1
|
Campbell KK, Wong KE, Kerchberger AM, Lysikowski J, Scott DJ, Sulistio MS. Simulation-Based Education in US Undergraduate Medical Education: A Descriptive Study. Simul Healthc 2023; 18:359-366. [PMID: 36584239 DOI: 10.1097/sih.0000000000000705] [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: 12/31/2022]
Abstract
PURPOSE Simulation-based education (SBE) provides experiential learning, improvement in quality of care, and reduction in errors. In 2011, the Association of American Medical Colleges described adoption of SBE in 68.0% of medical schools and 25.0% of teaching hospitals. We sought to examine current trends of SBE integration in American undergraduate medical education since previous publications. METHODS From 2016 to 2019, University of Texas Southwestern Medical Center postgraduate year 1 residents were invited to participate in a survey assessing medical school simulation experience with 26 clinical tasks from three categories: procedural, communication, and other. Deidentified results were analyzed to assess demographics including sex, specialty, residency program type, allopathic versus osteopathic medical school, and medical school region. RESULTS Nine hundred sixty-seven of 1047 (92.3%) responses were obtained, representing 139 US medical schools, 91% from allopathic training. Of procedural tasks, most simulated was suturing (n = 848, 89.6%) and least simulated was thoracentesis (n = 737, 80.9%). Of communication tasks, most simulated was taking a history (n = 475, 51.1% reporting simulation >30) and least simulated (never or ≤1) were obtaining a consent (n = 669, 73.2%) and disclosing a medical error (n = 666, 72.4%). Of other tasks, most simulated was chest compressions (n = 898, 96.0%) and least simulated was operating a defibrillator (n = 206, 22.1%). Results were similar regardless of procedural or nonprocedural program. There was no significant difference in SBE exposure between allopathic and osteopathic students ( P = 0.89). Two participants (0.002%) reported no simulation exposure. CONCLUSIONS Our study is the first to describe a high prevalence of SBE adoption in medical schools nationwide since the Association of American Medical Colleges' 2011 publication, with overall equal exposure for students regardless of residency type and allopathic or osteopathic medical school. Despite widespread adoption of simulation, opportunities remain to expand SBE use to teach critically important communication skills.
Collapse
Affiliation(s)
- Krystle K Campbell
- From the UT Southwestern Simulation Center (K.K.C.), University of Texas Southwestern Medical Center, Dallas, TX; Division of Cardiology, Department of Internal Medicine (K.E.W.), and Division of Cardiology, Department of Internal Medicine (A.M.K.), Washington University of St Louis, St Louis, MO; and Simulation Center (J.L.), Department of Surgery (D.J.S.), and Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (M.S.S.)
| | | | | | | | | | | |
Collapse
|
2
|
Arunachalam S, Pau A, Nadarajah VD, Babar MG, Samarasekera DD. Entrustable professional activities in undergraduate dental education: A practical model for development and validation. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2023; 27:332-342. [PMID: 35484781 DOI: 10.1111/eje.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 02/02/2022] [Accepted: 04/24/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Entrustable professional activities (EPAs) are tasks that a person who is qualified or is in the process to be credentialed are allowed to engage. There are several levels of entrustment based on degrees of supervision assigned to each EPA. This paper aims to describe the process and outcome of creating EPAs; validate EPAs relevant to undergraduate dental training. METHODS A draft set of EPA statements was developed based on the consensus of an expert panel. These were then mapped to the nationally determined minimum experience thresholds (clinical and procedural experiences/competencies) and aligned to task-based instructional strategy. The EPAs were validated to improve the relevance by using a criterion-based rubric. RESULTS An end-to-end process workflow led to the development of an EPA-based educational framework to bridge the gaps in the curriculum. The process identified a total of 41 EPAs and out of which, 10 EPAs were notated as core EPAs and will be subjected to structured workplace-based assessment complying to the national standards. The validation exercise rated core EPAs with an overall score matching close to the cut-off of 4.07 (Equal rubric). CONCLUSION The end-to-end process workflow provided the opportunity to elaborate a structured process for the development of EPAs for undergraduate dental education. As validation is a continuous process, feedback from implementation will inform the next steps.
