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Stoffels M, Broeksma LA, Barry M, van der Burgt SME, Daelmans HEM, Peerdeman SM, Kusurkar RA. Bridging School and Practice? Barriers to the Integration of 'Boundary Objects' for Learning and Assessment in Clinical Nursing Education. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:392-405. [PMID: 39006554 PMCID: PMC11243767 DOI: 10.5334/pme.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 06/21/2024] [Indexed: 07/16/2024]
Abstract
Introduction In clinical health professions education, portfolios, assignments and assessment standards are used to enhance learning. When these tools fulfill a bridging function between school and practice, they can be considered 'boundary objects'. In the clinical setting, these tools may be experienced as time-consuming and lacking value. This study aimed to investigate the barriers to the integration of boundary objects for learning and assessment from a Cultural-Historical Activity Theory (CHAT) perspective in clinical nursing education. Methods Nineteen interviews and five observations were conducted with team leads, clinical educators, supervisors, students, and teachers to obtain insight into intentions and use of boundary objects for learning and assessment. Boundary objects (assessment standards, assignments, feedback/reflection/patient care/development plan templates) were collected. The data collection and thematic analysis were guided by CHAT. Results Barriers to the integration of boundary objects included: a) conflicting requirements in clinical competency monitoring and assessment, b) different application of analytical skills, and c) incomplete integration of boundary objects for self-regulated learning into supervision practice. These barriers were amplified by the simultaneous use of boundary objects for learning and assessment. Underlying contradictions included different objectives between school and practice, and tensions between the distribution of labor in the clinical setting and school's rules. Discussion School and practice have both convergent and divergent priorities around students' clinical learning. Boundary objects can promote continuity in learning and increase students' understanding of clinical practice. However, effective integration requires for flexible rules that allow for collaborative learning around patient care.
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Affiliation(s)
- Malou Stoffels
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
- Amsterdam UMC, VUmc Amstel Academy, Institute for Education and Training, The Netherlands
- LEARN! research institute for learning and education, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands
| | - Louti A Broeksma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
| | - Margot Barry
- RadboudUmc Health Academy, Nijmegen, The Netherlands
| | - Stephanie M E van der Burgt
- Amsterdam UMC location University of Amsterdam, Teaching and Learning Center (TLC), Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Hester E M Daelmans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Department of skills training, The Netherlands
| | - Saskia M Peerdeman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
- Research institute: Amsterdam Public Health (APH), program Quality of Care, Amsterdam, The Netherlands
| | - Rashmi A Kusurkar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
- LEARN! research institute for learning and education, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
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Gardner AK, Rodgers DL, Steinert Y, Davis R, Condron C, Peterson DT, Rohra A, Viggers S, Eppich WJ, Reedy G. Mapping the Terrain of Faculty Development for Simulation: A Scoping Review. Simul Healthc 2024; 19:S75-S89. [PMID: 38240621 DOI: 10.1097/sih.0000000000000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
ABSTRACT Understanding what interventions and approaches are currently being used to improve the knowledge, skills, and effectiveness of instructors in simulation-based education is an integral step for carving out the future of simulation. The current study is a scoping review on the topic, to uncover what is known about faculty development for simulation-based education.We screened 3259 abstracts and included 35 studies in this scoping review. Our findings reveal a clear image that the landscape of faculty development in simulation is widely diverse, revealing an array of foundations, terrains, and peaks even within the same zone of focus. As the field of faculty development in simulation continues to mature, we would hope that greater continuity and cohesiveness across the literature would continue to grow as well. Recommendations provided here may help provide the pathway toward that aim.
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Affiliation(s)
- Aimee K Gardner
- From the Baylor College of Medicine (A.K.G., R.D., A.R.), Houston, TX; Indiana University School of Medicine (D.L.R.), Indianapolis, IN; McGill University, Faculty of Medicine and Health Sciences (Y.S.), Montréal, Canada; Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, RCSI SIM Center for Simulation Education and Research (C.C., W.J.E.), Dublin, Ireland; The University of Alabama at Birmingham (D.T.P.), Birmingham, AL; Copenhagen Academy for Medical Education and Simulation (S.V.), Copenhagen, Denmark; and King's College London (G.R.), London, United Kingdom
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Somerville SG, Harrison NM, Lewis SA. Twelve tips for the pre-brief to promote psychological safety in simulation-based education. MEDICAL TEACHER 2023; 45:1349-1356. [PMID: 37210674 DOI: 10.1080/0142159x.2023.2214305] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
It is recognised that simulation-based education can be stressful, and this can impact negatively on learning. A fundamental aspect of facilitating simulation is creating a safe educational environment. Edmondson's seminal work on creating psychological safety among interpersonal teams has been embraced by the healthcare simulation community. Psychological safety is an underpinning philosophy for creating simulation experiences in which learners can develop within a stimulating and challenging yet supportive social atmosphere. Through careful design and thoughtful delivery, the introductory phase of simulation, the pre-briefing, can effectively prepare learners for simulation, reduce learner anxiety, and promote psychological safety, to enhance learning experiences. These twelve tips provide guidance for conducting a pre-brief and promoting a psychologically safe environment for simulation-based education.
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Affiliation(s)
| | - Neil Malcolm Harrison
- Clinical Skills Centre, Dundee Institute for Healthcare Simulation, School of Medicine, University of Dundee, Dundee, Scotland
| | - Steven Anthony Lewis
- Clinical Skills Centre, Dundee Institute for Healthcare Simulation, School of Medicine, University of Dundee, Dundee, Scotland
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Shah AP, Cleland J, Hawick L, Walker KA, Walker KG. Integrating simulation into surgical training: a qualitative case study of a national programme. Adv Simul (Lond) 2023; 8:20. [PMID: 37596692 PMCID: PMC10436455 DOI: 10.1186/s41077-023-00259-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Applying simulation-based education (SBE) into surgical curricula is challenging and exacerbated by the absence of guidance on implementation processes. Empirical studies evaluating implementation of SBE interventions focus primarily on outcomes. However, understanding the processes involved in organising, planning, and delivering SBE adds knowledge on how best to develop, implement, and sustain surgical SBE. This study used a reform of early years surgical training to explore the implementation of a new SBE programme in Scotland. It aimed to understand the processes that are involved in the relative success (or failure) when implementing surgical SBE interventions. METHODS This qualitative case study, underpinned by social constructionism, used publicly available documents and the relevant surgical SBE literature to inform the research focus and contextualise data obtained from semi-structured interviews with core surgical trainees (n = 46), consultant surgeons (n = 25), and key leaders with roles in surgical training governance in Scotland (n = 7). Initial data coding and analysis were inductive. Secondary data analysis was then undertaken using Normalisation Process Theory (NPT). NPTs' four constructs (coherence, cognitive participation, collective action, reflexive monitoring) provided an explanatory framework for scrutinising how interventions are implemented, embedded, and integrated into practice, i.e. the "normalisation" process. RESULTS Distributed leadership (individual SBE initiatives assigned to faculty but overall programme overseen by a single leader) and the quality improvement practise of iterative refinement were identified as key novel processes promoting successful normalisation of the new SBE programme. Other processes widely described in the literature were also identified: stakeholder collaboration, personal contacts/relational processes, effective communication, faculty development, effective leadership, and tight programme management. The study also identified that learners valued SBE activities in group- or team-based social environments over isolated deliberate practice. CONCLUSIONS SBE is most effective when designed as a comprehensive programme aligned to the curriculum. Programmes incorporating both group-based and isolated SBE activities promote deliberate practice. Distributed leadership amongst faculty attracts wide engagement integral to SBE programme implementation, while iterative programme refinement through regular evaluation and action on feedback encourages integration into practice. The knowledge contributed by critically analysing SBE programme implementation processes can support development of much needed guidance in this area.
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Affiliation(s)
- Adarsh P Shah
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lorraine Hawick
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kim A Walker
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kenneth G Walker
- NHS Education for Scotland, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, UK.
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Shah AP, Walker KA, Walker KG, Cleland J. Context matters in curriculum reform: An analysis of change in surgical training. MEDICAL EDUCATION 2023; 57:741-752. [PMID: 36869257 DOI: 10.1111/medu.15071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Education and training reforms are typically devised by accreditation bodies and rolled out nationally. This top-down approach is positioned as contextually independent, yet context is highly influential in shaping the impact of change. Given this, it is critical to consider how curriculum reform plays out as it meets local settings. We have therefore used a national-level curriculum reform process of surgical training, Improving Surgical Training (IST), to examine the influence of context in IST implementation across two UK countries. METHODS Adopting a case study approach, we used document data for contextualisation purposes and semi-structured interviews with key stakeholders across multiple organisations (n = 17, plus four follow-up interviews) as our main source of data. Initial data coding and analysis were inductive. We followed this with a secondary analysis using Engeström's second-generation activity theory nested within an overarching framework of complexity theory to help tease out some key elements of IST development and implementation. RESULTS The introduction of IST into the surgical training system was historically situated within a landscape of previous reforms. IST's aims collided with existing practices and rules, thus creating tensions. In one country, the systems of IST and surgical training came together to some extent, mostly due to processes of social networks, negotiation and leverage nested in a relatively cohesive setting. These processes were not apparent in the other country, and instead of transformative change, the system contracted. Change was not integrated, and the reform was halted. CONCLUSIONS Our use of a case study approach and complexity theory deepens understanding of how history, systems and contexts interact to facilitate or inhibit change within one area of medical education. Our study paves the way for further empirical work examining the influence of context in curriculum reform, and thus determining how best to bring about change in practice.
