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Huang J, Huang C, Chen J, Huang K. Perception of clinical teachers about their roles and current practice at affiliated hospitals of medical universities in China. MEDICAL EDUCATION ONLINE 2024; 29:2325182. [PMID: 38465652 DOI: 10.1080/10872981.2024.2325182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
Phenomenon: The increase in clinical and teaching workload has brought enormous pressure to clinical teachers. Clinical teachers play an extremely important role in the quality of higher medical education and the cultivation of medical talents. However, few studies have examined the attitudes and practices of clinical teachers regarding the role of teachers in China. This study aimed to investigate clinical teachers' perceptions about their roles and current practices at affiliated hospitals of medical universities in China. Approach: Responses from 312 Chinese clinical teachers were included in the analyses. The data were collected using the questionnaires of perception and practice regarding the role of teachers which consisted of 12 items rated on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree), and scored by calculating the mean. The data were analyzed using the Statistical Package for Social Sciences, version 22.0 (IBM SPSS Corp). Findings: The mean score of perception of clinical teachers regarding the role of teachers was 4.51 (SD = 0.72), and the mean score of practice was 3.69 (SD = 1.17). Multivariable binary logistic regression model showed that undertaking very few/few clinical teaching workload, 'thinking it is my obligation to carry out teaching work seriously' and 'thinking it is my duty to train medical talents' were not only significant determinants of good perception but also good practice. Additionally, 'thinking hospital attached great importance to clinical teaching' was the significant determinant of good perception. Insights: Chinese clinical teachers demonstrate less positive perception and practice regarding the roles of teacher than clinical teachers in developed countries. Affiliated hospitals of medical universities should hold training sessions regularly and take targeted intervention measures to enhance clinical teachers' perception and practice regarding the roles of teacher.
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Affiliation(s)
- Jinmeng Huang
- Educational Evaluation and Faculty Development Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Chunxia Huang
- School of Foreign Languages, Guangxi Medical University, Nanning, Guangxi, China
| | - Jinmei Chen
- Educational Evaluation and Faculty Development Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Kaiyong Huang
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Colleges and Universities Key Laboratory of Prevention and Control of Highly Prevalent Diseases, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of Environment and Health Research, Guangxi Medical University, Nanning, Guangxi, China
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Yu Z, Hu X, Li H, Hu N, Li Y. A thematic content analysis of the structure and effects of good doctor abilities in China. BMC Health Serv Res 2024; 24:819. [PMID: 39014401 PMCID: PMC11253447 DOI: 10.1186/s12913-024-11145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/23/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The efforts to explore and build the structure of good doctor abilities are important because they help improve the quality of education for medical students and better standardize the working performance of doctors. However, at present, no worldwide standards for such a structure have been established. In this study, we endeavoured to map the structure of good doctor abilities and identify their effects. METHODS With a focus on China, a thematic content analysis was adopted in this study to analyse the personal profiles of 50 widely recognized good doctors. NVivo11 software was used. RESULTS The Structure and Effects of Good Doctor Abilities in China model was proposed, and interpretations were made based on AMO theory. Good doctor abilities fall within six categories: rigorous clinical thinking, skilled in diagnosis and therapy, clinical empathy, continuous learning and innovation, enhancing and sharing experiences, and communication and coordination. These abilities have positive impacts on doctors' work performances and social benefits by encouraging good behaviours, ultimately promoting the sustainable development of the hospitals where they serve. CONCLUSIONS In this study, we established a model of the structure and effects of good-doctor abilities in China and interpreted its mechanism, innovation and theory diversification in "good-doctor" research. Moreover, this study has practical significance because it provides systematic and well-targeted criteria for improving the professionalism of doctors, promoting more good doctor behaviours, providing guidance for regulating doctors' conduct and providing a reference for medical education and working performance reviews worldwide.
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Affiliation(s)
- Zhongguang Yu
- College of Economics and Management, Wuhan University, Wuhan, Hubei, 430072, China
- Respiratory Center, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xiang Hu
- Business School, Hubei University, Wuhan, Hubei, 430062, China
| | - Hongjin Li
- Tongji Medical College, Huazhong Science and Technology University, Wuhan, Hubei, 430030, China
| | - Ning Hu
- School of Management, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Yanping Li
- College of Economics and Management, Wuhan University, Wuhan, Hubei, 430072, China.
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Wurth S, Maisonneuve H, Moussa MA, Campion B, Caire Fon N, Peltier C, Audétat MC. Development of complex pedagogical competencies and reflexivity in clinical teachers via distance learning: a mixed methods study. MEDICAL EDUCATION ONLINE 2023; 28:2265163. [PMID: 37818594 PMCID: PMC10569352 DOI: 10.1080/10872981.2023.2265163] [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: 04/26/2023] [Accepted: 09/26/2023] [Indexed: 10/12/2023]
Abstract
Clinical reasoning is the cornerstone to healthcare practice and teaching it appropriately is of utmost importance. Yet there is little formal training for clinical supervisors in supervising this reasoning process. Distance education provides interesting opportunities for continuous professional development of healthcare professionals. This mixed methods study aimed at gaining in-depth understanding about whether and how clinical teachers can develop complex pedagogical competencies through participation in a Massive Open Online Course on the supervision of clinical reasoning (MOOC SCR). Participants self-assed their clinical supervision skills before and after partaking in the MOOC SCR through the Maastricht Clinical Teachers Questionnaire. Item scores and the distribution of response proportions before and after participation were compared using paired t-tests and McNemar's tests respectively. In parallel, the evolution of a subset of MOOC participants' pedagogical practice and posture was explored via semi-structured interviews throughout and beyond their MOOC participation using simulated and personal situational recalls. The verbatim were analysed with standard thematic analysis. Quantitative and qualitative findings converged and their integration demonstrated that partaking in the MOOC SCR promoted the development of complex pedagogical competencies and reflexivity with the participants. This was quantitatively evidenced by significantly higher self-assessed supervision skills and corresponding attitudes after completing the MOOC. The qualitative data provided rich descriptions of how this progression in pedagogical practice and posture occurred in the field and how it was shaped by participants' interaction with the MOOC's content and their motivations to progress. Our findings provide evidence for the development of pedagogical skills and corresponding attitudes for the supervision of clinical reasoning through participation in the MOOC SCR and contribute to the literature body on the opportunities that distance learning provides for the development of pedagogical competencies. The extent to which the pedagogical underpinnings of the MOOC contributed to these developments remains to be determined.
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Affiliation(s)
- Sophie Wurth
- Unit for Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Hubert Maisonneuve
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mohamed Amir Moussa
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Baptiste Campion
- Institute of Higher Studies in Social Communications, Brussels School of Journalism and Communication, Brussels, Belgium
| | - Nathalie Caire Fon
- Family Medicine and Emergency Medicine Department, Medicine, Université de Montréal, Montréal, Canada
| | - Claire Peltier
- Unit for Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Faculty of Educational Sciences, Université Laval, Quebec City, Canada
| | - Marie-Claude Audétat
- Unit for Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Yao J, Yuan H, Zhu M, Wang J, Wang Q, Chen Z, Chen Y, Zhang X. Nursing student learning of evidence-based nursing through case-based learning and flipped learning: A mixed study. Nurs Open 2023; 10:6551-6558. [PMID: 37394713 PMCID: PMC10416045 DOI: 10.1002/nop2.1910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 05/02/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
AIM To evaluate a teaching experience in evidence-based nursing learning through case-based learning (CBL) and flipped learning (FL). DESIGN Embedded mixed methods study. METHODS In the first phase, a questionnaire on utility, satisfaction and perceived competency development is used to collect quantitative data, and the open question instrument is used to collect qualitative data. After the first phase, an in-depth semi-structured interview is used. RESULTS Five themes are identified: the enhancement of learning content, knowledge integration and transfer, the development of teamwork competency, the didactic support of FL and the difficulties and challenges faced by students. Regarding utility, 'combine theory and practice' and 'select the best evidence from what is found in the search' have the highest values. The most developed skills are communication and critical thinking ability. Finally, most participants are satisfied. CONCLUSIONS The combination of CBL and FL is an innovative strategy for learning evidence-based nursing courses. No Patient or Public Contribution.
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Affiliation(s)
- Jiannan Yao
- Department of Fundamental Nursing, School of NursingJilin UniversityChangchunChina
- The First Affiliated Hospital of the China Medical UniversityShenyangChina
| | - Hua Yuan
- Department of Fundamental Nursing, School of NursingJilin UniversityChangchunChina
| | - Mingyue Zhu
- Department of Fundamental Nursing, School of NursingJilin UniversityChangchunChina
| | - Jia Wang
- Department of Fundamental Nursing, School of NursingJilin UniversityChangchunChina
| | - Qiuchen Wang
- Department of Fundamental Nursing, School of NursingJilin UniversityChangchunChina
| | - Zhiming Chen
- Department of Fundamental Nursing, School of NursingJilin UniversityChangchunChina
| | - Yahong Chen
- China‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Xiuying Zhang
- Department of Fundamental Nursing, School of NursingJilin UniversityChangchunChina
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Milos Nymberg V, Jakobsson U. How Do Clinical Supervisors and Managers in Swedish Primary Care Perceive Their Opportunities to Meet the Learning Needs of Medical Students? ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:521-533. [PMID: 35607515 PMCID: PMC9123911 DOI: 10.2147/amep.s348012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/12/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Primary health care centers (PHCCs) in Sweden are struggling to maintain a balance between increasing demands of service and supervision and learning activities for a growing number of students. We sought a deeper understanding of primary care physicians and managers behavioral intention towards supervising, and their perceptions of the structural preconditions and support needed. METHODS The study combines two theoretical approaches, the Theory of Planned Behavior (TPB) and Social Practice Theory. A questionnaire with 22 items including an open-ended question was designed to collect quantitative and qualitative data and sent to clinical supervisors and managers at PHCCs in Southern Sweden. The aim was to map a) participants' behavioral intention and perceived capacity to act to improve supervision and b) their perceptions of structural prerequisites and support needed to sustain and develop clinical supervision practice. RESULTS A total of 181 questionnaires were returned, with a total response rate of 60.7%. Behavior predictors (attitudes, subjective norms, and perceived behavioral control) were positively correlated to behavioral intention towards supervising and building supervising competence. Three themes emerged from the content analysis of the qualitative data: "Time and distribution", "Improved communication and support systems" and "Elimination of structural barriers.". DISCUSSION The manager and supervisor reports suggest that the intentions and capacity of individuals (individuals' agency) is not a strong barrier to high-quality supervising and teaching in PHCC. Organizational preconditions for sustaining and developing supervision practice exist, and structural barriers for exercising agency could be eliminated according to PHCC managers and supervisors. However, a conclusion of our study from a practice theory perspective is that how and to what degree primary care physicians engage in supervision and competence building is determined by how the workplace - and the medical school - afford participation in supervision-related workplace activities. Improved communication between medical school, managers and supervising physicians and on-site faculty development integrated in daily clinical work were described as important facilitators of a favorable supervision and learning environment.