Collapse
Affiliation(s)
| | - Allan Pau
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Vishna Devi Nadarajah
- Pro Vice Chancellor, Education & Institutional Development, International Medical University, Kuala Lumpur, Malaysia
| | - Muneer Gohar Babar
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | | |
Collapse
|
3
|
Li P, Jiang F, Yin L, Chen YQ, Shao L, Li Y, Gao YJ, Lu MH. Perceptions of the CanMEDS Competencies of Faculty and Students in Different Curriculum Systems of a Medical School in China. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:1061-1070. [PMID: 36132622 PMCID: PMC9484775 DOI: 10.2147/amep.s367129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 09/06/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The Ottawa-Shanghai Joint School of Medicine (OSJSM) has adopted the uOttawa's undergraduate medical education (UGME) program vertically integrated (VI) curriculum.However, limited information is available regarding whether the VI and non-VI curricula foster different perspectives on necessary competencies. METHODS This study included 167 undergraduate medical students and 142 faculty members from different curricula at the Shanghai Jiao Tong University School of Medicine. Participants completed a questionnaire, rating the importance of competencies relating to the seven CanMEDS roles. RESULTS The cognitive level regarding the competencies required to be a successful clinician was significantly higher among participants from VI versus non-VI curricula. All participants gave the highest ratings to the Medical Expert and Professional roles, and rated the Health Advocate role as least important. Competency ratings did not significantly differ between students from VI versus non-VI curricula. Ratings between VI and non-VI faculty showed only one significant difference, namely the competence of"Constantly update clinical knowledge and professional skills" was ranked significantly higher by faculty of non-VI curricula. In the top rated 10 competencies, the Communicator role was considered more important by participants from VI versus non-VI curricula. CONCLUSION The cognitive level regarding the competencies was related to the curriculum system. The Communicator role seemed to be paid more attention in VI curricula, however, other competencies was not demonstrated to be related to the curriculum system.
Collapse
Affiliation(s)
- Pingping Li
- Department of Medical Teaching, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Fan Jiang
- Department of Developmental and Behavior Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Lei Yin
- Department of Nephrology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Yi Qi Chen
- School of Pediatrics, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Li Shao
- Office of Educational Administration, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yi Li
- School of Clinical Medicine, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yi Jin Gao
- Department of Hematology/Oncology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Mei Hua Lu
- Department of Medical Teaching, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| |
Collapse
|
4
|
Padley J, Boyd S, Jones A, Walters L. Transitioning from university to postgraduate medical training: A narrative review of work readiness of medical graduates. Health Sci Rep 2021; 4:e270. [PMID: 33855193 PMCID: PMC8025846 DOI: 10.1002/hsr2.270] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/16/2021] [Accepted: 03/04/2021] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Work readiness is often described in terms of the clinical competence medical graduates bring to day 1 of internship. Despite being increasingly viewed as a key graduate outcome, work readiness has remained poorly defined. OBJECTIVE This narrative review draws on the international literature to explore how different research methods provide differing insight into what constitutes work readiness of medical graduates. From this, we explored contributory factors and developed a conceptual framework to better understand work readiness. METHODS Databases were searched using the terms including "ready," "readiness," "preparedness," "medical graduates," "intern," and "junior doctor." Information was summarized using a textual description template that included information on study setting, participants, methodologies, limitations, and key result areas (including measures/themes and study conclusions). Consensus discussions between authors led to the naming and understanding of the key themes. RESULTS Seventy studies were included in the review. Study participants included final-year medical students (n = 20), junior doctors early in internship (n = 24), and junior doctors late in internship or postgraduate year 2 and above (n = 23). Most studies explored work readiness through the retrospective self-report of the students and/or junior doctor participants. Quantitative research methods elaborated on key skills-based competencies, whereas qualitative research methods provided insight into key contextual and individual characteristics that contributed to preparedness. CONCLUSIONS Different research methods provided insight into competencies, as well as individual and contextual aspects, associated with preparedness for practice. The transition from university to clinical practice is significant and requires personal capability and confidence, as well as a supportive training context. Enabling students to engage authentically in clinical environments enhanced preparedness by promoting understanding of role and responsibility. Individual resilience is important, but contextual factors, including provision of adequate support and feedback, can enhance or subtract from feeling prepared. We propose a novel conceptual framework for better understanding work readiness.
Collapse
Affiliation(s)
- James Padley
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Sarah Boyd
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Alison Jones
- College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Lucie Walters
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
- Adelaide Rural Clinical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| |
Collapse
|
5
|
Wijnen-Meijer M, van den Broek S, Koens F, Ten Cate O. Vertical integration in medical education: the broader perspective. BMC MEDICAL EDUCATION 2020; 20:509. [PMID: 33317495 PMCID: PMC7737281 DOI: 10.1186/s12909-020-02433-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/07/2020] [Indexed: 05/19/2023]
Abstract
Curricular integration represents collaborations between disciplines to establish a coherent curriculum and has become the dominant recommendation for medical education in the second half of the twentieth century. Vertical integration specifically is the integration between the clinical and basic science parts throughout the program. Vertically integrated curricula present basic sciences imbedded in a clinical context from the start of medical school.The authors briefly discuss vertical integration in relationship with context theory, motivation theory, professional identity formation, transition to practice and the continuum of education and practice. They conclude that vertical integration, rather than horizontal integration, extends far beyond curriculum structure. They consider vertical integration a philosophy of education, with impact on students' maturation and engagement with the profession, and which applies not only to undergraduate education but to the lifelong learning of professionals. The definition of vertical integration as "an educational approach that fosters a gradual increase of learner participation in the professional community through a stepwise increase of knowledge-based engagement in practice with graduated responsibilities in patient care" is more comprehensive than its older conceptualization.