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Affiliation(s)
- Adarsh P Shah
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kim A Walker
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kenneth G Walker
- NHS Education for Scotland, Centre for Health Science, Inverness, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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Ogden K, Kilpatrick S, Elmer S. Examining the nexus between medical education and complexity: a systematic review to inform practice and research. BMC MEDICAL EDUCATION 2023; 23:494. [PMID: 37408005 DOI: 10.1186/s12909-023-04471-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/23/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Medical education is a multifarious endeavour integrating a range of pedagogies and philosophies. Complexity as a science or theory ('complexity') signals a move away from a reductionist paradigm to one which appreciates that interactions in multi-component systems, such as healthcare systems, can result in adaptive and emergent outcomes. This examination of the nexus between medical education and complexity theory aims to discover ways that complexity theory can inform medical education and medical education research. METHODS A structured literature review was conducted to examine the nexus between medical education and complexity; 5 databases were searched using relevant terms. Papers were included if they engaged fully with complexity as a science or theory and were significantly focused on medical education. All types of papers were included, including conceptual papers (e.g. opinion and theoretical discussions), case studies, program evaluations and empirical research. A narrative and thematic synthesis was undertaken to create a deep understanding of the use of complexity in medical education. RESULTS Eighty-three papers were included; the majority were conceptual papers. The context and theoretical underpinnings of complexity as a relevant theory for medical education were identified. Bibliographic and temporal observations were noted regarding the entry of complexity into medical education. Complexity was relied upon as a theoretical framework for empirical studies covering a variety of elements within medical education including: knowledge and learning theories; curricular, program and faculty development; program evaluation and medical education research; assessment and admissions; professionalism and leadership; and learning for systems, about systems and in systems. DISCUSSION There is a call for greater use of theory by medical educators. Complexity within medical education is established, although not widespread. Individualistic cultures of medicine and comfort with reductionist epistemologies challenges its introduction. However, complexity was found to be a useful theory across a range of areas by a limited number of authors and is increasingly used by medical educators and medical education researchers. This review has further conceptualized how complexity is being used to support medical education and medical education research. CONCLUSION This literature review can assist in understanding how complexity can be useful in medical educationalists' practice.
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Affiliation(s)
- Kathryn Ogden
- Tasmanian School of Medicine, University of Tasmania, Launceston, TAS, Australia.
- Launceston Clinical School, Locked Bag 1377, Launceston, 7250, Australia.
| | - Sue Kilpatrick
- School of Education, University of Tasmania, Launceston, TAS, Australia
| | - Shandell Elmer
- School of Nursing, University of Tasmania, Launceston, TAS, Australia
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Rosendal AA, Sloth SB, Rölfing JD, Bie M, Jensen RD. Technical, Non-Technical, or Both? A Scoping Review of Skills in Simulation-Based Surgical Training. JOURNAL OF SURGICAL EDUCATION 2023; 80:731-749. [PMID: 36906398 DOI: 10.1016/j.jsurg.2023.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/10/2023] [Accepted: 02/15/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Technical and non-technical skills are traditionally investigated separately in simulation-based surgical training (SBST). Recent literature has indicated an interrelation of these skills, but a clear relationship is yet to be established. This scoping review aimed to identify published literature on the use of both technical and non-technical learning objectives in SBST and investigate how the entities are related. Additionally, this scoping study reviewed the literature with the aim of mapping how publications on technical and non-technical skills within SBST have changed over time. DESIGN We conducted a scoping review using the 5 step framework by Arksey and O'Malley and reported our results according to the PRISMA guidelines for scoping reviews. Four databases, PubMed, Web of Science, Embase and Cochrane Library, were systematically searched for empirical studies on SBST. Studies within surgical training addressing both technical and non-technical learning objectives and presenting primary data were included for further analysis. RESULTS Our scoping review identified 3144 articles on SBST published between 1981 and 2021. During our analysis, an emphasis on technical skills training in published literature was identified. However, recent years have seen an immense increase of publications within either technical or non-technical skills. A similar trend is seen in publications addressing both technical and non-technical. In total, 106 publications addressed both technical and non-technical learning objectives and were included for further analysis. Only 45 of the included articles addressed the relationship between technical and non-technical skills. These articles mainly focused on the effect of non-technical skills on technical skills. CONCLUSIONS Though literature on the relationship between technical and non-technical skills remains scarce, the included studies on technical skills and non-technical skills such as mental training suggest such a relationship exists. This implies that the separation of the skill sets is not necessarily beneficial for the outcome of SBST. A shift towards seeing technical and non-technical skills as intertwined may enhance learning outcomes from SBST.
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Affiliation(s)
- Amalie Asmind Rosendal
- Corporate HR MidtSim, Central Denmark Region, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Sigurd Beier Sloth
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark
| | - Jan Duedal Rölfing
- Corporate HR MidtSim, Central Denmark Region, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Magnus Bie
- Corporate HR MidtSim, Central Denmark Region, Aarhus, Denmark
| | - Rune Dall Jensen
- Corporate HR MidtSim, Central Denmark Region, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Shah AP, Walker KA, Walker KG, Hawick L, Cleland J. "It's making me think outside the box at times": a qualitative study of dynamic capabilities in surgical training. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:499-518. [PMID: 36287293 PMCID: PMC9607851 DOI: 10.1007/s10459-022-10170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
Craft specialties such as surgery endured widespread disruption to postgraduate education and training during the pandemic. Despite the expansive literature on rapid adaptations and innovations, generalisability of these descriptions is limited by scarce use of theory-driven methods. In this research, we explored UK surgical trainees' (n = 46) and consultant surgeons' (trainers, n = 25) perceptions of how learning in clinical environments changed during a time of extreme uncertainty (2020/2021). Our ultimate goal was to identify new ideas that could shape post-pandemic surgical training. We conducted semi-structured virtual interviews with participants from a range of working/training environments across thirteen Health Boards in Scotland. Initial analysis of interview transcripts was inductive. Dynamic capabilities theory (how effectively an organisation uses its resources to respond to environmental changes) and its micro-foundations (sensing, seizing, reconfiguring) were used for subsequent theory-driven analysis. Findings demonstrate that surgical training responded dynamically and adapted to external and internal environmental uncertainty. Sensing threats and opportunities in the clinical environment prompted trainers' institutions to seize new ways of working. Learners gained from reconfigured training opportunities (e.g., splitting operative cases between trainees), pan-surgical working (e.g., broader surgical exposure), redeployment (e.g., to medical specialties), collaborative working (working with new colleagues and in new ways) and supervision (shifting to online supervision). Our data foreground the human resource and structural reconfigurations, and technological innovations that effectively maintained surgical training during the pandemic, albeit in different ways. These adaptations and innovations could provide the foundations for enhancing surgical education and training in the post-pandemic era.
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Affiliation(s)
- Adarsh P Shah
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Kim A Walker
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Kenneth G Walker
- NHS Education for Scotland, Centre for Health Science, Inverness, UK
| | - Lorraine Hawick
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Wong WYA, Thistlethwaite J, Moni K, Roberts C. Using cultural historical activity theory to reflect on the sociocultural complexities in OSCE examiners' judgements. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:27-46. [PMID: 35943605 PMCID: PMC9992227 DOI: 10.1007/s10459-022-10139-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
Examiners' judgements play a critical role in competency-based assessments such as objective structured clinical examinations (OSCEs). The standardised nature of OSCEs and their alignment with regulatory accountability assure their wide use as high-stakes assessment in medical education. Research into examiner behaviours has predominantly explored the desirable psychometric characteristics of OSCEs, or investigated examiners' judgements from a cognitive rather than a sociocultural perspective. This study applies cultural historical activity theory (CHAT) to address this gap in exploring examiners' judgements in a high-stakes OSCE. Based on the idea that OSCE examiners' judgements are socially constructed and mediated by their clinical roles, the objective was to explore the sociocultural factors that influenced examiners' judgements of student competence and use the findings to inform examiner training to enhance assessment practice. Seventeen semi-structured interviews were conducted with examiners who assessed medical student competence in progressing to the next stage of training in a large-scale OSCE at one Australian university. The initial thematic analysis provided a basis for applying CHAT iteratively to explore the sociocultural factors and, specifically, the contradictions created by interactions between different elements such as examiners and rules, thus highlighting the factors influencing examiners' judgements. The findings indicated four key factors that influenced examiners' judgements: examiners' contrasting beliefs about the purpose of the OSCE; their varying perceptions of the marking criteria; divergent expectations of student competence; and idiosyncratic judgement practices. These factors were interrelated with the activity systems of the medical school's assessment practices and the examiners' clinical work contexts. Contradictions were identified through the guiding principles of multi-voicedness and historicity. The exploration of the sociocultural factors that may influence the consistency of examiners' judgements was facilitated by applying CHAT as an analytical framework. Reflecting upon these factors at organisational and system levels generated insights for creating fit-for-purpose examiner training to enhance assessment practice.
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Affiliation(s)
- Wai Yee Amy Wong
- School of Education and Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4072, Australia.
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, BT9 7BL, UK.
| | - Jill Thistlethwaite
- Faculty of Health, The University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Karen Moni
- School of Education, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Chris Roberts
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
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Sader J, Diana A, Coen M, Nendaz M, Audétat MC. A GP's clinical reasoning in the context of multimorbidity: beyond the perception of an intuitive approach. Fam Pract 2023; 40:113-118. [PMID: 35849124 DOI: 10.1093/fampra/cmac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION GP's clinical reasoning processes in the context of patients suffering from multimorbidity are often a process which remains implicit. Therefore, the goal of this case study analysis is to gain a better understanding of the processes at play in the management of patients suffering from multimorbidity. METHODS A case study analysis, using a qualitative thematic analysis was conducted. This case follows a 54-year-old woman who has been under the care of her GP for almost 10 years and suffers from a number of chronic conditions. The clinical reasoning of an experienced GP who can explicitly unfold his processes was chosen for this case analysis. RESULTS Four main themes emerged from this case analysis: The different roles that GPs have to manage; the GP's cognitive flexibility and continual adaptation of their clinical reasoning processes, the patient's empowerment, and the challenges related to the collaboration with specialists and healthcare professionals. CONCLUSION This could help GPs gain a clearer understanding of their clinical reasoning processes and motivate them to communicate their findings with others during clinical supervision or teaching. Furthermore, this may emphasize the importance of valuing the role of the primary care physician in the management of multimorbid patients.