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Affiliation(s)
| | - Ulf Jakobsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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Anderson M, Hills-Meyer PR, Stamm JM, Brown K. Integrating Clinical Reasoning Skills in a Pre-professional Undergraduate Human Anatomy Course. ANATOMICAL SCIENCES EDUCATION 2022; 15:304-316. [PMID: 33387378 DOI: 10.1002/ase.2050] [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: 01/09/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 06/12/2023]
Abstract
Clinically integrated curricula in health science education has been shown to promote the development of problem-solving schema and positively impact knowledge acquisition. Despite its' purported benefits, this type of curricula can impose a high cognitive load, which may negatively impact novice learners' knowledge acquisition and problem-solving schema development. Introducing explicit clinical reasoning instruction within pre-professional undergraduate basic science courses may limit factors that increase cognitive load, enhance knowledge acquisition, and foster developing clinical problem-solving skills. This study, conducted over the Fall and Spring semesters of the 2018-2019 school year, sought to evaluate whether the implementation of a clinical reasoning instructional intervention within a clinically integrated pre-professional undergraduate general human anatomy course influenced students' acquisition of anatomical knowledge and development of clinical problem-solving skills. Results of the study were mixed regarding the acquisition of anatomical knowledge. Both the intervention and comparison groups performed similarly on multiple choice examinations of anatomical knowledge. However, the clinical reasoning intervention positively impacted students' ability to apply clinical reasoning skills to anatomically based clinical case studies. Results from M\mixed between-within subjects analysis of variance comparing scores on Written Clinical Reasoning Assessments revealed a significant interaction between time and group affiliation, with the groups receiving the interventions outperforming the comparison groups: Fall, P < 0.001; Spring, P < 0.001. The results of this study may imply that explicit clinical reasoning instruction within a clinically integrated undergraduate Human Anatomy course could hold potential for fostering students' early clinical reasoning skills.
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Affiliation(s)
- Margene Anderson
- Department of Academic Technology, University of Wisconsin, Madison, Wisconsin
| | | | - Julie M Stamm
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin
| | - Kirsten Brown
- Doctoral Program in Educational Leadership Policy Studies, School of Education, Edgewood College, Madison, Wisconsin
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Ross S, Hamza D, Zulla R, Stasiuk S, Nichols D. Development of and Preliminary Validity Evidence for the EFeCT Feedback Scoring Tool. J Grad Med Educ 2022; 14:71-79. [PMID: 35222824 PMCID: PMC8848874 DOI: 10.4300/jgme-d-21-00602.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/31/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Narrative feedback, like verbal feedback, is essential to learning. Regardless of form, all feedback should be of high quality. This is becoming even more important as programs incorporate narrative feedback into the constellation of evidence used for summative decision-making. Continuously improving the quality of narrative feedback requires tools for evaluating it, and time to score. A tool is needed that does not require clinical educator expertise so scoring can be delegated to others. OBJECTIVE To develop an evidence-based tool to evaluate the quality of documented feedback that could be reliably used by clinical educators and non-experts. METHODS Following a literature review to identify elements of high-quality feedback, an expert consensus panel developed the scoring tool. Messick's unified concept of construct validity guided the collection of validity evidence throughout development and piloting (2013-2020). RESULTS The Evaluation of Feedback Captured Tool (EFeCT) contains 5 categories considered to be essential elements of high-quality feedback. Preliminary validity evidence supports content, substantive, and consequential validity facets. Generalizability evidence supports that EFeCT scores assigned to feedback samples show consistent interrater reliability scores between raters across 5 sessions, regardless of level of medical education or clinical expertise (Session 1: n=3, ICC=0.94; Session 2: n=6, ICC=0.90; Session 3: n=5, ICC=0.91; Session 4: n=6, ICC=0.89; Session 5: n=6, ICC=0.92). CONCLUSIONS There is preliminary validity evidence for the EFeCT as a useful tool for scoring the quality of documented feedback captured on assessment forms. Generalizability evidence indicated comparable EFeCT scores by raters regardless of level of expertise.
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Affiliation(s)
- Shelley Ross
- Shelley Ross, PhD, is Professor, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Deena Hamza
- Deena Hamza, PhD, is Competency-Based Medical Education Evaluation Lead for Postgraduate Medical Education, University of Alberta, Edmonton, AB, Canada
| | - Rosslynn Zulla
- Rosslynn Zulla, PhD, is a Specialist/Advisor, Faculty of Social Work, University of Calgary, AB, Canada
| | - Samantha Stasiuk
- Samantha Stasiuk, MD, MHPE, is Clinical Assistant Professor, Department of Family Practice, University of British Columbia, BC, Canada
| | - Darren Nichols
- Darren Nichols, MD, is Associate Professor, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
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Cairo Notari S, Sader J, Caire Fon N, Sommer JM, Pereira Miozzari AC, Janjic D, Nendaz M, Audétat M. Understanding GPs' clinical reasoning processes involved in managing patients suffering from multimorbidity: A systematic review of qualitative and quantitative research. Int J Clin Pract 2021; 75:e14187. [PMID: 33783098 PMCID: PMC8459259 DOI: 10.1111/ijcp.14187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/25/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Most consultations in primary care involve patients suffering from multimorbidity. Nevertheless, few studies exist on the clinical reasoning processes of general practitioners (GPs) during the follow-up of these patients. The aim of this systematic review is to summarise published evidence on how GPs reason and make decisions when managing patients with multimorbidity in the long term. METHODS A search of the relevant literature from Medline, Embase, PsycINFO, and ERIC databases was conducted in June 2019. The search terms were selected from five domains: primary care, clinical reasoning, chronic disease, multimorbidity, and issues of multimorbidity. Qualitative, quantitative, and mixed-methods studies published in English and French were included. Quality assessment was performed using the Mixed Methods Appraisal Tool. RESULTS A total of 2 165 abstracts and 362 full-text articles were assessed. Thirty-two studies met the inclusion criteria. Results showcased that GPs' clinical reasoning during the long-term management of multimorbidity is about setting intermediate goals of care in an ongoing process that adapts to the patients' constant evolution and contributes to preserve their quality of life. In the absence of guidelines adapted to multimorbidity, there is no single correct plan, but competing priorities and unavoidable uncertainties. Thus, GPs have to consider and weigh multiple factors simultaneously. In the context of multimorbidity, GPs describe their reasoning as essentially intuitive and seem to perceive it as less accurate. These clinical reasoning processes are nevertheless more analytical as they might think and rooted in deep knowledge of the individual patient. CONCLUSIONS Although the challenges GPs are facing in the long-term follow-up of patients suffering from multimorbidity are increasingly known, the literature currently offers limited information about GPs' clinical reasoning processes at play. GPs tend to underestimate the complexity and richness of their clinical reasoning, which may negatively impact their practice and their teaching.
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Affiliation(s)
- Sarah Cairo Notari
- Primary Care UnitFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Faculty of Psychology and Educational SciencesUniversity of GenevaGenevaSwitzerland
| | - Julia Sader
- Unit of Development and Research in Medical EducationFaculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Nathalie Caire Fon
- Department of Family Medicine and Emergency MedicineFaculty of MedicineUniversité de MontréalMontrealQCCanada
| | | | | | - Danilo Janjic
- Primary Care UnitFaculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical EducationFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Department of Internal MedicineUniversity Hospitals of GenevaGenevaSwitzerland
| | - Marie‐Claude Audétat
- Primary Care UnitFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Unit of Development and Research in Medical EducationFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Department of Family Medicine and Emergency MedicineFaculty of MedicineUniversité de MontréalMontrealQCCanada
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Chapman L, Mysko C, Coombridge H. Development of teaching, mentoring and supervision skills for basic training registrars: a frustrated apprenticeship? Intern Med J 2020; 51:1847-1853. [PMID: 32510770 DOI: 10.1111/imj.14935] [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: 12/05/2019] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Teaching, mentoring and supervision (TMS) are fundamental skills with a specific commitment within the Royal Australasian College of Physicians professional practice framework. The new basic training standards include 'use of appropriate educational techniques to facilitate the learning of peers, junior colleagues and other health professionals and to provide supervision for junior colleagues' but it is unclear how basic physician trainees and equivalent grade doctors (hereinafter 'registrars') will provide, learn or develop TMS skills. AIMS To explore how registrars provide, learn and develop TMS skills. METHODS Mixed methods approach. New Zealand registrars were invited to participate in anonymous survey regarding TMS experiences and learning. Focus groups explored skill acquisition and development more deeply. RESULTS A total of 121 registrars from 16 District Health Boards responded. Registrars supervise two juniors daily (range 0-4+). Fewer than 1:4 have formal training in TMS skills. Free text and focus group themes include: informal development by observing role models plus personal experience of giving and receiving TMS, inequitable access to development opportunities and formal training, barriers include workload and unsupportive learning cultures. Some registrars lack confidence in delivering TMS. CONCLUSIONS Registrars are expected to teach, mentor and supervise junior colleagues but experience a 'frustrated apprenticeship': formal training is minimal and informal training is dependent on variable role models, opportunities and systematic support. Registrars feel unprepared and lack confidence despite wanting to succeed in this domain. Suggestions for improvement include baseline formal training, purposeful role modelling by seniors and equitable promotion of TMS opportunities.
