Ophthalmology, Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark
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Evidence-based assessment of acupuncture skills using a newly developed simulation-based test. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2022. [DOI: 10.1016/j.wjam.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Jacobsen N, Nolsøe CP, Konge L, Graumann O, Dietrich CF, Sidhu PS, Gilja OH, Meloni MF, Berzigotti A, Harvey CJ, Deganello A, Prada F, Lerchbaumer MH, Laursen CB. Development of and Gathering Validity Evidence for a Theoretical Test in Contrast-Enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:248-256. [PMID: 34815128 DOI: 10.1016/j.ultrasmedbio.2021.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is an imaging modality applied in a broad field of medical specialties for diagnostic uses, guidance during biopsy procedures and ablation therapies and sonoporation therapy. Appropriate training and assessment of theoretical and practical competencies are recommended before practicing CEUS, but no validated assessment tools exist. This study was aimed at developing a theoretical multiple-choice question-based test for core CEUS competencies and gathering validity evidence for the test. An expert team developed the test via a Delphi process. The test was administered to medical doctors with varying CEUS experience, and the results were used to evaluate test items, internal-consistency reliability, ability to distinguish between different proficiency levels and to establish a pass/fail score. Validity evidence was gathered according to Messick's framework. The final test with 47 test items could distinguish between operators with and without CEUS experience with acceptable reliability. The pass/fail score led to considerable risk of false positives and negatives. The test may be used as an entry test before learning practical CEUS competencies but is not recommended for certification purposes because of the risk of false positives and negatives.
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Affiliation(s)
- Niels Jacobsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Regional Center for Technical Simulation (TechSim), Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Demark.
| | - Christian P Nolsøe
- Center for Surgical Ultrasound, Department of Surgery, Zealand University Hospital, Køge, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Christoph F Dietrich
- Department of Internal Medicine, Hirslanden Clinic (Beau-Site, Salem-Spital, and Permanence), Bern, Switzerland
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom; School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Odd H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Maria F Meloni
- Department of Interventional Ultrasound, IGEA S.p.A. Multispecialty Medical Clinic, Milan, Italy; Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Annalisa Berzigotti
- Department of Hepatology, University Clinic for Visceral Surgery and Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Chris J Harvey
- Department of Imaging, Imperial College NHS Healthcare Trust, Hammersmith Hospital, London, United Kingdom
| | - Annamaria Deganello
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom; School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Francesco Prada
- Neurosurgery Unit, Department of Neuroscience, Alessandro Manzoni Hospital, Lecco, Italy; Acoustic Neuroimaging and Therapy Lab, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy; Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia, USA; Focused Ultrasound Foundation, Charlottesville, Virginia, USA
| | - Markus H Lerchbaumer
- Charité University Hospital Berlin, Humboldt University of Berlin, Berlin, Germany; Department of Radiology, Berlin Institute of Health, Berlin, Germany
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Regional Center for Technical Simulation (TechSim), Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Demark
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Ternov NK, Vestergaard T, Hölmich LR, Karmisholt K, Wagenblast AL, Klyver H, Hald M, Schøllhammer L, Konge L, Chakera AH. Reliable test of clinicians' mastery in skin cancer diagnostics. Arch Dermatol Res 2020; 313:235-243. [PMID: 32596742 DOI: 10.1007/s00403-020-02097-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/17/2020] [Indexed: 11/25/2022]
Abstract
Differentiating between benign and malignant skin lesions can be very difficult and should only be done by sufficiently trained and skilled clinicians. To our knowledge there are no validated tests for reliable assessments of clinicians' ability to perform skin cancer diagnostics. To develop and gather validity evidence for a test in skin cancer diagnostics, a multiple-choice questionnaire (MCQ) was developed based on informal interviews with seven content experts from five skin cancer centers in Denmark. Validity evidence for the test was gathered from May until July 2019 using Messick's validity framework (content, response process, internal structure, relationship to other variables and consequences). Item content was revised through a Delphi-like review process and then piloted on 36 medical students and 136 doctors using a standardized response process. Results enabled an analysis of the internal structure and relationship to other variables of the test. Finally, the contrasting groups method was used to investigate the test's consequences (pass-fail standard). The initial 90-item MCQ was reduced to 40 items during the Delphi-like review process. Item analysis revealed that 25 of the 40 selected items were level I-III quality items with a high internal consistency (Cronbach's α = 0.83) and highly significant (P ≤ 0.0001) differences in test scores between participants with different occupations or levels of experience. A pass-fail standard of 12 (48%) correct answers was established using the contrasting groups' method. The skin cancer diagnostics MCQ developed in this study can be used for reliable assessments of clinicians' competencies.
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Affiliation(s)
- Niels Kvorning Ternov
- Department of Plastic Surgery, Herlev and Gentofte University Hospital, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark. .,Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark. .,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
| | - T Vestergaard
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Copenhagen, Denmark
| | - L Rosenkrantz Hölmich
- Department of Plastic Surgery, Herlev and Gentofte University Hospital, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - K Karmisholt
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - A L Wagenblast
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - H Klyver
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M Hald
- Department of Dermatology, Herlev and Gentofte University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - L Schøllhammer
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - L Konge
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - A H Chakera
- Department of Plastic Surgery, Herlev and Gentofte University Hospital, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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Hogarty DT, Hogarty JP, Hewitt AW. Smartphone use in ophthalmology: What is their place in clinical practice? Surv Ophthalmol 2020; 65:250-262. [DOI: 10.1016/j.survophthal.2019.09.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 01/02/2023]
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