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Affiliation(s)
- Julia Sader
- UDREM-Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,iEh2-Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alessandro Diana
- IuMFE-Institute of Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Matteo Coen
- UDREM-Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,HUG-Department of Medicine, University Hospitals Geneva, Geneva, Switzerland
| | - Mathieu Nendaz
- UDREM-Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,HUG-Department of Medicine, University Hospitals Geneva, Geneva, Switzerland
| | - Marie-Claude Audétat
- UDREM-Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,IuMFE-Institute of Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Sloth SB, Jensen RD, Seyer-Hansen M, De Win G, Christensen MK. Ticket to perform: an explorative study of trainees' engagement in and transfer of surgical training. BMC MEDICAL EDUCATION 2023; 23:64. [PMID: 36698177 PMCID: PMC9878748 DOI: 10.1186/s12909-023-04048-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/20/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Research suggests that simulation-based surgical skills training translates into improved operating room performance. Previous studies have predominantly focused on training methods and design and subsequent assessable performances and outcomes in the operating room, which only covers some aspects of training engagement and transfer of training. The purpose of this qualitative study was to contribute to the existing body of literature by exploring characteristics of first-year trainees' engagement in and perceptions of transfer of surgical skills training. METHODS We conducted an explorative study based on individual interviews with first-year trainees in General Surgery, Urology, and Gynaecology and Obstetrics who participated in a laparoscopic skills training program. Informants were interviewed during and two months after the training program. A thematic cross-case analysis was conducted using systematic text condensation. RESULTS We interviewed 12 informants, which produced 24 transcripts for analysis. We identified four main themes: (1) sportification of training, (2) modes of orientation, (3) transferrable skills, and (4) transfer opportunities. Informants described their surgical training using sports analogies of competition, timing, and step-by-step approaches. Visual orientations, kinaesthetic experiences, and elicited dialogues characterised training processes and engagement. These characteristics were identified in both the simulated and the clinical environment. Experiences of specific skills transfer included ambidexterity, coordination, instrument handling, and visuospatial ability. General transfer experiences were salient in informants' altered training approaches. Informants considered the simulation-based training an entry ticket to perform in the operating room and mentioned supervisor-trainee relationships and opportunities in the workplace as critical conditions of transfer. CONCLUSIONS Our findings elucidate characteristics of surgical training engagement that can be interpreted as self-regulated learning processes that transcend surgical training environments. Despite appreciating the immediate skills improvements resulting from training, trainees' narratives reflected a struggle to transfer their training to the clinical setting. Tensions existed between perceptions of transferable skills and experiences of transfer within the clinical work environments. These results resonate with research emphasising the importance of the work environment in the transfer process. Our findings provide insights that may inform the development of training programs that support self-regulated learning and transfer of training from the simulated to the clinical environment.
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Affiliation(s)
- Sigurd Beier Sloth
- Centre for Educational Development, Aarhus University, Trøjborgvej 82-84, 8200, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus, Denmark.
| | - Rune Dall Jensen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus, Denmark
- Corporate HR, MidtSim, Central Denmark Region, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
| | - Mikkel Seyer-Hansen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus, Denmark
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Gunter De Win
- Antwerp Surgical Training, Anatomy and Research Center (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
- Department of Urology, University Hospital Antwerp, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Mette Krogh Christensen
- Centre for Educational Development, Aarhus University, Trøjborgvej 82-84, 8200, Aarhus, Denmark
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Shah AP, Walker KA, Hawick L, Walker KG, Cleland J. Scratching beneath the surface: How organisational culture influences curricular reform. MEDICAL EDUCATION 2022. [PMID: 36458943 DOI: 10.1111/medu.14994] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Curricular reform is often proposed as the means to improve medical education and training. However, reform itself may not lead to noticeable change, possibly because the influence of organisational culture on change is given insufficient attention. We used a national reform of early-years surgical training as a natural opportunity to examine the interplay between organisational culture and change in surgical education. Our specific research question was: in what ways did organisational culture influence the implementation of Improving Surgical Training (IST)? METHODS This is a qualitative study underpinned by social constructivism. Interviews were conducted with core surgical trainees (n = 46) and their supervising consultants (n = 25) across Scotland in 2020-2021. Data coding and analysis were initially inductive. The themes indicated the importance of many cultural factors as barriers or enablers to IST implementation. We therefore carried out a deductive, secondary data analysis using Johnson's (1988) cultural web model to identify and examine the different elements of organisational culture and their impact on IST. RESULTS The cultural web enabled a detailed understanding of how organisational culture influenced IST implementation as per Johnson's six elements-Rituals and Routines (e.g. departmental rotas), Stories (e.g. historical training norms and culture), Symbols (e.g. feedback mechanisms, visibility and value placed on education), Power Structures (e.g. who has the power in local contexts), Organisational Structures (e.g. relationships and accountability) and the Control System (e.g. consultant job plans and service targets)-and how these interact. However, it did not shed light on the influence of exogenous events on change. CONCLUSION Our data reveal cultural reasons why this curricular reform met with varying degrees of success across different hospital sites, reinforcing that curricular reform is not simply about putting recommendations into practice. Many different aspects of context must be considered when planning and evaluating change in medical education and training.
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Affiliation(s)
- Adarsh P Shah
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kim A Walker
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Lorraine Hawick
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kenneth G Walker
- NHS Education for Scotland, Centre for Health Science, Inverness, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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Phinney LB, Fluet A, O'Brien BC, Seligman L, Hauer KE. Beyond Checking Boxes: Exploring Tensions With Use of a Workplace-Based Assessment Tool for Formative Assessment in Clerkships. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1511-1520. [PMID: 35703235 DOI: 10.1097/acm.0000000000004774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To understand the role of a workplace-based assessment (WBA) tool in facilitating feedback for medical students, this study explored changes and tensions in a clerkship feedback activity system through the lens of cultural historical activity theory (CHAT) over 2 years of tool implementation. METHOD This qualitative study uses CHAT to explore WBA use in core clerkships by identifying feedback activity system elements (e.g., community, tools, rules, objects) and tensions among these elements. University of California, San Francisco core clerkship students were invited to participate in semistructured interviews eliciting experience with a WBA tool intended to enhance direct observation and feedback in year 1 (2019) and year 2 (2020) of implementation. In year 1, the WBA tool required supervisor completion in the school's evaluation system on a computer. In year 2, both students and supervisors had WBA completion abilities and could access the form via a smartphone separate from the school's evaluation system. RESULTS Thirty-five students participated in interviews. The authors identified tensions that shifted with time and tool iterations. Year 1 students described tensions related to cumbersome tool design, fear of burdening supervisors, confusion over WBA purpose, WBA as checking boxes, and WBA usefulness depending on clerkship context and culture. Students perceived dissatisfaction with the year 1 tool version among peers and supervisors. The year 2 mobile-based tool and student completion capabilities helped to reduce many of the tensions noted in year 1. Students expressed wider WBA acceptance among peers and supervisors in year 2 and reported understanding WBA to be for low-stakes feedback, thereby supporting formative assessment for learning. CONCLUSIONS Using CHAT to explore changes in a feedback activity system with WBA tool iterations revealed elements important to WBA implementation, including designing technology for tool efficiency and affording students autonomy to document feedback with WBAs.
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Affiliation(s)
- Lauren B Phinney
- L.B. Phinney is a first-year internal medicine resident, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Angelina Fluet
- A. Fluet is a fourth-year medical student, University of California, San Francisco School of Medicine, San Francisco, California
| | - Bridget C O'Brien
- B.C. O'Brien is professor of medicine and education scientist, Department of Medicine and Center for Faculty Educators, University of California, San Francisco School of Medicine, San Francisco, California
| | - Lee Seligman
- L. Seligman is a second-year internal medicine resident, Department of Medicine, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
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How Prepared Are They? Pediatric Boot Camps and Intern Performance. Acad Pediatr 2022; 22:1237-1245. [PMID: 35577284 DOI: 10.1016/j.acap.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/28/2022] [Accepted: 05/07/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether participation in a pediatric boot camp during medical school was associated with higher intern performance. Secondary objectives were to determine whether participation in general boot camps, pediatric subinternships or pediatric electives was associated with higher performance. METHODS Intern surveys and faculty performance assessments during early internship were collected from a convenience sample of pediatric residency programs. Interns completed a survey regarding participation in medical school boot camps, pediatric subinternships and pediatric electives. Faculty assessed intern performance on selected Milestone-based subcompetencies on a 5-point scale following each intern's initial inpatient rotation and results were compared between groups. RESULTS Seventeen pediatric residency programs participated. Two hundred eighty-seven interns completed the survey (69%), and faculty completed assessments on 71% of these interns. Of interns with complete faculty assessments (n = 198), 25% participated in 5 or more days of pediatric boot camp, 30% in general boot camp, and 45% in no boot camp. There were no educationally significant associations between participation in 5 or more days of pediatric boot camp, general boot camp, subinternships, or electives and intern performance. Interns completing at least 10 days of pediatric boot camp (n = 25) had slightly higher ratings for incorporating feedback and engaging in help-seeking behavior during June and July only. CONCLUSIONS Participation in pediatric boot camps, general boot camps, pediatric subinternships or electives was not associated with substantially higher intern performance as measured by selected Milestone subcompetencies. Pediatric educators should carefully consider boot camp curricula and anticipated outcomes associated with boot camp participation.