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Affiliation(s)
- Laura Chapman
- Department of Medicine, University of Auckland, Auckland, New Zealand.,Department of General Medicine, Waitemata District Health Board, Auckland, New Zealand
| | - Christopher Mysko
- Department of General Medicine, Waitemata District Health Board, Auckland, New Zealand
| | - Hannah Coombridge
- Department of General Medicine, Waitemata District Health Board, Auckland, New Zealand
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Bajwa NM, De Grasset J, Audétat MC, Jastrow N, Richard-Lepouriel H, Dominicé Dao M, Nendaz MR, Junod Perron N. Training junior faculty to become clinical teachers: The value of personalized coaching. MEDICAL TEACHER 2020; 42:663-672. [PMID: 32130055 DOI: 10.1080/0142159x.2020.1732316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Junior clinical faculty require institutional support in the acquisition of feedback and clinical supervision skills of trainees. We tested the effectiveness of a personalized coaching versus guided self-reflection format of a faculty development program at improving faculty skills and self-efficacy.Methods: Participants were evaluated both before and after the program using a four-station Objective Structured Teaching Exercise (OSTE). A gain-score analysis, one-way ANOVA, and paired t-tests were used to evaluate both groups. The impact on the learning environment was measured by resident ratings of the Maastricht Clinical Teaching Questionnaire.Results: One hundred and twenty-seven participants completed the study over a three-year period. Both groups had significant improvements in self-efficacy. Participants in the coaching group demonstrated superior performance in encouraging learner self-reflection, teaching effectiveness, verifying learner understanding, exploring feelings/needs, and defining learning objectives. Over a 5-year period, the overall institutional learning climate significantly improved concerning faculty role-modeling, coaching, articulation, and explorations skills.Conclusion: Offering a contextualized faculty-development program using OSTEs that provides multiple opportunities for feedback and is focused on creating a community of practice is an effective method to facilitate the transfer of skills to the clinical environment, supports teacher identity development, and favorably impacts the learning climate.
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Affiliation(s)
- Nadia M Bajwa
- Department of General Pediatrics at the Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Jehanne De Grasset
- Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Marie-Claude Audétat
- Faculty of Medicine, Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Nicole Jastrow
- Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | | | - Melissa Dominicé Dao
- Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu R Nendaz
- Faculty of Medicine, Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Noëlle Junod Perron
- Department of community medicine and primary care, Geneva University Hospitals, Geneva, Switzerland
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Expanding Faculty Development of Teaching Skills: A National Needs Assessment of Pediatric Critical Care Medicine Faculty. Pediatr Crit Care Med 2020; 21:486-493. [PMID: 32150125 DOI: 10.1097/pcc.0000000000002265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES High-quality clinical teaching is an essential element in preparing trainees to become independently competent clinicians. In order to better understand the context-specific faculty development needs of teaching faculty in a specific community, we sought to determine the self-reported teaching skill deficits of pediatric critical care medicine faculty and their preferences and motivations regarding faculty development to enhance their teaching. DESIGN Modified Delphi technique was used to create an online survey in which respondents rated their need for education on a variety of teaching skills, their preferred learning modalities, and factors that motivate their participation in faculty development. SETTING Pediatric Critical Care Medicine divisions at the 64 sites in the United States with fellowship programs. SUBJECTS Five-hundred forty-five Pediatric Critical Care Medicine faculty who teach fellows and other trainees. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Response rate was 40%. Respondents reported a median of 8.5 years (interquartile range, 4-16 yr) as teaching faculty. The median age of faculty was 44.6 years (interquartile range, 38-50 yr). Only 20% of respondents indicated that improving their teaching was a low priority. Thirty-six percent of respondents had not participated in any formal teaching skill development as faculty. The most frequently cited factors motivating engagement in faculty development were education being included as part of regularly attended conferences, resources readily available when needed, and participation promoted by a supervisor. Preferred learning modalities included a brief discussion with a colleague, a 10-minute video, and a regular conference series. CONCLUSIONS Pediatric Critical Care Medicine faculty reported they experience challenges in teaching and would benefit from faculty development training aimed at improving their knowledge and skills about being an educator. Preferred learning methods and motivating factors highlight the importance of efficiency in content delivery and endorsement by faculty supervisors. Consideration of these needs and preferences may be useful in creating context-focused, community of practice-based faculty development programs.
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Konishi E, Saiki T, Kamiyama H, Nishiya K, Tsunekawa K, Imafuku R, Fujisaki K, Suzuki Y. Improved cognitive apprenticeship clinical teaching after a faculty development program. Pediatr Int 2020; 62:542-548. [PMID: 31834972 DOI: 10.1111/ped.14095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/15/2019] [Accepted: 12/10/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND While it is well known that the cognitive apprenticeship is an effective workplace-based teaching approach for clinical teachers, the effects of faculty development (FD) have not been analyzed from that perspective. The purpose of this study was to investigate self-assessment by clinical teachers of their educational perceptions and behaviors after a FD program using the cognitive apprenticeship model. METHODS Board-certified pediatricians who participated in a 3-day FD program on practical clinical teaching were asked to complete questionnaires. Fifty participants completed two questionnaires prior to and 3 and 6 months after the FD program: the first was on the participants' general perceptions and behaviors in relation to their own clinical education and the second was a self-assessment using the Maastricht Clinical Teaching Questionnaire (MCTQ) that was developed based on the cognitive apprenticeship model. RESULTS The general survey demonstrated that 78% of the participants experienced positive changes in their educational perceptions 6 months after FD. Self-assessment using the MCTQ showed that the scores in the categories of "articulation," "exploration," and "safe learning environment" remained significantly improved 6 months after the FD program. CONCLUSIONS The participants' self-perceived improvement in behaviors was sustainable for 6 months after participation the FD program. The results of the MCTQ show that through their experiences in the FD program, the participants seemingly transformed their clinical teaching to become interactive facilitators, encouraging self-directed learning. Our results also suggest that the MCTQ can be used for self-assessment of clinical teachers and to enhance the effectiveness of the FD program.
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Affiliation(s)
- Eri Konishi
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Pediatrics, Matsue Red Cross Hospital, Matsue, Japan.,Committee of Education, Japan Pediatric Society, Tokyo, Japan
| | - Takuya Saiki
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroshi Kamiyama
- Committee of Education, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Katsumi Nishiya
- Committee of Education, Japan Pediatric Society, Tokyo, Japan.,Center for Medical Education, Kansai Medical University, Osaka, Japan
| | - Koji Tsunekawa
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Rintaro Imafuku
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazuhiko Fujisaki
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yasuyuki Suzuki
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan.,Committee of Education, Japan Pediatric Society, Tokyo, Japan
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13
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Jirativanont T, Phoowanakulchai S, Waitayawinyu P, Suphathamwit A, Apidechakul P, Raksamani K. Residents as teachers: optimizing the benefit of a difficult airway management simulation session. ASIAN BIOMED 2020. [DOI: 10.1515/abm-2019-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Simulation is widely used in airway management training.
Objectives
To show that assigning anesthesia residents’ simulation educator roles improved cognitive learning outcomes.
Methods
Postgraduate second- and third-year (PGY-2 and PGY-3) anesthesia residents were randomly assigned to three groups: a teacher group (T), a hot-seat (active participant) group (H), and an observer group (O). After a train-the-trainer session, the T group prepared simulation scenarios for difficult airway management and then conducted the simulation sessions and post-session debriefing. The H group participated in the scenarios, and the O group observed the sessions. All participants attended the post-session debriefing. Evaluation was conducted at pretest, immediate posttest, and 3 months (retention test). Score differentiation and average normalized gain were calculated. Participants completed a post-simulation class survey.
Results
Participants were 49 residents (PGY-2 = 24, PGY-3 = 25). The T group had the highest posttest score (17.06 ± 1.23); this score significantly differed from the O group (14.75 ± 2.57, P = 0.003) but not the H group (15.64 ± 1.54, P = 0.103). The average normalized gain was significantly higher in the T group than in the H and O groups (0.51 ± 0.22, 0.18 ± 0.32, and 0.17 ± 0.47, respectively; P = 0.012). Participants retained knowledge at 3 months after the session, with no significant differences among the groups. Most participants (45%) preferred to be active scenario participants, and 20% preferred to teach. Overall satisfaction was high in all groups.
Conclusion
This study showed that a teaching role can be effectively applied for residents in simulation-based education on difficult airway management to support better learning outcomes.