Collapse
Affiliation(s)
- Marjo Wijnen-Meijer
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany.
| | | | - Franciska Koens
- Amsterdam UMC, Faculty of Medicine Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Olle Ten Cate
- University Medical Center Utrecht, Center for Research and Development of Education, Utrecht, The Netherlands
| |
Collapse
|
6
|
van den Broek S, Querido S, Wijnen-Meijer M, van Dijk M, Ten Cate O. Social Identification with the Medical Profession in the Transition from Student to Practitioner. TEACHING AND LEARNING IN MEDICINE 2020; 32:271-281. [PMID: 32075422 DOI: 10.1080/10401334.2020.1723593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Phenomenon: This study explores professional identity formation during a final year of medical school designed to ease the transition from student to practitioner. Although still part of the undergraduate curriculum, this "transitional year" gives trainees more clinical responsibilities than in earlier rotations. Trainees are no longer regarded as regular clerks but work in a unique position as "semi-physicians," performing similar tasks as a junior resident during extended rotations. Approach: We analyzed transcripts from interviews with 21 transitional-year medical trainees at University Medical Center Utrecht about workplace experiences that affect the development of professional identity. We used Social Identity Approach as a lens for analysis. This is a theoretical approach from social psychology that explores how group memberships constitute an important component of individual self-concepts in a process called 'social identification.' The transcripts were analyzed using thematic analysis, with a focus on how three dimensions of social identification with the professional group emerge in the context of a transitional year: cognitive centrality (the prominence of the group for self-definition), in-group affect (positivity of feelings associated with group membership) and in-group ties (perception of fit and ties with group members). Findings: Students were very aware of being a practitioner versus a student in the position of semi-physician and performing tasks successfully (i.e., cognitive centrality). Students experienced more continuity in patient care in transitional-year rotations than in previous clerkships and felt increased clinical responsibility. As a semi-physician they felt they could make a significant contribution to patient care. Students experienced a sense of pride and purpose when being more central to their patients' care (i.e., in-group affect). Finally, in extended rotations, the trainees became integrated into daily social routines with colleagues, and they had close contact with their supervisors who could confirm their fit with the group, giving them a sense of belonging (i.e., in-group ties). Insights: Using the three-dimension model of social identification revealed how students come to identify with the social group of practitioners in the context of a transitional year with extended rotations, increased clinical responsibilities, and being in the position of a "semi-physician." These findings shed light on the identity transition from student to practitioner within such a curricular structure.
Collapse
Affiliation(s)
| | - Sophie Querido
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjo Wijnen-Meijer
- School of Medicine, Technical University of Munich, TUM Medical Education Center, Munich, Germany
| | - Marijke van Dijk
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
7
|
Czeskleba A, Holzhausen Y, Peters H. Clinical reasoning for acute dyspnoea: comparison between final-year medical students from discipline- and competency-based undergraduate programmes. BMC MEDICAL EDUCATION 2020; 20:161. [PMID: 32429955 PMCID: PMC7238574 DOI: 10.1186/s12909-020-02055-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/29/2020] [Indexed: 06/11/2023]
Abstract
UNLABELLED Clinical reasoning for acute dyspnoea: Comparison of final-year medical students from discipline- and competency-based undergraduate programmes. BACKGROUND The global shift to competency-based medical education aims to improve the performance of its trainees, including in the key competency domain of clinical reasoning. However, research on whether such education actually improves clinical reasoning is sparse. The purpose of this study is to compare assessed clinical reasoning performance in digitally presented cases of acute dyspnoea between final-year medical students from a traditional, discipline-based and those from an integrated, competency-based undergraduate programme. METHODS A total of 60 medical students in their final-year clerkships participated in the study; 30 were from a discipline-based programme, and 30 were from a competency-based programme of the same faculty. The students completed a knowledge test consisting of 22 single choice items and a computer-based test of clinical reasoning with six video-based case scenarios with different underlying diseases leading to dyspnoea. The operationalized measures of clinical reasoning were the number and relevance of the diagnostic tests chosen, time to diagnosis and diagnostic accuracy. RESULTS The two groups did not differ in their knowledge of the acute dyspnoea content domain. With regard to clinical reasoning, the selection of relevant tests, time required to make a diagnosis and accuracy of the diagnosis varied across the six case scenarios in both groups. However, the results from the measures of the clinical reasoning process did not differ between the students from the two types of undergraduate medical programmes. No significant differences were found with regard to the selection of relevant diagnostic tests (M = 63.8% vs. M = 62.8%), the time to a diagnosis (M = 128.7 s vs. M = 136.4 s) or the accuracy of diagnosis (M = 82.2% vs. M = 77.0%). CONCLUSIONS Key indicators of the clinical reasoning process, when assessed with objectively measured parameters, did not differ between final-year medical students from a traditional, discipline-based and those from an integrated, competency-based undergraduate programme in the domain of acute dyspnoea. The results substantiate and expand those of previous studies based on subjective assessor ratings that showed limited change in the clinical reasoning performance of medical students with competency-based undergraduate education.