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Law M, Veinot P, Mylopoulos M, Bryden P, Brydges R. Applying activity theory to undergraduate medical curriculum reform: Lessons in contradictions from multiple stakeholders' perspectives. MEDICAL TEACHER 2022; 44:800-811. [PMID: 35199616 DOI: 10.1080/0142159x.2022.2041190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Medical school curricula require regular updating. We adopted an activity theory lens to conduct a holistic, multiple stakeholder-informed analysis of curricular reform, aiming to understand how the social relations between groups contribute to unanticipated tensions and outcomes. METHODS A research assistant conducted semi-structured interviews with purposively sampled (N = 19) administrative staff, faculty course leads, faculty tutors, curriculum developers, change leaders and student leaders. The team applied a framework analysis to guide within and between stakeholder comparisons. RESULTS Participants reported unique (N = 21) and cross-cutting (N = 17) contradictions underscoring emerging drivers of current and potential change. Unique contradictions raised by 1-2 groups represented seeds of change that had the potential to spread across all groups. By contrast, two general types of cross-cutting contradictions arose when one group had a dominant, confirming voice or two or more groups had contrasting perspectives. CONCLUSIONS While finding contradictions was expected, our analysis profiled their nature and some of the specific tensions they raised across and within stakeholder groups. The activity theory lens provided an accessible way to unravel curricular reform into manageable units of analysis. Systematically identifying contradictions arising from curricular reform will help stakeholders collaborate with a shared purpose toward positive, sustained change.
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Affiliation(s)
- Marcus Law
- Department of Family and Community Medicine, and MD program, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paula Veinot
- Independent Research Consultant, Halifax, Nova Scotia, Canada
| | - Maria Mylopoulos
- Temerty Faculty of Medicine and Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Pier Bryden
- Department of Psychiatry, and Clinical Affairs and Professional Values, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Brydges
- Technology-Enabled Education, St. Michael's Hospital, Unity Health Toronto, and Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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James HK, Fawdington RA. Freestyle Deliberate Practice Cadaveric Hand Surgery Simulation Training for Orthopedic Residents: Cohort Study. JMIR MEDICAL EDUCATION 2022; 8:e34791. [PMID: 35767315 PMCID: PMC9280454 DOI: 10.2196/34791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cadaveric simulation training may be part of the solution to reduced quantity and quality of operative surgical training in the modern climate. Cadaveric simulation allows the early part of the surgical learning curve to be moved away from patients into the laboratory, and there is a growing body of evidence that it may be an effective adjunct to traditional methods for training surgical residents. It is typically resource constrained as cadaveric material and facilities are expensive. Therefore, there is a need to be sure that any given cadaveric training intervention is maximally impactful. Deliberate practice (DP) theory as applied to cadaveric simulation training might enhance the educational impact. OBJECTIVE The objectives of this study were (1) to assess the impact of a freestyle DP cadaveric hand surgery simulation training intervention on self-reported operative confidence for 3 different procedures and (2) to assess the subjective transfer validity, perceived educational value, and simulation fidelity of the training. METHODS This study used validated questionnaires to assess the training impact on a cohort of orthopedic residents. The freestyle course structure allowed the residents to prospectively define personalized learning objectives, which were then addressed through DP. The study was conducted at Keele Anatomy and Surgical Training Centre, a medical school with an integrated cadaveric training laboratory in England, United Kingdom. A total of 22 orthopedic surgery residents of postgraduate year (PGY) 5-10 from 3 regional surgical training programs participated in this study. RESULTS The most junior (PGY 5-6) residents had the greatest self-reported confidence gains after training for the 3 procedures (distal radius open reduction internal fixation, flexor tendon repair, ulnar shortening osteotomy), and these gains diminished with resident seniority. The confidence gains were proportional to the perceived procedural complexity, with the most complex procedure having the lowest pretraining confidence score across all experience levels, and the greatest confidence increase in posttraining. Midstage (PGY 7-8) residents reported receiving the highest level of educational benefit from the training but perceived the simulation to be less realistic, compared to either the junior or senior residents. The most senior residents (PGY 9-10) reported the greatest satisfaction with the self-directed, freestyle nature of the training. All groups reported that they were extremely likely to transfer their technical skill gains to their workplace, that they would change their current practice based on these skills, and that their patients would benefit as a result of their having undertaken the training. CONCLUSIONS Freestyle, resident-directed cadaveric simulation provides optimum DP conditions whereby residents can target their individualized learning needs. By receiving intensive, directed feedback from faculty, they can make rapid skill gains in a short amount of time. Subjective transfer validity potential from the training was very high, and objective, quantitative evidence of this is required from future work.
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Affiliation(s)
- Hannah K James
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Ross A Fawdington
- Department of Trauma and Orthopaedics, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Walker KG, Shah AP, Brennan PM, Blackhall VI, Nicol LG, Yalamarthi S, Vella M, Cleland J. Scotland's "Incentivised Laparoscopy Practice" programme: Engaging trainees with take-home laparoscopy simulation. Surgeon 2022; 21:190-197. [PMID: 35739002 DOI: 10.1016/j.surge.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The transfer validity of portable laparoscopy simulation is well established. However, attempts to integrate take-home simulation into surgical training have met with inconsistent engagement worldwide, as for example in our 2014-15 study of an Incentivised Laparoscopy Practice programme (ILPv1). Drawing on learning from our subsequent multi-centre study examining barriers and facilitators, we revised the programme for 2018 onwards. We now report on engagement with the 2018-2022 versions of this home-based simulation programme (ILP v2.1-2.3). METHODS In ILP v2.1-2.3, three consecutive year-groups of new-start Core Surgical Trainees (n = 48, 46 and 53) were loaned portable simulators. The 6-month education programme included induction, technical support, and intermittent feedback. Six tasks were prescribed, with video instruction and charting of metric scores. Video uploads were required and scored by faculty. A pass resulted in an eCertificate, expected at Annual Review (but not mandatory for progression). ILP was set within a wider reform, "Improving Surgical Training". RESULTS ILP v2.1-2.3 saw pass rates of 94%, 76% and 70% respectively (45/48, 35/46 and 37/53 trainees), compared with only 26% (7/27) in ILP v1, despite now including some trainees not intending careers in laparoscopic specialties. The ILP v2.2 group all reported their engagement with the whole simulation strategy was hampered by the COVID19 pandemic. CONCLUSIONS Simply providing take-home simulators, no matter how good, is not enough. To achieve trainee engagement, a whole programme is required, with motivated learners, individual and group practice, intermittent feedback, and clear goals and assessments. ILP is a complex intervention, best understood as a "reform within a reform, within a context."
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Affiliation(s)
- Kenneth G Walker
- Scottish Surgical Simulation Collaborative, Royal College of Surgeons of Edinburgh and Royal College of Physicians and Surgeons of Glasgow, Scotland, UK; NHS Education for Scotland, Edinburgh, Scotland, UK; Raigmore Hospital (NHS Highland) and Centre for Health Science, Inverness, Scotland, UK.
| | - Adarsh P Shah
- Scottish Surgical Simulation Collaborative, Royal College of Surgeons of Edinburgh and Royal College of Physicians and Surgeons of Glasgow, Scotland, UK; Centre for Healthcare Education Research and Innovation, University of Aberdeen, Scotland, UK
| | - Paul M Brennan
- Centre for Clinical Brain Sciences, University of Edinburgh, Scotland, UK
| | - Vivienne I Blackhall
- Scottish Surgical Simulation Collaborative, Royal College of Surgeons of Edinburgh and Royal College of Physicians and Surgeons of Glasgow, Scotland, UK; Centre for Healthcare Education Research and Innovation, University of Aberdeen, Scotland, UK; Queen Elizabeth University Hospital (NHS Greater Glasgow & Clyde), Glasgow, Scotland, UK
| | - Laura G Nicol
- Scottish Surgical Simulation Collaborative, Royal College of Surgeons of Edinburgh and Royal College of Physicians and Surgeons of Glasgow, Scotland, UK; Dr Gray's Hospital Elgin (NHS Grampian), Scotland, UK
| | - Satheesh Yalamarthi
- Scottish Surgical Simulation Collaborative, Royal College of Surgeons of Edinburgh and Royal College of Physicians and Surgeons of Glasgow, Scotland, UK; NHS Education for Scotland, Edinburgh, Scotland, UK; Victoria Hospital (NHS Fife), Kirkaldy, Scotland, UK
| | - Mark Vella
- Scottish Surgical Simulation Collaborative, Royal College of Surgeons of Edinburgh and Royal College of Physicians and Surgeons of Glasgow, Scotland, UK; NHS Education for Scotland, Edinburgh, Scotland, UK; Royal Alexandra Hospital (NHS Greater Glasgow & Clyde), Paisley, Scotland, UK
| | - Jennifer Cleland
- Scottish Surgical Simulation Collaborative, Royal College of Surgeons of Edinburgh and Royal College of Physicians and Surgeons of Glasgow, Scotland, UK; Centre for Healthcare Education Research and Innovation, University of Aberdeen, Scotland, UK; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Bondzi-Simpson A, Lindo CJ, Hoy M, Lui JT. The Otolaryngology boot camp: a scoping review evaluating commonalities and appraisal for curriculum design and delivery. J Otolaryngol Head Neck Surg 2022; 51:23. [PMID: 35659365 PMCID: PMC9167522 DOI: 10.1186/s40463-022-00583-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Surgical boot camps are becoming increasingly popular in Otolaryngology-Head and Neck Surgery (OHNS) residency programs. Despite pioneering virtual reality and simulation-based surgical education, these boot camps have lacked critical appraisal. The objective of this article was to examine the adoption and utility of surgical boot camps in OHNS residency training programs around the world. DATA SOURCES Ovid Medline and PubMed databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews. Additionally, a grey literature search was performed. REVIEW METHODS Inclusion criteria were peer-reviewed publications and grey literature sources that reported on OHNS boot camps for the novice learner. The search was restricted to human studies published in English. Studies were excluded if they were not examining junior trainees. RESULTS A total of 551 articles were identified. Following removal of duplicates, screening, and full text review, 16 articles were included for analysis. Seven major boot camps were identified across various academic sites in the world. Most boot camps were one-day intensive camps incorporating a mixture of didactic, skill specific, and simulation sessions using an array of task trainers and high-fidelity simulators focusing on OHNS emergencies. Studies measuring trainee outcomes demonstrated improvement in trainee confidence, immediate knowledge, and skill acquisition. CONCLUSION Surgical boot camps appear to be an effective tool for short term knowledge and skill acquisition. Further studies should examine retention of skill and maintenance of confidence over longer intervals, as little is known about these lasting effects.