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Affiliation(s)
- Tachawan Jirativanont
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Sirima Phoowanakulchai
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Pichaya Waitayawinyu
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Aphichat Suphathamwit
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Parichad Apidechakul
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Kasana Raksamani
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
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14
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Clement T, Howard D, Lyon E, Silverman J, Molloy E. Video-triggered professional learning for general practice trainers: using the ‘cauldron of practice’ to explore teaching and learning. EDUCATION FOR PRIMARY CARE 2019; 31:112-118. [DOI: 10.1080/14739879.2019.1703560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Tim Clement
- Murray City Country Coast GP Training, Warrnambool, Australia
- Faculty of Health, School of Medicine, Deakin University, Geelong, Australia
| | - Duncan Howard
- Murray City Country Coast GP Training, Warrnambool, Australia
| | - Eldon Lyon
- Murray City Country Coast GP Training, Warrnambool, Australia
- Faculty of Health, School of Medicine, Deakin University, Geelong, Australia
| | - Jonathan Silverman
- Faculty of Health, School of Medicine, Deakin University, Geelong, Australia
| | - Elizabeth Molloy
- Department of Medical Education, University of Melbourne, Melbourne, Australia
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15
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Black CC. Experiential Teaching Paradigms: Adapting the Medical Education Literature to Academic Pathology Practice. Acad Pathol 2019; 6:2374289519892553. [PMID: 31840045 PMCID: PMC6900603 DOI: 10.1177/2374289519892553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/02/2019] [Indexed: 11/15/2022] Open
Abstract
The medical education literature has presented many experiential teaching paradigms to help faculty teach more effectively in busy clinical settings. Three prominent teaching models are The Aunt Minnie model, the SNAPPS model, and the One-Minute Preceptor. Teaching paradigms can help faculty to develop into effective teachers. Each of these models can be adapted to a busy academic pathology practice. The Aunt Minnie model is effective in cases with high pattern recognition, such as repetitive trays of biopsies. The SNAPPS model is learner directed and is easily adapted for an advanced learner with complex cases requiring ancillary testing. The One-Minute Preceptor method is effective for teachers with groups of learners, such as multiheaded scope sessions.
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Affiliation(s)
- Candice C. Black
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical
Center, Lebanon, NH, USA
- Candice C. Black, Department of Pathology and
Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical center Drive,
Lebanon, NH 03756, USA.
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16
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Klasen JM, Lingard LA. Allowing failure for educational purposes in postgraduate clinical training: A narrative review. MEDICAL TEACHER 2019; 41:1263-1269. [PMID: 31280625 DOI: 10.1080/0142159x.2019.1630728] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background: Educational domains such as pedagogy or psychology have embraced the philosophy that "allowing failure" in training and practice is essential to learn. In clinical training, however, allowing learners to fail is not explicitly discussed as a strategy, possibly due to the negative implications for patients. Therefore, we do not know whether clinical supervisors allow trainees to fail for educational purposes and, if so, how this supervisory strategy is used. Methods: To inform research on this topic, we conducted a narrative review to understand what was known about this educational strategy in postgraduate medicine. Results: Analyzing the selected literature, we found no studies directly exploring the question of clinical supervisors allowing failure as an educational strategy. However, related literature on resident errors suggested that trainees perceived their own errors to be highly instructive and that factors such as a sense of responsibility and emotional response influenced the educational impact of these errors. Conclusions: The lack of discussion in the medical education literature regarding allowing failure for learning suggests that we need research into the nature and extent of this supervisory strategy which may hold educational benefits but must be employed in a manner that upholds patient safety and safeguards trainee resilience.
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Affiliation(s)
- Jennifer M Klasen
- Clarunis, Center for Abdominal Surgery, University Hospital Basel , Basel , Switzerland
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17
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Zuily S, Phialy L, Sevim E, Germain E, Unlu O, Dufrost V, Risse J, Clerc-Urmès I, Baumann C, Berman JR, Lockshin MD, Wahl D, Erkan D. Impact of antiphospholipid syndrome iBook on medical students' improvement of knowledge: An international randomized controlled study. Eur J Rheumatol 2019; 6:207-211. [PMID: 31657703 DOI: 10.5152/eurjrheum.2019.19030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/09/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE iBook on Antiphospholipid Syndrome (APS) did not exist before our work, and hence the utility of an Apple iBook as a teaching method in APS for medical students has never been assessed. Our objective was to evaluate medical students' improvement of knowledge and satisfaction with an interactive APS iBook, in comparison with conventional teaching methods. METHODS An iBook designer with the guidance of a medical team developed the APS iBook in both French and English. Second-year medical students, naïve of APS knowledge, were enrolled from two institutions. For the "teaching intervention", participants were randomly assigned to three groups: a) APS iBook with interactive capability; b) printed copy of the APS iBook material; and c) classroom lecture presentation of the APS iBook material by a physician-scientist experienced in APS. The participants filled a standardized medical questionnaire about APS before and after teaching interventions to determine the relative change of knowledge. Participants were asked to fill out a standardized satisfaction survey. After 20 weeks of the intervention, recall capability of students was tested. RESULTS A total of 233 second-year medical students were enrolled (iBook group: 73; print group: 79, and lecture group: 81). Relative change of knowledge was not different between the iBook group and the printed material group; additionally, it was significantly higher in the lecture group than the two other methods. Satisfaction was significantly higher in both the lecture and the iBook groups than the print group, on several dimensions including overall quantitative satisfaction, subjective enhanced knowledge, interactivity, quality of content, comprehensibility, and pleasure of learning. Recall capability of students (n=109, 47%) was not significantly different among groups. CONCLUSION The APS iBook is as effective as printed material in improving medical student's knowledge, although a classroom lecture was the most effective method when compared to self-learning methods. Among self-learning methods, medical students are more satisfied with the APS iBook, whereas the recall capability was not different among groups. These results suggest that the APS iBook will help medical students in their curriculum and increase the awareness of APS among the community.
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Affiliation(s)
- Stephane Zuily
- Université de Lorraine, Faculty of Medicine, F-54000 Nancy, France.,CHRU Nancy, Vascular Medicine Division and Regional Competence Center for Rare Systemic and Autoimmune Diseases, F-54000 Nancy, France
| | - Laurent Phialy
- Université de Lorraine, Faculty of Medicine, F-54000 Nancy, France
| | - Ecem Sevim
- Hospital for Special Surgery, New York, NY, USA
| | - Eloïse Germain
- Université de Lorraine, Faculty of Medicine, F-54000 Nancy, France
| | - Ozan Unlu
- Weill Cornell Medicine, New York, NY, USA
| | - Virginie Dufrost
- Université de Lorraine, Faculty of Medicine, F-54000 Nancy, France.,CHRU Nancy, Vascular Medicine Division and Regional Competence Center for Rare Systemic and Autoimmune Diseases, F-54000 Nancy, France
| | - Jessie Risse
- Université de Lorraine, Faculty of Medicine, F-54000 Nancy, France.,CHRU Nancy, Vascular Medicine Division and Regional Competence Center for Rare Systemic and Autoimmune Diseases, F-54000 Nancy, France
| | - Isabelle Clerc-Urmès
- CHRU de Nancy, Platform of Clinical Research Support PARC (MDS unity), F-54000 Nancy, France
| | - Cédric Baumann
- CHRU de Nancy, Platform of Clinical Research Support PARC (MDS unity), F-54000 Nancy, France
| | - Jessica R Berman
- Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Michael D Lockshin
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Denis Wahl
- Université de Lorraine, Faculty of Medicine, F-54000 Nancy, France.,CHRU Nancy, Vascular Medicine Division and Regional Competence Center for Rare Systemic and Autoimmune Diseases, F-54000 Nancy, France
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
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18
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Campbell N, Wozniak H, Philip RL, Damarell RA. Peer-supported faculty development and workplace teaching: an integrative review. MEDICAL EDUCATION 2019; 53:978-988. [PMID: 31238387 PMCID: PMC6771963 DOI: 10.1111/medu.13896] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 12/21/2018] [Accepted: 03/27/2019] [Indexed: 05/10/2023]
Abstract
CONTEXT The use of peer support as a faculty development technique to improve clinical teaching is uncommon in medical education, despite the benefits of situating learning in the workplace. The authors therefore conducted a broad search seeking theoretical and empirical literature describing peer support strategies for clinical teachers in health care workplaces. This included descriptive and non-experimental studies that are often excluded from reviews. The review aimed to identify and assess existing initiatives and to synthesise key challenges and benefits. METHODS An integrative literature review was undertaken (2004-2017), based on searches of eight international electronic databases and targeted manual searches. Key concepts, elements and models were mapped using an iterative, constant comparative method. An evaluative framework, drawing on previous research, informed conclusions regarding the quality of evidence. RESULTS From a pool of 5735 papers, 34 met the inclusion criteria. The majority referred to studies conducted in the USA (59%) and in the medical profession (71%). Analysis revealed a trend towards using a collaborative model (56%), voluntary participation (59%), and direct workplace observation by a peer clinician (68%). Design features of the peer support strategy were commonly reported (65%), with half providing outcome measures (56%). Few papers reported on process evaluation (15%) or evidence of programme sustainability (15%). Despite logistical and time-associated challenges, benefits accrued to individuals and the workplace, and included improved teaching practices. Embedding the peer support strategy into routine organisational practice proved effective. CONCLUSIONS The results indicated that a workplace-based peer support model is an acceptable and effective faculty development strategy for health care clinical teachers. Conceptualising workplace-based peer support via a sociocultural model that acknowledges the significance of educational design, peers as collaborators and the importance of workplace context and culture is emphasised. Future research should focus on clarification studies informed by contemporary models of faculty development, in which factors impacting the health care workplace are considered.