Collapse
Affiliation(s)
- Anja Czeskleba
- Dieter Scheffner Centre for Medical Education and Educational Research, Dean’s Office of Study Affairs, Charité – Universitätsmedizin Berlin, Charité Platz 1, 10117 Berlin, Germany
| | - Ylva Holzhausen
- Dieter Scheffner Centre for Medical Education and Educational Research, Dean’s Office of Study Affairs, Charité – Universitätsmedizin Berlin, Charité Platz 1, 10117 Berlin, Germany
| | - Harm Peters
- Dieter Scheffner Centre for Medical Education and Educational Research, Dean’s Office of Study Affairs, Charité – Universitätsmedizin Berlin, Charité Platz 1, 10117 Berlin, Germany
| |
Collapse
|
8
|
Querido S, De Rond M, Wigersma L, van den Broek S, ten Cate O. The Significance of Experiencing Clinical Responsibilities for Specialty Career Choice. MEDICAL SCIENCE EDUCATOR 2020; 30:163-171. [PMID: 34457655 PMCID: PMC8368942 DOI: 10.1007/s40670-019-00832-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM Medical trainees make career choices in the final year of medical school or after graduation, if they do not continue with residency directly. Most Dutch medical students are trained in vertically integrated (VI) curricula, with early clinical experience and a gradual increase in clinical responsibilities. Students in such curricula have been reported to make career choices at an earlier stage than graduates from more traditionally designed curricula. Many Dutch graduates build further clinical experience after graduation as physicians-not-in-training (PNITs) before beginning residency. We explored how students make career choices and whether pre-residency clinical responsibilities influence this choice. METHOD A qualitative study with a phenomenology approach was used. The authors conducted a longitudinal interview study of medical students with two intervals over a 2-year period. The interview questions covered how trainees establish career preferences and which factors affect preference and choice over time. RESULTS Experiencing clinical responsibility was a key factor for career preference during all interview rounds. Being a PNIT who makes diagnostic and therapeutic decisions, have their own patients and have significant patient care responsibilities creates opportunities to build an image of a future context of employment. Some participants mentioned that their experience of having full responsibility as a PNIT was pivotal in a career preference change. CONCLUSION Clinical responsibility as a student or a PNIT appears to be important for career preference and choice. The experience of responsibility as a medical doctor forces trainees to reflect on personal needs and to consider which career preference fits best.
Collapse
Affiliation(s)
- Sophie Querido
- Central Board for Specialty training in Elderly Care Medicine in the Netherlands (SOON), P.O. Box 19025, 3501 DA Utrecht, The Netherlands
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marlies De Rond
- Royal Dutch Medical Association (KNMG), Utrecht, The Netherlands
| | - Lode Wigersma
- Dutch Association of Public Health Physicians (VAV), Utrecht, The Netherlands
| | - Sjoukje van den Broek
- Center of Education and Training, Unit of Medical Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olle ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
9
|
Buist N, Webster CS. Simulation Training to Improve the Ability of First-Year Doctors to Assess and Manage Deteriorating Patients: a Systematic Review and Meta-analysis. MEDICAL SCIENCE EDUCATOR 2019; 29:749-761. [PMID: 34457539 PMCID: PMC8368756 DOI: 10.1007/s40670-019-00755-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Many simulation courses now exist which aim to prepare first-year doctors for the task of assessing and managing potentially deteriorating patients. Despite the substantial resources required, the degree to which participants benefit from such courses, and which aspects of the simulation training are optimal for learning, remains unclear. A systematic literature search was undertaken across seven electronic databases. Inclusion criteria were that the intervention must be a simulation of a deteriorating patient scenario that would likely be experienced by first-year doctors, and that participants being first-year doctors or in their final year of medical school. Studies reporting quantitative benefits of simulation on participants' knowledge and simulator performance underwent meta-analyses. The search returned 1444 articles, of which 48 met inclusion criteria. All studies showed a benefit of simulation training, but outcomes were largely limited to self-rated or objective tests of knowledge, or simulator performance. The meta-analysis demonstrated that simulation improved participant performance by 16% as assessed by structured observation of a simulated scenario, and participant knowledge by 7% as assessed by written assessments. A mixed-methods analysis found conflicting evidence about which aspects of simulation were optimal for learning. The results of the review indicate that simulation is an important tool to improve first-year doctors' confidence, knowledge and simulator performance with regard to assessment and management of a potentially deteriorating patient. Future research should now seek to clarify the extent to which these improvements translate into clinical practice, and which aspects of simulation are best suited to achieve this.