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Affiliation(s)
- Adom Bondzi-Simpson
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - C J Lindo
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Monica Hoy
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Justin T Lui
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.
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A systematic review of methodological principles and delivery of surgical simulation bootcamps. Am J Surg 2021; 223:1079-1087. [PMID: 34865734 DOI: 10.1016/j.amjsurg.2021.10.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/27/2021] [Accepted: 10/31/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The growth of "bootcamp style" simulation training in surgical practice has been exponential over the last decade. Developing and delivering a surgical bootcamp requires a significant investment. This systematic review aims to identify the key components that allow for a successful and rewarding surgical bootcamp course to be implemented that can be applied to all surgical specialities. METHODS To understand the surgical bootcamp principles and delivery mechanisms, we searched peer-reviewed, English language studies published between 2000 and 21. RESULTS From 137 articles, 14 studies with a Medical Education Research Quality Instrument Score of >11.5 were included. Most studies followed the core components; delivery at transition (12), mapping syllabus (13), multimodality delivery (14), and deliberate practice with formative feedback (12) apart from 1:1 training by only 2 studies. CONCLUSIONS Our review suggests that Surgical bootcamp can be an extremely useful education tool for trainees if 5 pillars of a boot camp are respected.
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Cleland J, MacLeod A, Ellaway RH. The curious case of case study research. MEDICAL EDUCATION 2021; 55:1131-1141. [PMID: 33905143 DOI: 10.1111/medu.14544] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/24/2021] [Accepted: 04/21/2021] [Indexed: 06/12/2023]
Abstract
The conceptualisation of 'good' medical education research as hypothesis testing to identify universal truths that are generalisable across contexts has been challenged. Joining this conversation, the field of health professions education research is complex and contextual and there are ways of examining and reporting locally based activities and innovations, which can be of general value. This position leads to a focus on case study research (CSR), inquiry bound in time and place that generates thick descriptions and close interpretations to reach explanations. CSR has grown in sophistication in recent years and can inform practice and advance the science of medical and health professions education. The authors evaluated the current state of the science of CSR in the medical education literature by identifying and reviewing 160 papers. Most articles presented as 'case studies' were not in fact CSR. Moreover, most articles failed to go beyond a 'we did this' account. The authors explore definitions of CSR, and they examine dominant CSR methodologists, Yin, Stake and Merriam, and their respective approaches to CSR. They then set out some of the basic tenets of CSR (case definition, methods of data collection and analysis) and consider the logics of CSR (its structures, purposes, assumptions and symbols). CSR challenges are considered next (such as emic and etic perspectives; ethical complexities; generalisability; quality; and reporting and reflexivity). The authors conclude that context is a mechanism, which needs to be understood, and rigorous CSR provides the structures and criticality to do so, opening up new areas of understanding and inquiry.
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Affiliation(s)
- Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University Ringgold Standard Institution, Singapore City, Singapore
| | - Anna MacLeod
- Division of Medical Education, Clinical Research Centre, Dalhousie University, Halifax, NS, Canada
| | - Rachel Helen Ellaway
- Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
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Qureshi SP. Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:923-935. [PMID: 34456600 PMCID: PMC8390886 DOI: 10.2147/amep.s313250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/28/2021] [Indexed: 06/13/2023]
Abstract
Cultural historical activity theory (CHAT) is a social theory which is useful as a methodological framework for the vital task of studying practice-based learning in complex learning environments. CHAT is an apparatus considering learning as occurring through practice, through collective activity, and mediated by culturally specific instruments. Because CHAT is increasingly drawn upon in medical education academia, it is necessary for medical educationalists to be familiar with this theory. This methodology article explains how CHAT theorizes learning in dynamic workplaces within an activity system comprising multiple practitioners engaged in activity, which is collaborative, multi-voiced, and bounded by a shared intended object. It provides an accessible overview of the central concepts within CHAT and a description of a methodological strategy (activity system analysis) to incorporate CHAT into one's own work. CHAT also theorizes where tensions lie within and between activity systems, causing difficulties in achieving the intended object, defining such tensions as contradictions. It is through the overcoming of past contradictions that activity has come to exist in its current form, abiding by social norms of the present time, and CHAT allows consideration of how practice within a system may be changed through resolution of contradictions. For example, the Change Laboratory is a contrived intervention where practitioners consciously contribute to developing and embedding new, improved ways of practicing using CHAT principles. This allows practitioners to have agency in improving their own areas of learning and practice. Throughout this article, examples are provided of how CHAT has been usefully applied to various aspects of medical education research, including undergraduate education, postgraduate education, and continuous professional development. By building on the introduction to CHAT provided in this article, the reader can start to use CHAT methodologically to describe complexity, identify practice-based contradictions, and develop improved forms of practice-based learning, in his/her own context.
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Affiliation(s)
- Shaun Peter Qureshi
- Palliative Medicine, NHS Greater Glasgow and Clyde, Glasgow, UK
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
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Lee-Riddle GS, Sigmon DF, Newton AD, Kelz RR, Dumon KR, Morris JB. Surgical Boot Camps Increases Confidence for Residents Transitioning to Senior Responsibilities. JOURNAL OF SURGICAL EDUCATION 2021; 78:987-990. [PMID: 32928699 DOI: 10.1016/j.jsurg.2020.08.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Surgical boot camps enhance the confidence of medical students and surgical interns. The impact of boot camps on the confidence of post-graduate year (PGY) 2 residents is unknown. We hypothesized that a postinternship boot camp would improve the confidence of PGY-2 residents in managing their newfound responsibilities. We also hypothesized that the effect of a tailored high-impact boot camp would persist over time. DESIGN A 2-hour boot camp at our simulation center was implemented for PGY-2 residents in 2016 and 2017. Confidence in handling boot camp scenarios was measured on a 1 to 5 Likert scale before and after the boot camp. Three-month follow-up was assessed in the 2017 cohort. PARTICIPANTS Thirty-one PGY-2 residents (n = 16 in 2016, n = 15 in 2017) completed the boot camp. RESULTS Residents reported increased confidence in placing central lines (p < 0.001), placing chest tubes (p = 0.01), managing emergency airways (p < 0.001), running a code (p = 0.03), and fulfilling the role of in-house senior resident (p < 0.001). Three-month follow-up in 2017 (n = 10) demonstrated no difference in confidence compared to postboot camp results. CONCLUSIONS Boot camps can durably improve confidence in skills expected of PGY-2 residents assuming in-house senior resident responsibilities.
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Affiliation(s)
- Grace S Lee-Riddle
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David F Sigmon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew D Newton
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jon B Morris
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Shah AP, Falconer R, Watson AJM, Walker KG. Teaching Surgical Residents in the COVID-19 Era: The Value of a Simulation Strategy. JOURNAL OF SURGICAL EDUCATION 2021; 78:751-752. [PMID: 32933884 PMCID: PMC7466943 DOI: 10.1016/j.jsurg.2020.08.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Adarsh P Shah
- Centre for Healthcare Education Research and Innovation, University of Aberdeen, Aberdeen, Scotland, United Kingdom.
| | - Rachel Falconer
- Highland Medical Education Centre, Centre for Health Science, Raigmore Hospital, Inverness, Scotland, United Kingdom
| | - Angus J M Watson
- Highland Medical Education Centre, Centre for Health Science, Raigmore Hospital, Inverness, Scotland, United Kingdom
| | - Kenneth G Walker
- Highland Medical Education Centre, Centre for Health Science, Raigmore Hospital, Inverness, Scotland, United Kingdom; NHS Education for Scotland, Edinburgh, Scotland, United Kingdom
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Goldman J, Kuper A, Baker GR, Bulmer B, Coffey M, Jeffs L, Shea C, Whitehead C, Shojania KG, Wong B. Experiential Learning in Project-Based Quality Improvement Education: Questioning Assumptions and Identifying Future Directions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1745-1754. [PMID: 32079957 DOI: 10.1097/acm.0000000000003203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Project-based experiential learning is a defining element of quality improvement (QI) education despite ongoing challenges and uncertainties. The authors examined stakeholders' perceptions and experiences of QI project-based learning to increase understanding of factors that influence learning and project experiences. METHOD The authors used a case study approach to examine QI project-based learning in 3 advanced longitudinal QI programs, 2 at the University of Toronto and 1 at an academic tertiary-care hospital. From March 2016 to June 2017, they undertook 135 hours of education program observation and 58 interviews with learners, program directors, project coaches, and institutional leaders and reviewed relevant documents. They analyzed data using a conventional and directed data analysis approach. RESULTS The findings provide insight into 5 key factors that influenced participants' project-based learning experiences and outcomes: (1) variable emphasis on learning versus project objectives and resulting benefits, tensions, and consequences; (2) challenges integrating the QI project into the curriculum timeline; (3) project coaching factors (e.g., ability, capacity, role clarity); (4) participants' differing access to resources and ability to direct a QI project given their professional roles; and (5) workplace environment influence on project success. CONCLUSIONS The findings contribute to an empirical basis toward more effective experiential learning in QI by identifying factors to target and optimize. Expanding conceptualizations of project-based learning for QI education beyond learner-initiated, time-bound projects, which are at the core of many QI educational initiatives, may be necessary to improve learning and project outcomes.