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Affiliation(s)
- Narelle Campbell
- Flinders NT, College of Medicine and Public Health, Flinders UniversityDarwinNorthern TerritoryAustralia
- Prideaux Centre for Research in Health Professions EducationCollege of Medicine & Public HealthBedford ParkSouth AustraliaAustralia
| | - Helen Wozniak
- Prideaux Centre for Research in Health Professions EducationCollege of Medicine & Public HealthBedford ParkSouth AustraliaAustralia
- Office of Medical Education, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Robyn L Philip
- Flinders NT, College of Medicine and Public Health, Flinders UniversityDarwinNorthern TerritoryAustralia
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19
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Lacasse M, Audétat MC, Boileau É, Caire Fon N, Dufour MH, Laferrière MC, Lafleur A, La Rue È, Lee S, Nendaz M, Paquette Raynard E, Simard C, Steinert Y, Théorêt J. Interventions for undergraduate and postgraduate medical learners with academic difficulties: A BEME systematic review: BEME Guide No. 56. MEDICAL TEACHER 2019; 41:981-1001. [PMID: 31081426 DOI: 10.1080/0142159x.2019.1596239] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background: Clinical teachers often struggle to report unsatisfactory trainee performance, partly because of a lack of evidence-based remediation options. Objectives: To identify interventions for undergraduate (UG) and postgraduate (PG) medical learners experiencing academic difficulties, link them to a theory-based framework and provide literature-based recommendations around their use. Methods: This systematic review searched MEDLINE, CINAHL, EMBASE, ERIC, Education Source and PsycINFO (1990-2016) combining these concepts: medical education, professional competence/difficulty and educational support. Original research/innovation reports describing intervention(s) for UG/PG medical learners with academic difficulties were included. Data extraction employed Michie's Behavior Change Techniques (BCT) Taxonomy and program evaluation models from Stufflebeam and Kirkpatrick. Quality appraisal used the Mixed Methods Appraisal Tool (MMAT). The authors synthesized extracted evidence by adapting the GRADE approach to formulate recommendations. Results: Sixty-eight articles met the inclusion criteria, most commonly addressing knowledge (66.2%), skills (53.9%) and attitudinal problems (26.2%), or learner personal issues (41.5%). The most common BCTs were Shaping knowledge, Feedback/monitoring, and Repetition/substitution. Quality appraisal was variable (MMAT 0-100%). A thematic content analysis identified 109 interventions (UG: n = 84, PG: n = 58), providing 24 strong, 48 moderate, 26 weak and 11 very weak recommendations. Conclusion: This review provides a repertoire of literature-based interventions for teaching/learning, faculty development, and research purposes.
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Affiliation(s)
- Miriam Lacasse
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
| | - Marie-Claude Audétat
- Department of Family Medicine and Emergency Medicine, Université de Montréal , Montreal , Canada
- Family Medicine Unit (UIGP), University of Geneva , Geneva , Switzerland
- Department of Family and Emergency Medicine, Université de Sherbrooke , Sherbrooke , Canada
| | | | - Nathalie Caire Fon
- Department of Family Medicine and Emergency Medicine, Université de Montréal , Montreal , Canada
| | - Marie-Hélène Dufour
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
| | | | | | - Ève La Rue
- Department of Family and Community Medicine, University of Toronto , Toronto , Canada
| | - Shirley Lee
- Unit of Development and Research (UDREM), University of Geneva , Geneva , Switzerland
- Canadian Medical Protective Association , Ottawa , Canada
| | - Mathieu Nendaz
- Family Medicine Unit (UIGP), University of Geneva , Geneva , Switzerland
- Department of Medicine, University Hospitals , Geneva , Switzerland
| | | | - Caroline Simard
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
| | - Yvonne Steinert
- Institute of Health Sciences Education, Faculty of Medicine, McGill University , Montreal , Canada
| | - Johanne Théorêt
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
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20
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Haque W, Gurney T, Reed WG, North CS, Pollio DE, Pollio EW, Wagner JM. Key Attributes of a Medical Learning Community Mentor at One Medical School. MEDICAL SCIENCE EDUCATOR 2019; 29:721-730. [PMID: 34457537 PMCID: PMC8368459 DOI: 10.1007/s40670-019-00746-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE The purpose of this study was to discover the elements required for a successful learning community (LC) faculty member educator of medical students. METHOD The authors in this qualitative study evaluated six 90-min focus groups of faculty members. The groups included 31 experienced and 19 inexperienced LC faculty members at the University of Texas Southwestern Medical School. After achieving excellent interrater reliability, transcriptions of the discussions were subjected to thematic analysis using ATLAS.ti software. RESULTS Five major themes emerged: (1) LC faculty characteristics/competency, (2) suggested faculty development methods, (3) factors outside the LC environment influencing student relationships, (4) student attributes influencing teaching techniques, and (5) measuring and improving history and physical skills. Faculty characteristics/competency subthemes included role-modeling, mentoring, and teaching competence. Suggested faculty development methods subthemes included assessing and giving feedback to faculty, peer development, and learning from experts. Experienced LC faculty focused more attention on teaching competence and mentoring competence than inexperienced LC faculty. DISCUSSION The themes with the most extensive discussion among the experienced LC faculty groups may represent qualities to be sought in future mentor recruitment and faculty development. Future studies could build on this study by similarly investigating student perceptions.
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Affiliation(s)
- Waqas Haque
- University of Texas Southwestern Medical School, 5323 Harry Hines Blvd., Dallas, TX 75390-9006 USA
| | - Troy Gurney
- University of Texas Southwestern Medical School, 5323 Harry Hines Blvd., Dallas, TX 75390-9006 USA
| | - W. Gary Reed
- Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX USA
| | - Carol S. North
- University of Texas Southwestern Medical School, 5323 Harry Hines Blvd., Dallas, TX 75390-9006 USA
- Altshuler Center for Education & Research at Metrocare Services, Dallas, TX USA
| | - David E. Pollio
- Department of Social Work, University of Alabama at Birmingham College of Arts and Sciences, Birmingham, AL USA
| | - E. Whitney Pollio
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL USA
| | - James M. Wagner
- Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX USA
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21
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Bettendorf B, Quinn-Leering K, Toth H, Tews M. Teaching when Time Is Limited: a Resident and Fellow as Educator Video Module. MEDICAL SCIENCE EDUCATOR 2019; 29:631-635. [PMID: 34457525 PMCID: PMC8368690 DOI: 10.1007/s40670-019-00731-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Research has demonstrated that residents and fellows (hereafter referred to as "residents") play a significant role in the education of medical students. However, residents often feel unprepared to teach effectively and efficiently in busy clinical environments. ACTIVITY The Residents as Educators Committee at the Medical College of Wisconsin sought to create an online module for residents to promote five key elements of teaching medical students in a busy clinical environment when time is limited. The module includes a narrated presentation highlighting key attributes of excellent clinical teachers as well as video clips presenting teaching pearls from award-winning resident educators. All incoming residents during the 2015-2016 academic year were required to view the module and complete a mandatory post-test, representing over 80 specialties and subspecialties. RESULTS A total of 325 residents viewed the module and took the required post-test. Of this group, 294 residents (91.4%) completed the optional evaluation. The module was rated highly in terms of content, format, and likelihood to change teaching practices. DISCUSSION The teaching provided by residents is vital to the success of future generations of medical students. The online module developed at the Medical College of Wisconsin may be useful to a larger audience of residents at other institutions. Additionally, further studies could determine the effectiveness of the module by examining the teaching evaluations of residents before and after viewing the module.
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Affiliation(s)
- Brittany Bettendorf
- Department of Internal Medicine, Division of Immunology, University of Iowa, 200 Hawkins Drive, C42 GH, Iowa City, IA 52242 USA
| | - Kathleen Quinn-Leering
- Accreditation Council for Graduate Medical Education, 401 North Michigan Avenue, Suite 2000, Chicago, IL 60642 USA
| | - Heather Toth
- Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226 USA
| | - Matthew Tews
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912 USA
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22
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Johnson CE, Keating JL, Farlie MK, Kent F, Leech M, Molloy EK. Educators' behaviours during feedback in authentic clinical practice settings: an observational study and systematic analysis. BMC MEDICAL EDUCATION 2019; 19:129. [PMID: 31046776 PMCID: PMC6498493 DOI: 10.1186/s12909-019-1524-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 03/17/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND Verbal feedback plays a critical role in health professions education but it is not clear which components of effective feedback have been successfully translated from the literature into supervisory practice in the workplace, and which have not. The purpose of this study was to observe and systematically analyse educators' behaviours during authentic feedback episodes in contemporary clinical practice. METHODS Educators and learners videoed themselves during formal feedback sessions in routine hospital training. Researchers compared educators' practice to a published set of 25 educator behaviours recommended for quality feedback. Individual educator behaviours were rated 0 = not seen, 1 = done somewhat, 2 = consistently done. To characterise individual educator's practice, their behaviour scores were summed. To describe how commonly each behaviour was observed across all the videos, mean scores were calculated. RESULTS Researchers analysed 36 videos involving 34 educators (26 medical, 4 nursing, 4 physiotherapy professionals) and 35 learners across different health professions, specialties, levels of experience and gender. There was considerable variation in both educators' feedback practices, indicated by total scores for individual educators ranging from 5.7 to 34.2 (maximum possible 48), and how frequently specific feedback behaviours were seen across all the videos, indicated by mean scores for each behaviour ranging from 0.1 to 1.75 (maximum possible 2). Educators commonly provided performance analysis, described how the task should be performed, and were respectful and supportive. However a number of recommended feedback behaviours were rarely seen, such as clarifying the session purpose and expectations, promoting learner involvement, creating an action plan or arranging a subsequent review. CONCLUSIONS These findings clarify contemporary feedback practice and inform the design of educational initiatives to help health professional educators and learners to better realise the potential of feedback.
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Affiliation(s)
- Christina E. Johnson
- Monash Doctors Education, Monash Health and Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria Australia
| | - Jennifer L. Keating
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Melanie K. Farlie
- Allied Health Workforce Innovation, Strategy, Education & Research (WISER) Unit, Monash Health, and School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences at Monash University, Melbourne, Australia
| | - Fiona Kent
- Education Portfolio, Faculty Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Michelle Leech
- Monash School of Medicine, Faculty of Medicine, Nursing & Health Sciences, Monash University and Monash Health, Melbourne, Australia
| | - Elizabeth K. Molloy
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Australia
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23
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Boileau E, Audétat MC, St-Onge C. Just-in-time faculty development: a mobile application helps clinical teachers verify and describe clinical reasoning difficulties. BMC MEDICAL EDUCATION 2019; 19:120. [PMID: 31039779 PMCID: PMC6492340 DOI: 10.1186/s12909-019-1558-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 04/15/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although clinical teachers can often identify struggling learners readily and reliably, they can be reluctant to act upon their impressions, resulting in failure to fail. In the absence of a clear process for identifying and remediating struggling learners, clinical teachers can be put off by the prospect of navigating the politically and personally charged waters of remediation and potential failing of students. METHODS To address this gap, we developed a problem-solving algorithm to support clinical teachers from the identification through the remediation of learners with clinical reasoning difficulties, which have significant implications for patient care. Based on this algorithm, a mobile application (Pdx) was developed and assessed in two emergency departments at a Canadian university, from 2015 to 2016, using interpretive description as our research design. Semi-structured interviews were conducted before and after a three-month trial with the application. Interviews were analysed both deductively, using pre-determined categories, and inductively, using emerging categories. RESULTS Twelve clinical teachers were interviewed. Their experience with the application revealed their need to first validate their impressions of difficulties in learners and to find the right words to describe them before difficulties could be addressed. The application was unanimously considered helpful regarding both these aspects, while the mobile format appeared instrumental in allowing clinical teachers to quickly access targeted information during clinical supervision. CONCLUSIONS The value placed on verifying impressions and finding the right words to pinpoint difficulties should be further explored in endeavours that aim to address the failure to fail phenomenon. Moreover, just-in-time mobile solutions, which mirror habitual clinical practices, may be used profitably for knowledge transfer in medical education, as an alternative form of faculty development.
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Affiliation(s)
- Elisabeth Boileau
- Department of Family and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-Claude Audétat
- Faculty of Medicine, Université de Genève, Geneva, Switzerland
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Christina St-Onge
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Canada
- Paul Grand’Maison de la SMUS, Université de Sherbrooke, 3001, 12e avenue N, Sherbrooke, QC J1H 5N4 Canada
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Sidhu NS, Edwards M. Deliberate teaching tools for clinical teaching encounters: A critical scoping review and thematic analysis to establish definitional clarity. MEDICAL TEACHER 2019; 41:282-296. [PMID: 29703088 DOI: 10.1080/0142159x.2018.1463087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE AND METHOD We conducted a scoping review of tools designed to add structure to clinical teaching, with a thematic analysis to establish definitional clarity. RESULTS Six thousand and forty nine citations were screened, 434 reviewed for eligibility, and 230 identified as meeting study inclusion criteria. Eighty-nine names and 51 definitions were identified. Based on a post facto thematic analysis, we propose that these tools be named "deliberate teaching tools" (DTTs) and defined as "frameworks that enable clinicians to have a purposeful and considered approach to teaching encounters by incorporating elements identified with good teaching practice." We identified 46 DTTs in the literature, with 38 (82.6%) originally described for the medical setting. Forty justification articles consisted of 16 feedback surveys, 13 controlled trials, seven pre-post intervention studies with no control group, and four observation studies. Current evidence of efficacy is not entirely conclusive, and many studies contain methodology flaws. Forty-nine clarification articles comprised 12 systematic reviews and 37 narrative reviews. The most number of DTTs described by any review was four. A common design theme was identified in approximately three-quarters of DTTs. CONCLUSIONS Applicability of DTTs to specific alternate settings should be considered in context, and appropriately designed justification studies are warranted to demonstrate efficacy.
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Affiliation(s)
- Navdeep S Sidhu
- a Department of Anaesthesia and Perioperative Medicine , North Shore Hospital , Auckland , New Zealand
- b Department of Anaesthesiology , University of Auckland , Auckland , New Zealand
| | - Morgan Edwards
- a Department of Anaesthesia and Perioperative Medicine , North Shore Hospital , Auckland , New Zealand
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De Grasset J, Audetat MC, Bajwa N, Jastrow N, Richard-Lepouriel H, Nendaz M, Junod Perron N. Medical students' professional identity development from being actors in an objective structured teaching exercise. MEDICAL TEACHER 2018; 40:1151-1158. [PMID: 29683013 DOI: 10.1080/0142159x.2018.1457212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Medical students develop professional identity through structured activities and impromptu interactions in various settings. We explored if contributing to an Objective Structured Teaching Exercise (OSTE) influenced students' professional identity development. METHODS University clinical faculty members participated in a faculty development program on clinical supervision. Medical students who participated in OSTEs as simulated residents were interviewed in focus groups about what they learnt from the experience and how the experience influenced their vision of learning and teaching. Transcripts were analyzed using the Goldie's personality and social structure perspective model. RESULTS Twenty-five medical students out of 32 students involved in OSTEs participated. On an institutional level, students developed a feeling of belonging to the institution. At an interactional level, students realized they could influence the teaching interaction by actively seeking or giving feedback. On the personal level, students realized that errors could become sources of learning and felt better prepared to receive faculty feedback. CONCLUSION Taking part in OSTEs as a simulated resident has a positive impact on students' vision regarding the institution as a learning environment and their own role by actively seeking or giving feedback. OSTEs support their professional identity development regarding learning and teaching while sustaining faculty development.
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Affiliation(s)
- Jehanne De Grasset
- a Institute of Primary Care , Geneva University Hospitals , Genève , Switzerland
| | - Marie-Claude Audetat
- a Institute of Primary Care , Geneva University Hospitals , Genève , Switzerland
- b Unit of Development and Research in Medical Education, Faculty of Medicine , University of Geneva , Genève , Switzerland
| | - Nadia Bajwa
- a Institute of Primary Care , Geneva University Hospitals , Genève , Switzerland
- b Unit of Development and Research in Medical Education, Faculty of Medicine , University of Geneva , Genève , Switzerland
| | - Nicole Jastrow
- a Institute of Primary Care , Geneva University Hospitals , Genève , Switzerland
| | | | - Mathieu Nendaz
- a Institute of Primary Care , Geneva University Hospitals , Genève , Switzerland
- b Unit of Development and Research in Medical Education, Faculty of Medicine , University of Geneva , Genève , Switzerland
| | - Noelle Junod Perron
- a Institute of Primary Care , Geneva University Hospitals , Genève , Switzerland
- b Unit of Development and Research in Medical Education, Faculty of Medicine , University of Geneva , Genève , Switzerland
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Pourmand K, Sewell JL, Shah BJ. What Makes a Good Endoscopic Teacher: A Qualitative Analysis. JOURNAL OF SURGICAL EDUCATION 2018; 75:1195-1199. [PMID: 29574017 DOI: 10.1016/j.jsurg.2018.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/12/2018] [Accepted: 02/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Teaching learners to perform endoscopic procedures is challenging, yet effective endoscopy teaching practices are not well-described in the literature, and prior studies have focused on perspectives of supervising physicians rather than learners. We sought to characterize, from the perspective of endoscopy learners, endoscopic teaching behaviors perceived as beneficial and detrimental to learning using qualitative methods. DESIGN This is a prospective qualitative content analysis. Gastroenterology fellows from 2 tertiary care centers anonymously provided feedback regarding supervising physicians' teaching behaviors during endoscopic training between March 2016 and December 2016. Preprinted cards were completed at the conclusion of procedures to document behaviors that fellows perceived as enhancing or hampering their learning. Two investigators performed content analysis of written comments; each identified behavior was assigned positive or negative valence. SETTING Mount Sinai Hospital in New York, New York and University of California San Francisco in San Francisco, California. Both institutions are academic tertiary care centers. PARTICIPANTS A total of 19 gastroenterology fellows at 2 training institutions participated. RESULTS A total of 239 teaching behaviors were identified by 19 fellows who worked with 31 supervising physicians; 29 unique behaviors were identified and organized into 7 themes: teaching, learning environment, autonomy, communication, coaching, feedback, and professionalism. Of all, 185 (77.4%) behaviors were reported as beneficial, and 54 (22.6%) as detrimental to the learning experience. Behaviors related to teaching were most often perceived as beneficial, while behaviors related to professionalism and communication were most often perceived as detrimental to learning. CONCLUSIONS Specific teaching behaviors may help or hinder learning of endoscopic skills. These behaviors may be useful for efforts related to teaching evaluation, faculty development, and direct teaching.