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Affiliation(s)
- Joanne Goldman
- J. Goldman is assistant professor, Department of Medicine, scientist, Centre for Quality Improvement and Patient Safety, and cross-appointed researcher, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-1589-4070
| | - Ayelet Kuper
- A. Kuper is associate professor, Department of Medicine, scientist and associate director, Wilson Centre for Research in Education, University Health Network, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - G Ross Baker
- G.R. Baker is professor and program lead, Quality Improvement and Patient Safety, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Beverly Bulmer
- B. Bulmer is vice president, Education, St. Michael's Hospital, Unity Health Toronto, and lecturer, Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maitreya Coffey
- M. Coffey is associate professor, Department of Paediatrics, University of Toronto, medical officer for patient safety, Hospital for Sick Children, Toronto, Ontario, Canada, and associate clinical director, Children's Hospitals Solutions for Patient Safety, Cincinnati, Ohio
| | - Lianne Jeffs
- L. Jeffs is research and innovation lead scholar in residence and senior clinician scientist, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, associate professor, Lawrence S. Bloomberg Faculty of Nursing, Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, and affiliate scientist, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Christine Shea
- C. Shea is program director and lecturer, Quality Improvement and Patient Safety, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Whitehead
- C. Whitehead is professor, Department of Family and Community Medicine, director and scientist, Wilson Centre for Research in Education, University Health Network, University of Toronto, and vice president of education, Women's College Hospital, Toronto, Ontario, Canada
| | - Kaveh G Shojania
- K.G. Shojania is professor and vice chair, Department of Medicine, Faculty of Medicine, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-9942-0130
| | - Brian Wong
- B. Wong is associate professor, Department of Medicine, University of Toronto, director, Centre for Quality Improvement and Patient Safety, Faculty of Medicine, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Inequality in Training: Bridging the Gap. Indian J Orthop 2020; 54:537-538. [PMID: 32836365 PMCID: PMC7394045 DOI: 10.1007/s43465-020-00204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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James HK, Pattison GTR, Griffin DR, Fisher JD. How Does Cadaveric Simulation Influence Learning in Orthopedic Residents? JOURNAL OF SURGICAL EDUCATION 2020; 77:671-682. [PMID: 32147464 DOI: 10.1016/j.jsurg.2019.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/07/2019] [Accepted: 12/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The objectives of this study were to understand how cadaveric simulation impacts learning in orthopedic residents, why it is a useful training tool, and how skills learnt in the simulated environment translate into the workplace. DESIGN This is a qualitative research study using in-depth, semistructured interviews with orthopedic residents who underwent an intensive cadaveric simulation training course. SETTING The study was conducted at the University Hospital Coventry & Warwickshire, a tertiary care center with integrated cadaveric training laboratory in England, United Kingdom. PARTICIPANTS Orthopedic surgery residents in the intervention group of a randomized controlled trial comparing intensive cadaveric simulation training with standard "on the job" training were invited to participate. Eleven of 14 eligible residents were interviewed (PGY 3-6, 8 male and 3 female). RESULTS Learning from cadaveric simulation can be broadly categorized into intrinsic, surgeon-driven factors, and extrinsic environmental factors. Intrinsic factors include participant ability to "buy-in" to the simulation exercise, willingness to push one's own learning boundaries in a "safe space" and take out on resident experience and self-reported confidence, with the greatest learning gains seen at around the PGY4 stage in individuals who reported low preintervention operative confidence. Extrinsic factors included; the opportunity to perform operations in their entirety without external pressures or attending "take-over," leading to subjective improvement in participant operative fluency and confidence. The intensive supervision of subspecialist attending surgeons giving real-time performance feedback, tips and tricks, and the opportunity to practice unusual approaches was highly valued by participants, as was paired learning with alternating roles as primary surgeon/assistant and multidisciplinary involvement of scrub-staff and radiographers. Cadaveric simulation added educational value beyond that obtained in low-fidelity simulation training by "stirring into practice" and "becoming through doing." In providing ultrarealistic representation of the space, ritualism, and costuming of the operating theater, cadaveric simulation training also enabled the development of a range of nontechnical skills and sociocultural "nontechnical" lessons of surgery. CONCLUSIONS Cadaveric simulation enhances learning in both technical and nontechnical skills in junior orthopedic residents within a single training package. Direct transfer of skills learnt in the simulation training to the real-world operating theater, with consequent patient benefit, was reported. Cadaveric simulation in the UK training system of orthopedics may be of greatest utility at around the PGY 4 stage, at which point operative fluency, independence, and confidence can be rapidly improved in the cadaveric laboratory, to enable the attainment of competence in index trauma operations.
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Affiliation(s)
- Hannah K James
- Clinical Trials Unit, Warwick Medical School, Coventry, United Kingdom; Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom.
| | - Giles T R Pattison
- Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Damian R Griffin
- Clinical Trials Unit, Warwick Medical School, Coventry, United Kingdom; Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Joanne D Fisher
- Clinical Trials Unit, Warwick Medical School, Coventry, United Kingdom
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Walker KG, Blackhall VI, Hogg ME, Watson AJM. Eight Years of Scottish Surgical Boot Camps: How We Do It Now. JOURNAL OF SURGICAL EDUCATION 2020; 77:235-241. [PMID: 31889694 DOI: 10.1016/j.jsurg.2019.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/16/2019] [Accepted: 11/03/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Scottish Surgical Boot Camps are the induction course for new start Core Surgical Trainees (Residents) in Scotland. The aim is to capitalise on trainees' receptiveness at a time of transition, and to give them a safe and "flying start." At their inception, these were the first such courses in the UK to integrate technical and non-technical skills training. As well as knowledge and skills, trainees have learned norms and expectations of a community of professional practice. METHODS Over 9 consecutive years of delivery and quality improvement, faculty have learned much about the safe use of simulation, as an adjuvant training modality for a range of competences required in the operating room, the clinic/office, the wards and other clinical domains. CONCLUSION In this paper we describe the development and content of the course, discuss the importance of the whole "activity system," and present some evaluation data. We give tips for success, such as using simulations of escalating complexity, and the power of seemingly incidental Learning Outcomes.
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Affiliation(s)
- Kenneth G Walker
- Highland Medical Education Centre, Centre for Health Science, Raigmore Hospital, Inverness, Scotland, United Kingdom.
| | - Vivienne I Blackhall
- Highland Medical Education Centre, Centre for Health Science, Raigmore Hospital, Inverness, Scotland, United Kingdom
| | - Morag E Hogg
- Highland Medical Education Centre, Centre for Health Science, Raigmore Hospital, Inverness, Scotland, United Kingdom
| | - Angus J M Watson
- Highland Medical Education Centre, Centre for Health Science, Raigmore Hospital, Inverness, Scotland, United Kingdom
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Duffy CC, Nawoor-Quinn Z, Burlacu CL. "Rapid sequence induction"-an anaesthesiology boot camp. Ir J Med Sci 2019; 189:1047-1051. [PMID: 31828507 DOI: 10.1007/s11845-019-02146-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/15/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The novice anaesthesiology trainee must rapidly assimilate the cognitive, technical and non-technical skills necessary to competently respond to critical events in their new role. Providing trainees with the safe and controlled environment of high-fidelity patient simulation is one method to compensate for gaps in trainee experience, offering the potential for effective training. An anaesthesiology boot camp was set up to increase the knowledge, clinical, technical and non-technical competencies of the novice trainee, creating a framework for their future learning and practice. Anaesthetic nurses also attended to incorporated teamwork and collaboration into the boot camp. METHODS Seven novice anaesthesiology trainees and 3 anaesthetic nurses attended 3 4-h boot camp sessions. The boot camp consisted of the following: (1) interactive didactic lectures; (2) task-trainer technical skills teaching; and, (3) high-fidelity simulations. Pre- and post-course evaluation forms including a multiple-choice-questions (MCQ) assessing knowledge were completed. RESULTS Nine participants fully completed the boot camp. There was a significant increase in post-MCQ score (p = 0.001). Feedback from participants included "well organised", "helpful" and "structured approach" with all participants agreeing or strongly agreeing that it was relevant training for their practice. DISCUSSION We have created the first Irish anaesthesiology boot camp, demonstrating the important role that simulation has in enhancing medical education. Our results showed both knowledge attainment and participant satisfaction in this method of learning. Anaesthesiology boot camps are the ideal method to provide novice trainees with a framework for their initial introduction into anaesthesia.
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Affiliation(s)
- Caoimhe C Duffy
- Department of Anaesthesiology, Intensive Care and Pain Medicine, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland.