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Affiliation(s)
- Kamron Pourmand
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Justin L Sewell
- Department of Medicine, Division of Gastroenterology, University of California San Francisco, San Francisco, California
| | - Brijen J Shah
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
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von Below B, Rödjer S, Mattsson B, Hange D, Wahlqvist M. What factors motivate junior doctors to engage as clinical tutors? A qualitative study. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2018; 9:151-157. [PMID: 29860243 PMCID: PMC6129157 DOI: 10.5116/ijme.5b07.d108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The study aimed to explore and identify factors motivating junior doctors to engage as long-term clinical tutors in undergraduate medical education. METHODS In this qualitative study, twenty-seven participants were recruited among junior doctors attending preparatory tutor courses at the Sahlgrenska Academy, University of Gothenburg, and the Primary Healthcare system, West Sweden. They were asked to respond to open-ended questions and write a short account of their needs as clinical tutors for medical students. A qualitative content analysis was performed. RESULTS A main theme emerged: "Let me develop my skills in a supportive workplace, provide feedback and merits, and I will continue tutoring". Participants described suitable personality as fundamental, and the need to develop professional skills, both as clinical tutors and physicians. Tutor education was an important source of knowledge and stimulation. A workplace environment, supporting learning and the tutor's role, was considered important, including having an adequate time frame. A clear and well-prepared assignment was regarded essential. Junior doctors requested feedback and merits in their work as long-term tutors. Clinical tutorship was considered an optional task. CONCLUSIONS In this exploratory study, motivating factors of junior doctors' engagement as future long-term tutors were identified. It is important to form a process where junior doctors can build up professional competence as clinical tutors and physicians. To ensure a sustainable tutorship in the future, we suggest that universities and healthcare authorities acknowledge and further study these motivating factors.
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Affiliation(s)
- Bernhard von Below
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Stig Rödjer
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Bengt Mattsson
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Dominique Hange
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Mats Wahlqvist
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
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Wakatsuki S, Tanaka P, Vinagre R, Marty A, Thomsen JLDL, Macario A. What Makes for Good Anesthesia Teaching by Faculty in the Operating Room? The Perspective of Anesthesiology Residents. Cureus 2018; 10:e2563. [PMID: 29974018 PMCID: PMC6029730 DOI: 10.7759/cureus.2563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Teaching during patient care is an important competency for faculty. Little is known about anesthesiology resident preferences for teaching by anesthesiology faculty in the operating room (OR). If the behaviors and characteristics of anesthesia teaching in the OR that are most valued by residents were identified, faculty could incorporate that best practice to teach residents during OR cases. The objective of this phenomenological study was to interview anesthesiology residents to determine what they perceive the best faculty teachers are doing in the OR to educate residents. Methods Thirty randomly selected anesthesiology residents (10 in each post-graduate year class) were interviewed using a semi-structured approach with a predetermined question: “Based on your experiences as a resident, when you think about the best-attending teachers in the OR, what are the best-attending teachers doing in the OR to teach that other faculty maybe are not doing?” Interviews were recorded, transcribed, converted into codes, and grouped into themes derived from the cognitive apprenticeship framework, which includes content, teaching methods, sequencing, and social characteristics. Results Resident responses were separated into a total of 134 answers, with similar answers grouped into one of 27 different codes. The most commonly mentioned codes were: autonomy – step back and let resident work through (mentioned by 13 residents), reasoning – explain why attending does things (12), context – teach something relevant to the case (8), commitment – take time to teach (8), literature – bring relevant papers (8), prior knowledge – assess the baseline level (7), flexibility – be open to trying different approaches (7), focus on just a few learning points (6), reflection – ask resident questions (6), provide real-time feedback (6), teach back – ask residents to explain what they were taught in their own words (5), belonging – facilitate communication with the OR team (5), psychological safety – be open and approachable (5), equanimity – stay calm and collected (5), select proper timing for instruction when the resident is not occupied with patient care (5), visualization – use graphs or diagrams (5), and specify learning goals ahead of time (5). Conclusion The best practice for OR teaching, as perceived by anesthesia residents, includes social characteristics, such as context, commitment, psychological safety, equanimity, and proper timing, as well as teaching methods, such as autonomy, reasoning, literature, prior knowledge, flexibility, reflection, real-time feedback, and teach back. Further studies can determine if training anesthesiology faculty to incorporate these elements increases the caliber of daily teaching in the OR.
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Affiliation(s)
- Shin Wakatsuki
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
| | - Pedro Tanaka
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
| | - Rafael Vinagre
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
| | - Adrian Marty
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
| | | | - Alex Macario
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
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Irby DM, O'Sullivan PS. Developing and rewarding teachers as educators and scholars: remarkable progress and daunting challenges. MEDICAL EDUCATION 2018; 52:58-67. [PMID: 28771776 DOI: 10.1111/medu.13379] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/10/2017] [Accepted: 05/18/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT This article describes the scholarly work that has addressed the fifth recommendation of the 1988 World Conference on Medical Education: 'Train teachers as educators, not content experts alone, and reward excellence in this field as fully as excellence in biomedical research or clinical practice'. PROGRESS Over the past 30 years, scholars have defined the preparation needed for teaching and other educator roles, and created faculty development delivery systems to train teachers as educators. To reward the excellence of educators, scholars have expanded definitions of scholarship, defined educator roles and criteria for judging excellence, and developed educator portfolios to make achievements visible for peer review. Despite these efforts, the scholarship of discovery continues to be more highly prized and rewarded than the scholarship of teaching. These values are deeply embedded in university culture and policies. CHALLENGES To remedy the structural inequalities between researchers and educators, a holistic approach to rewarding the broad range of educational roles and educational scholarship is needed. This requires strong advocacy to create changes in academic rewards and support policies, provide a clear career trajectory for educators using learning analytics, expand programmes for faculty development, support health professions education scholarship units and academies of medical educators, and create mechanisms to ensure high standards for all educators.
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Affiliation(s)
- David M Irby
- Department of Medicine, UCSF, San Francisco, California, USA
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Audétat MC, Laurin S, Dory V, Charlin B, Nendaz MR. Diagnosis and management of clinical reasoning difficulties: Part II. Clinical reasoning difficulties: Management and remediation strategies . MEDICAL TEACHER 2017; 39:797-801. [PMID: 28587511 DOI: 10.1080/0142159x.2017.1331034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Part II of this AMEE Guide provides a detailed overview of the main difficulties in clinical reasoning, including the cues to look out for in clinical supervision, the root causes of each difficulty and targeted remediation strategies. Specific challenges and issues related to the management of clinical reasoning difficulties will also be discussed.
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Affiliation(s)
- Marie-Claude Audétat
- a Department of Family and Emergency Medicine , Faculty of Medicine, Université de Montréal , Montreal , Canada
- b Unit of Development and Research in Medical Education , Faculty of Medicine, University of Geneva , Geneva , Switzerland
| | - Suzanne Laurin
- b Unit of Development and Research in Medical Education , Faculty of Medicine, University of Geneva , Geneva , Switzerland
| | - Valérie Dory
- c Centre for Medical Education & Department of Medicine , Faculty of Medicine, McGill University , Montreal , Canada
| | - Bernard Charlin
- d CPASS, Faculty of Medicine , Université de Montréal , Montreal , Canada
| | - Mathieu R Nendaz
- b Unit of Development and Research in Medical Education , Faculty of Medicine, University of Geneva , Geneva , Switzerland
- e Department of General Internal Medicine , Rehabilitation, and Geriatrics, University of Geneva , Geneva , Switzerland
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Audétat MC, Laurin S, Dory V, Charlin B, Nendaz MR. Diagnosis and management of clinical reasoning difficulties: Part I. Clinical reasoning supervision and educational diagnosis. MEDICAL TEACHER 2017; 39:792-796. [PMID: 28587534 DOI: 10.1080/0142159x.2017.1331033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There are many obstacles to the timely identification of clinical reasoning difficulties in health professions education. This guide aims to provide readers with a framework for supervising clinical reasoning and identifying the potential difficulties as they may occur at each step of the reasoning process.
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Affiliation(s)
- Marie-Claude Audétat
- a Department of Family and Emergency Medicine, Faculty of Medicine , Université de Montréal , Montreal , Canada
- b Unit of Development and Research in Medical Education, Faculty of Medicine , University of Geneva , Geneva , Switzerland
| | - Suzanne Laurin
- a Department of Family and Emergency Medicine, Faculty of Medicine , Université de Montréal , Montreal , Canada
| | - Valérie Dory
- c Centre for Medical Education & Department of Medicine, Faculty of Medicine , McGill University , Montreal , Canada
| | - Bernard Charlin
- d CPASS, Faculty of Medicine , Université de Montréal , Montreal , Canada
| | - Mathieu R Nendaz
- b Unit of Development and Research in Medical Education, Faculty of Medicine , University of Geneva , Geneva , Switzerland
- e Department of General Internal Medicine, Rehabilitation, and Geriatrics , University of Geneva , Geneva , Switzerland
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van Lankveld T, Schoonenboom J, Kusurkar RA, Volman M, Beishuizen J, Croiset G. Integrating the teaching role into one's identity: a qualitative study of beginning undergraduate medical teachers. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:601-622. [PMID: 27318712 PMCID: PMC5498609 DOI: 10.1007/s10459-016-9694-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 06/07/2016] [Indexed: 05/13/2023]
Abstract
Beginning medical teachers often see themselves as doctors or researchers rather than as teachers. Using both figured worlds theory and dialogical self theory, this study explores how beginning teachers in the field of undergraduate medical education integrate the teacher role into their identity. A qualitative study was performed, involving 18 beginning medical teachers at a Dutch medical school. The teachers were interviewed twice and kept a logbook over a period of 7 months. The study shows that the integration of the teacher role into the teachers' identity was hampered by the idea that teaching is perceived by others as a low status occupation. Some teachers experienced significant tension because of this, while others showed resilience in resisting the negative associations that were thought to exist regarding teaching. The teachers used five different identity narratives in order to integrate the teacher role into their identity, in which the positions of teacher and doctor or researcher were found to be combined, adopted or rejected in diverse ways. The five identity narratives were: (1) coalition between the I-position of teacher and other I-positions; (2) no integration of the I-position of teacher: holding on to other I-positions; (3) construction of the I-position of teacher and other I-positions as opposites; (4) coalition between the I-position of teacher and a third position of coordinator; and (5) meta-position: trivialising the importance of status. These identity narratives offer starting points for supporting undergraduate teachers during their early professional years.
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Affiliation(s)
- T van Lankveld
- Academic Centre for Human Behaviour and Movement, Faculty of Behavioural and Movement Sciences, LEARN!, VU University Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
- VUmc School of Medical Sciences Amsterdam, LEARN!, VU University Medical Center, Amsterdam, The Netherlands.
| | - J Schoonenboom
- Academic Centre for Human Behaviour and Movement, Faculty of Behavioural and Movement Sciences, LEARN!, VU University Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
- Department of Education, University of Vienna, Vienna, Austria
| | - R A Kusurkar
- VUmc School of Medical Sciences Amsterdam, LEARN!, VU University Medical Center, Amsterdam, The Netherlands
| | - M Volman
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - J Beishuizen
- Academic Centre for Human Behaviour and Movement, Faculty of Behavioural and Movement Sciences, LEARN!, VU University Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
| | - G Croiset
- VUmc School of Medical Sciences Amsterdam, LEARN!, VU University Medical Center, Amsterdam, The Netherlands
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Côté L, Rocque R, Audétat MC. Content and conceptual frameworks of psychology and social work preceptor feedback related to the educational requests of family medicine residents. PATIENT EDUCATION AND COUNSELING 2017; 100:1194-1202. [PMID: 28129931 DOI: 10.1016/j.pec.2017.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 11/29/2016] [Accepted: 01/13/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Supervision of communication competency in clinical settings in medicine is an important component of professional training. The purpose of this study was to describe the content and rationale of psychology and social work preceptor feedback to family medicine residents who express educational needs during case-based written vignettes. METHODS We conducted a qualitative study with 25 psychology and social work preceptors from family medicine departments of the three French-speaking universities in the province of Quebec, Canada. During an individual interview, preceptors were asked to respond to three short case-based written vignettes depicting resident educational issues regarding communication and to explain their responses. Authors analyzed the content of responses and the conceptual frameworks reported. RESULTS The three vignettes elicited 475 responses, including 58 distinct responses and 33 distinct conceptual frameworks. Therapeutic alliance and stages of grief were the two most reported conceptual frameworks. CONCLUSION The vignettes stimulated a wealth of responses and conceptual frameworks among psychology and social work preceptors in family medicine. PRACTICAL IMPLICATIONS The complete list of responses could be useful for faculty development activities by stimulating preceptors' reflexive practice with regard to their responses, the educational goals of these responses and the conceptual frameworks underlying their feedback.
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Affiliation(s)
- Luc Côté
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada; Faculty of Medicine, Ferdinand-Vandry Building, Office 2476, Quebec, G1V 0A6, Canada.
| | - Rhéa Rocque
- School of Psychology, Laval University, Quebec, Canada; Faculty of Social Sciences, Félix-Antoine-Savard Building, 2325 Allée des Bibliothèques, Québec, G1V 0A6, Canada.
| | - Marie-Claude Audétat
- Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland; Primary Care Unit (UIGP), BFM Local 4091, Centre Médical Universitaire de Genève, 9 Avenue de Champel, 1211 Genève 4, Switzerland.
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Chen HC, Fogh S, Kobashi B, Teherani A, Ten Cate O, O'Sullivan P. An interview study of how clinical teachers develop skills to attend to different level learners. MEDICAL TEACHER 2016; 38:578-84. [PMID: 26343164 DOI: 10.3109/0142159x.2015.1073238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE One clinical teaching challenge is the engagement of learners at different levels. Faculty development offerings mostly address general strategies applicable to all learners. This study examined how clinical faculty members develop the skills to work with different level learners. METHODS We conducted semi-structured interviews with medical school faculty members identified as excellent clinical teachers teaching multiple levels of learners. They discussed how they developed their approach to teaching different level learners and how their teaching evolved over time. We performed thematic analysis of the interview transcripts using open and axial coding. RESULTS We interviewed 19 faculty members and identified three themes related to development of teaching practices: teacher agency and work-based learning of teaching strategies, developmental trajectory of clinical teachers, and interplay between clinical confidence and teaching skills. Faculty members were proactive in using on-the-job experiences to develop their teaching practices. Their teaching practices followed a developmental trajectory towards learner centeredness, and this evolution was associated with the development of clinical skills and confidence. CONCLUSIONS Learning skills to teach multi-level learners requires workplace learning. Faculty development should include workplace learning opportunities and use a developmental approach that accounts for the trajectory of teaching as well as clinical skills attainment.
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Affiliation(s)
| | | | | | | | - Olle Ten Cate
- b University Medical Center Utrecht , The Netherlands
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Cilliers FJ, Tekian A. Effective Faculty Development in an Institutional Context: Designing for Transfer. J Grad Med Educ 2016; 8:145-9. [PMID: 27168878 PMCID: PMC4857507 DOI: 10.4300/jgme-d-15-00117.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Francois J. Cilliers
- Corresponding author: Francois J. Cilliers, MBChB, MPhil HE, PhD, University of Cape Town, Education Development Unit, Department of Health Sciences Education, 2.10 Anatomy Building, Faculty of Health Sciences, Anzio Road, 7925 Observatory, South Africa, +27.0.21.406.6646, fax +27.0.21.406.6244,
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Chan LK, Yang J, Irby DM. Application of the one-minute preceptor technique by novice teachers in the gross anatomy laboratory. ANATOMICAL SCIENCES EDUCATION 2015; 8:539-546. [PMID: 25573139 DOI: 10.1002/ase.1515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/11/2014] [Accepted: 12/20/2014] [Indexed: 06/04/2023]
Abstract
The one-minute preceptor (OMP) was originally developed in the ambulatory care setting as a time-efficient teaching technique for learner-centered clinical training. There are also possible advantages of using the OMP in the gross anatomy laboratory. However, in a previous study it was found that providing training to experienced gross anatomy teachers in the use of the OMP did not result in improvement in students' perceptions of their learning, probably because of the fact that the experienced teachers had already developed their own pedagogical approaches. In the current study, we examined the effects of training novice teachers with about four years of gross anatomy teaching experience, in the use of the OMP in the gross anatomy laboratory, by surveying students to collect their views on their learning experiences, by observing the teachers' teaching behaviors before and after they were trained in OMP, and then by interviewing them. More students reported a better learning experience in the session after the teachers had been trained in the OMP than reported worse, in eight out of the nine items related to their learning experiences. The novice teachers were receptive to the OMP. After the OMP training, the novice teachers were observed to engage more in getting commitments from the students and in reinforcing what the students have done right, two of the five OMP microskills. They considered the OMP to be very useful for their development as anatomy teachers.
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Affiliation(s)
- Lap Ki Chan
- Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
- Department of Anatomy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Jian Yang
- Department of Anatomy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - David M Irby
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, California
- Office of Research and Development in Medical Education, University of California San Francisco, San Francisco, California
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Wenrich MD, Jackson MB, Maestas RR, Wolfhagen IHAP, Scherpbier AJJ. From Cheerleader to Coach: The Developmental Progression of Bedside Teachers in Giving Feedback to Early Learners. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:S91-S97. [PMID: 26505108 DOI: 10.1097/acm.0000000000000901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Medical students learn clinical skills at the bedside from teaching clinicians, who often learn to teach by teaching. Little is known about the process of becoming an effective clinical teacher. Understanding how teaching skills and approaches change with experience may help tailor faculty development for new teachers. Focusing on giving feedback to early learners, the authors asked: What is the developmental progression of clinician-teachers as they learn to give clinical skills feedback to medical students? METHOD This qualitative study included longitudinal interviews with clinician-teachers over five years in a new clinical skills teaching program for preclinical medical students. Techniques derived from grounded theory were used for initial analyses. The current study focused on one theme identified in initial analyses: giving feedback to students. Transcript passages were organized by interview year, coded, and discussed in year clusters; thematic codes were compared and emergent codes developed. RESULTS Themes related to giving feedback demonstrated a dyadic structure: characteristic of less experienced teachers versus characteristic of experienced teachers. Seven dominant dyadic themes emerged, including teacher as cheerleader versus coach, concern about student fragility versus understanding resilience, and focus on creating a safe environment versus challenging students within a safe environment. CONCLUSIONS With consistent teaching, clinical teachers demonstrated progress in giving feedback to students in multiple areas, including understanding students' developmental trajectory and needs, developing tools and strategies, and adopting a dynamic, challenging, inclusive team approach. Ongoing teaching opportunities with targeted faculty development may help improve clinician-teachers' feedback skills and approaches.
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Dougherty PJ. CORR curriculum - orthopaedic education: Faculty development begins at home. Clin Orthop Relat Res 2014; 472:3637-43. [PMID: 25298280 PMCID: PMC4397787 DOI: 10.1007/s11999-014-3986-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/26/2014] [Indexed: 01/31/2023]
Affiliation(s)
- Paul J. Dougherty
- Detroit Medical Center, 4201 St. Antoine, Suite 4G, Detroit, MI 48201 USA
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Eva KW. Lessons learned by those prepared to greet chance head on. MEDICAL EDUCATION 2014; 48:738-739. [PMID: 25039726 DOI: 10.1111/medu.12519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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