- College of Anaesthesiologists Simulation Training Programme (CAST), College of Anaesthesiology of Ireland, Merrion Square North, Dublin 2, Ireland.
| | - Zeenat Nawoor-Quinn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland
- College of Anaesthesiologists Simulation Training Programme (CAST), College of Anaesthesiology of Ireland, Merrion Square North, Dublin 2, Ireland
| | - Crina L Burlacu
- Department of Anaesthesiology, Intensive Care and Pain Medicine, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland
- College of Anaesthesiologists Simulation Training Programme (CAST), College of Anaesthesiology of Ireland, Merrion Square North, Dublin 2, Ireland
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Nakazato T, Callahan Z, Kuchta K, Linn JG, Joehl RJ, Ujiki MB. A 1-day simulation-based boot camp for incoming general surgery residents improves confidence and technical skills. Surgery 2019; 166:572-579. [DOI: 10.1016/j.surg.2019.05.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/19/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
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Abstract
Burnout is a widespread problem in health care. Factors that contribute to enhancing engagement and building resiliency are widely discussed, but the data supporting these practices are not well understood. Interventions aimed at increasing engagement and promoting resiliency are targeted toward individual practitioners, health care institutions, and national organizations. Knowledge of the data supporting various kinds of interventions is vital to implementing change meaningfully. Prevention of burnout should start early in training with appropriate modeling and input from mentors and should incorporate stress management strategies. The most compelling data for building resilience requires institutions, physicians, and their support staff to align their values to create a mutual culture of wellness and engagement. It is imperative that institutional and national reform allows us as physicians to preserve our relationships with patients and colleagues, while also prioritizing time to reflect and pursue outside interests that recharge and restore.
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Affiliation(s)
- Najjia N Mahmoud
- Division of Colon and Rectal Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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Aitken G, Jones D, Fawns T, Sutherland D, Henderson S. Using Bourdieu to explore graduate attributes in two online Master's programmes. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:559-576. [PMID: 30915641 PMCID: PMC6647485 DOI: 10.1007/s10459-019-09885-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 03/16/2019] [Indexed: 05/25/2023]
Abstract
Within the expansion of postgraduate educational qualifications for health professionals, graduate attributes have become important markers of outcomes and value. However, it is not clear how or when graduate attributes develop, or how they are applied in professional practice after graduation. We interviewed 17 graduates from two online Master's programmes to explore their perceptions of how postgraduate study had influenced their practice and professional identity. Our thematic analysis produced three main themes (academic voice, infectious curiosity, and expanding worldview) which reflected changes in the participants' confidence, attitude, perspective, and agency across professional and academic settings. We then conducted a secondary phase of analysis using Bourdieu's concepts of 'field', 'capital', and 'habitus'. While graduate attributes have been conceptualised as the context-independent acquisition of traits that can be employed by individuals, Bourdieu's framework highlights their relational qualities: they are caught up in the cultural history and context of the student/professional, the reputation of the awarding institution, and the graduate's location within a network of professional peers.
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Affiliation(s)
- Gillian Aitken
- Edinburgh Medical School, Chancellor's Building, Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Derek Jones
- Edinburgh Medical School, Chancellor's Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Tim Fawns
- Edinburgh Medical School, Chancellor's Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Douglas Sutherland
- Edinburgh Medical School, Chancellor's Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Sarah Henderson
- Edinburgh Medical School, Chancellor's Building, Little France Crescent, Edinburgh, EH16 4SB, UK
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Bearman M, Greenhill J, Nestel D. The power of simulation: a large-scale narrative analysis of learners' experiences. MEDICAL EDUCATION 2019; 53:369-379. [PMID: 30334299 PMCID: PMC6518920 DOI: 10.1111/medu.13747] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/23/2018] [Accepted: 09/07/2018] [Indexed: 05/28/2023]
Abstract
CONTEXT Simulation-based education (SBE) includes a broad spectrum of simulation activities, which are individually well researched. An extensive literature reports on SBE methods, topics and modalities, but there are limited studies investigating how simulation as a holistic phenomenon promotes learning. This study seeks to identify the ways in which health professionals narrate powerful SBE experiences and through this to understand in what ways SBE may influence learning. METHODS Three hundred and twenty-seven narratives about powerful learning through SBE were gathered from participants' online reflections from a national faculty development programme in SBE. Narrative and thematic analyses were conducted on included texts, using 'transformative learning theory' as a sensitising notion. RESULTS Narratives were categorised into the following categories: progress (267/327 = 81%); transformation (25/327 = 8%); practice (27/328 = 8%); and humiliation (8/327 = 2%). Recurrent features across narrative categories were as follows: early experiences in training; dramatic scenarios; developing appreciation of SBE; highly emotional experiences; things that 'went wrong'; and ongoing reflection. Themes regarding mechanisms that supported learning were as follows: verisimilitude; feedback, debriefing and facilitation; observation of self and others; repetition of activities; and role-playing the patient. CONCLUSIONS The results generally support the notion that SBE is experienced as a holistic phenomenon, rather than separate modalities. The narrative categories, recurrent features and learning themes tended to work across all simulation modalities, with the exception of 'being in the patient's shoes' being supported by role-play in particular. Although powerful experiences were not necessarily transformative ones, they often occurred at formative stages of training. There was a strong sense that things going wrong in simulation scenarios (and the associated emotions and reflection) were a key part of learning. This underlines SBE's potential role in helping learners see fallibility as part of professional practice.
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Affiliation(s)
- Margaret Bearman
- Centre for Research in Assessment and Digital LearningDeakin UniversityGeelongVictoriaAustralia
| | - Jennene Greenhill
- Rural Clinical SchoolFlinders UniversityRenmarkSouth AustraliaAustralia
| | - Debra Nestel
- Monash Institute for Health and Clinical EducationMonash UniversityClaytonVictoriaAustralia
- Department of Surgery (Austin)University of MelbourneHeidelbergVictoriaAustralia
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Pete Devon E, Tenney-Soeiro R, Ronan J, Balmer DF. A Pediatric Preintern Boot Camp: Program Development and Evaluation Informed by a Conceptual Framework. Acad Pediatr 2019; 19:165-169. [PMID: 30121317 DOI: 10.1016/j.acap.2018.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/05/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Boot camps are being developed and implemented by a growing number of medical schools to facilitate medical students' transition to internship. However, there is limited conceptual understanding of how this facilitation occurs. METHODS We developed and piloted a 1-week pediatric boot camp in 2015, then significantly revised and evaluated the program in 2016-2017 using a conceptual framework of self-efficacy. Consistent with this framework, the revised boot camp focuses on enhancing practical skills that can ease medical students' transition to internship. Observations and course evaluations informed process evaluation, whereas learner assessments immediately after and at 6 months after the boot camp informed outcomes evaluation in terms of both perceived self-efficacy and confidence. RESULTS Medical students valued sessions that were "hands on," and program improvements were made to include a variety of interactive curricular activities. Data from course evaluations provided evidence of increased perceived self-efficacy. Learner assessment showed a medium to large effect size for confidence in nearly all specific skills that were queried and a positive, albeit attenuated, effect on perceived self-efficacy at 6 months. CONCLUSIONS Program evaluation of a pediatric boot camp informed by a conceptual framework of self-efficacy shed light on how it might facilitate medical students' transition to internship. A similar conceptual framework may be useful for other trainee preparatory courses.
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Affiliation(s)
- Erin Pete Devon
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Rebecca Tenney-Soeiro
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Jeanine Ronan
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Dorene F Balmer
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pa
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Cleland J, Durning SJ. Education and service: how theories can help in understanding tensions. MEDICAL EDUCATION 2019; 53:42-55. [PMID: 30357894 DOI: 10.1111/medu.13738] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/09/2018] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This paper reviews why tensions between service and education persist and highlights that this is an area of medical education research (MER) that, to date, lacks a robust body of theory-driven research. After carrying out a review of the literature on service-education tensions in medical education and training, we turn to consider how theory can help provide new insights into service-education tensions. METHODS We conducted a search of the literature on service-education tensions since 1998 to examine the use of theory in studies on this topic. RESULTS We identified 44 out of 603 relevant papers. Their focus fell into four broad categories: time residents spent on 'service' and 'education'; perceptions of the balance between service and education; considerations of how best to define service and education, and the impact of structural and systems changes on education/training. Of the papers reporting primary research, the dominant methodology was the bespoke survey. Rarely were the precise natures of tensions or how different factors interact to cause tensions examined in detail. DISCUSSION Through discussion and reflection, we then agreed on the applicability of four sociocultural theories for illuminating some examples of service-education tensions. We present four sociocultural theories: Holland's figured worlds, Kemmis et al.'s practice architectures, Lave and Wenger's situated learning and Engeström's cultural-historical activity theory (CHAT or AT). We describe each and then briefly illustrate how each theory can support new ways of thinking and potential directions for research focusing on education-service tensions. CONCLUSIONS The use of theory in research studies will not resolve service-education tensions. However, what theory can do is illuminate and magnify different aspects of service-education tensions, to generate new insight and knowledge that can then be used to inform future research and changes in practice.
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Affiliation(s)
- Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Dentistry and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Steven J Durning
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Jensen RD, Seyer-Hansen M, Cristancho SM, Christensen MK. Being a surgeon or doing surgery? A qualitative study of learning in the operating room. MEDICAL EDUCATION 2018; 52:861-876. [PMID: 29992693 DOI: 10.1111/medu.13619] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/12/2017] [Accepted: 04/05/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT A key concern for surgical educators is to prepare students to perform in the operating room while ensuring patient safety. Recent years have seen a renewed discussion of medical education through practice theoretical and sociomaterial lenses. These lenses are introduced to understand and prepare the learner to perform in the given context. This paper takes its point of departure from practice theory by introducing a lens through which to understand learning environments in surgery. METHODS Using a multi-site ethnographic and practice-based design, this study investigates how aspiring surgical students are stirred into surgical practices and learn to engage as surgeons. During 70 hours of observations of medical students' participation in the operating room, we analysed how the phenomenon of surgical learning can be perceived as instances of transformation in and among social practices. RESULTS By applying an analytical perspective, this article highlights the use of practice theory in surgical education, which can help to establish a firmer understanding of the learning environment and thereby help educators to improve curricula and prepare students more effectively to enter surgical training. CONCLUSIONS The use of a practice theory adds the perspective that the education of surgeons needs to take the sayings, doings and relatings that constitute a surgical practice into account when preparing students to perform in their future workplace. In this way, surgical training can be perceived as a process of being stirred into practice. This means that one learns by participating in the practice of providing high-quality care, where the aim is to teach students to be surgeons instead of teaching them to perform surgery.
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Affiliation(s)
- Rune Dall Jensen
- Centre for Health Sciences Education, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Mikkel Seyer-Hansen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Demark
| | - Sayra M Cristancho
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Affiliation(s)
- Jennifer Cleland
- Centre for Healthcare Education Research and Innovation, Institute of Education for Medical and Dental Sciences, School of Medicine, Dentistry and Nutrition, University of Aberdeen, Aberdeen, UK.
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Kenny L, Booth K, Freystaetter K, Wood G, Reynolds G, Rathinam S, Moorjani N. Training cardiothoracic surgeons of the future: The UK experience. J Thorac Cardiovasc Surg 2018; 155:2526-2538.e2. [DOI: 10.1016/j.jtcvs.2018.01.088] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 01/15/2018] [Accepted: 01/26/2018] [Indexed: 12/11/2022]
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Cleland J, Roberts R, Kitto S, Strand P, Johnston P. Using paradox theory to understand responses to tensions between service and training in general surgery. MEDICAL EDUCATION 2018; 52:288-301. [PMID: 29105861 DOI: 10.1111/medu.13475] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/26/2017] [Accepted: 09/06/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT The tension between service and training in pressured health care environments can have a detrimental impact on training quality and job satisfaction. Yet the management literature proposes that competing demands are inherent in organisational settings: it is not the demands as such that lead to negative outcomes but how people and organisations react to opposing tensions. We explored how key stakeholders responded to competing service-training demands in a surgical setting that had recently gone through a highly-publicised organisational crisis. METHODS This was an explanatory case study of a general surgery unit. Public documents informed the research questions and the data were triangulated with semi-structured interviews (n = 14) with key stakeholders. Data coding and analysis were initially inductive but, after the themes emerged, we used a paradox lens to group themes into four contextual dimensions: performing, organising, belonging and learning. RESULTS Tensions were apparent in the data, with managers, surgeons and trainees or residents in conflict with each other because of different goals or priorities and divergent perspectives on the same issue of balancing service and training (performing). This adversely impacted on relationships across and within groups (belonging, learning) and led to individuals prioritising their own goals rather than working for the 'greater good' (performing, belonging). Yet although relationships and communication improved, the approach to getting a better balance maintained the 'compartmentalisation' of training (organising) rather than acknowledging that training and service cannot be separated. DISCUSSION Stakeholder responses to the tensions provided temporary relief but were unlikely to lead to real change if the tension between service and training was considered to be an interdependent and persistent paradox. Reframing the service-training paradox in this way may encourage adjusting responses to create effective working partnerships. Our findings add to the body of knowledge on this topic, and will resonate with all those engaged in surgical and other postgraduate training.
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Affiliation(s)
- Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Dentistry and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Ruby Roberts
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Dentistry and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Simon Kitto
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
| | - Pia Strand
- The Faculty of Medicine Centre for Teaching and Learning, Lund University, Lund, Sweden
| | - Peter Johnston
- NHS Education for Scotland, Northern Deanery, Aberdeen, UK
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Teodorczuk A, Thomson R, Chan K, Rogers GD. When I say … resilience. MEDICAL EDUCATION 2017; 51:1206-1208. [PMID: 28744999 DOI: 10.1111/medu.13368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/07/2017] [Accepted: 05/04/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Andrew Teodorczuk
- School of Medicine, Griffith University, Southport, Queensland, Australia
- Health Institute for the Development of Education and Scholarship (Health IDEAS), Griffith University, Queensland, Australia
| | - Richard Thomson
- School of Medical Education, Newcastle University, Newcastle-upon-Tyne, UK
| | - Kwong Chan
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Gary D Rogers
- School of Medicine, Griffith University, Southport, Queensland, Australia
- Health Institute for the Development of Education and Scholarship (Health IDEAS), Griffith University, Queensland, Australia
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40
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Glasbey J, Sinclair P, Mohan H, Harries R. 40-4-40: educational and economic outcomes of a free, international surgical training event. Postgrad Med J 2017; 93:730-735. [PMID: 28701324 DOI: 10.1136/postgradmedj-2017-134874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/03/2017] [Accepted: 05/08/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE OF STUDY To demonstrate a model for delivery of an international surgical training event, and demonstrate its educational and economic outcomes. STUDY DESIGN The Association of Surgeons in Training (ASiT) ran a course series on 16 January 2016 across the UK and Ireland. A mandatory, self-reported, online questionnaire collected delegate feedback, using 5-point Likert Scales, and a NetPromoter feedback tool. Precourse and postcourse matched questionnaires were collected for 'Foundation Skills in Surgery' (FSS) courses. Paired economic analysis was performed. Statistical analysis was carried out using RStudio (V.3.1.1 Boston, Massachusetts, USA). RESULTS Forty courses were held across the UK and Ireland (65.0% technical, 35.0% non-technical), with 184 faculty members. Of 570 delegates, 529 fully completed the feedback survey (92.8% response rate); 56.5% were male. The median age was 26 years (range: 18-67 years). The mean overall course NetPromoter Score was 8.7 out of 10. On logistic regression high NetPromoter Score was associated with completing a Foundation Skills in Surgery course (R=0.44, OR: 1.49, p=0.025) and having clear learning outcomes (R=0.72, OR: 2.04, p=0.029) but not associated with specialty, course style or teaching style. For Foundation Skills in Surgery courses, delegates reported increased commitment to a career in surgery (p<0.001), confidence with basic surgical skills (p<0.001) and confidence with assisting in theatre (p<0.001). A comparable cost saving of £231,462.37 was calculated across the 40 courses. CONCLUSION The ASiT '40-4-40' event demonstrated the diversity and depth of surgical training, with 40 synchronous technical and non-technical courses, demonstrable educational benefit and a significant cost saving to surgical trainees.
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Affiliation(s)
- James Glasbey
- Association of Surgeons in Training, Royal College of Surgeons of England, London, UK
| | - Piriyah Sinclair
- Association of Surgeons in Training, Royal College of Surgeons of England, London, UK
| | - Helen Mohan
- Association of Surgeons in Training, Royal College of Surgeons of England, London, UK
| | - Rhiannon Harries
- Association of Surgeons in Training, Royal College of Surgeons of England, London, UK
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Cleland JA. The qualitative orientation in medical education research. KOREAN JOURNAL OF MEDICAL EDUCATION 2017; 29:61-71. [PMID: 28597869 PMCID: PMC5465434 DOI: 10.3946/kjme.2017.53] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 05/07/2017] [Accepted: 05/07/2017] [Indexed: 05/14/2023]
Abstract
Qualitative research is very important in educational research as it addresses the "how" and "why" research questions and enables deeper understanding of experiences, phenomena and context. Qualitative research allows you to ask questions that cannot be easily put into numbers to understand human experience. Getting at the everyday realities of some social phenomenon and studying important questions as they are really practiced helps extend knowledge and understanding. To do so, you need to understand the philosophical stance of qualitative research and work from this to develop the research question, study design, data collection methods and data analysis. In this article, I provide an overview of the assumptions underlying qualitative research and the role of the researcher in the qualitative process. I then go on to discuss the type of research objectives which are common in qualitative research, then introduce the main qualitative designs, data collection tools, and finally the basics of qualitative analysis. I introduce the criteria by which you can judge the quality of qualitative research. Many classic references are cited in this article, and I urge you to seek out some of these further reading to inform your qualitative research program.
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Affiliation(s)
- Jennifer Anne Cleland
- Corresponding Author: Jennifer Anne Cleland (http://orcid.org/0000-0003-1433-9323) Institute of Education in Medical and Dental Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25, 2ZD, UK Tel: +44.0.1224.437257
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42
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Lovell B. How to build a resilient surgeon: communities, cultures and complexity. MEDICAL EDUCATION 2016; 50:800-802. [PMID: 27402038 DOI: 10.1111/medu.13081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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43
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Cleland J, Patey R, Thomas I, Walker K, O’Connor P, Russ S. Supporting transitions in medical career pathways: the role of simulation-based education. Adv Simul (Lond) 2016; 1:14. [PMID: 29449983 PMCID: PMC5806248 DOI: 10.1186/s41077-016-0015-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/15/2016] [Indexed: 12/03/2022] Open
Abstract
Transitions, or periods of change, in medical career pathways can be challenging episodes, requiring the transitioning clinician to take on new roles and responsibilities, adapt to new cultural dynamics, change behaviour patterns, and successfully manage uncertainty. These intensive learning periods present risks to patient safety. Simulation-based education (SBE) is a pedagogic approach that allows clinicians to practise their technical and non-technical skills in a safe environment to increase preparedness for practice. In this commentary, we present the potential uses, strengths, and limitations of SBE for supporting transitions across medical career pathways, discussing educational utility, outcome and process evaluation, and cost and value, and introduce a new perspective on considering the gains from SBE. We provide case-study examples of the application of SBE to illustrate these points and stimulate discussion.
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Affiliation(s)
- Jennifer Cleland
- Institute of Education for Medical and Dental Sciences, University of Aberdeen, Room 1:132 Polwarth Building, Foresterhill,, AB25 2ZD UK
| | - Rona Patey
- Institute of Education for Medical and Dental Sciences, University of Aberdeen, Room 1:132 Polwarth Building, Foresterhill,, AB25 2ZD UK
| | - Ian Thomas
- Raigmore Hospital, NHS Highland, Inverness, UK
| | | | | | - Stephanie Russ
- Institute of Education for Medical and Dental Sciences, University of Aberdeen, Room 1:132 Polwarth Building, Foresterhill,, AB25 2ZD UK
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