Collapse
Affiliation(s)
- Nicholas Buist
- Department of Emergency Medicine, Whangarei Hospital, Northland District Health Board, Maunu Rd, Private Bag 9742, Whangarei, 0110 New Zealand
| | - Craig S. Webster
- Centre for Medical and Health Sciences Education and Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| |
Collapse
|
10
|
Ten Cate O, Borleffs J, van Dijk M, Westerveld T. Training medical students for the twenty-first century: Rationale and development of the Utrecht curriculum "CRU+". MEDICAL TEACHER 2018; 40:461-466. [PMID: 29468920 DOI: 10.1080/0142159x.2018.1435855] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
AIM The aim of this report, written for the 40th anniversary issue of Medical Teacher, is to document 20 years of development of the Utrecht undergraduate medical curriculum, as both to exhibit accountability and to inform the community of the process and choices that can be made in long-term curriculum development. METHODS We used the SPICES model, created by Medical Teacher's Editor Ronald Harden and colleagues in 1984. RESULTS The Utrecht six-year program, now called "CRU+", has many distinct features that were introduced, most of which are well documented. A limited selection includes • A new 3+3 years Bachelor-Master structure following the EU Bologna rules leading to MD registration for cohorts of about 300. • Horizontally integrated classroom teaching of basic sciences with clinical disciplines predominantly in groups of 12 and limited lectures. • Mandatory knowledge retention tests, retesting the clinically relevant core knowledge from block tests of semesters one through four. • Vertical integration not only linking clinical experience with background knowledge, but also exemplified by a stepwise increase in health care responsibilities throughout the curriculum. • A final year focussing on growth towards the level of a primary responsible physician in a 12-week sub-internship for a limited number of patients and beds, in a chosen specialty. The student is called a semi-physician in the clerkship of this transitional year to residency. • Teaching skills training for all medical graduates, an elective teaching rotation and various peer-teaching arrangements throughout the curriculum. • Integrated semi-longitudinal clerkships with an assessment focus on entrustment decisions for Entrustable Professional Activities. CONCLUSION UMC Utrecht has made a continuous attempt to both develop its medical curriculum and to study and report on its development in the literature, regarding new methods found and insights derived. UMC Utrecht will remain committed to developing training to meet twenty-first century demands of medical graduates.
Collapse
Affiliation(s)
- Olle Ten Cate
- a Center for Research and Development of Education , UMC Utrecht , Utrecht , The Netherlands
| | - Jan Borleffs
- b University Medical Centre Groningen, University of Groningen , Groningen , The Netherlands
| | - Marijke van Dijk
- c University Medical Center Utrecht - UMC Utrecht Medical School , Utrecht , The Netherlands
| | - Tineke Westerveld
- d University Medical Center Utrecht - Internal Medicine , Utrecht , The Netherlands
| |
Collapse
|
11
|
Ten Cate O, Graafmans L, Posthumus I, Welink L, van Dijk M. The EPA-based Utrecht undergraduate clinical curriculum: Development and implementation. MEDICAL TEACHER 2018; 40:506-513. [PMID: 29468913 DOI: 10.1080/0142159x.2018.1435856] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
AIM As reports of the application of entrustable professional activities (EPAs) increase, not only for postgraduate but also for undergraduate medical education, there is a need for descriptions of what a UME curriculum with EPAs could look like. We provide such a description based on the experiences at University Medical Center Utrecht, the Netherlands, which can be used as an example by other curriculum developers. METHODS In a three-year process, the UMC Utrecht Curriculum Committee developed a clinical workplace curriculum with an EPA structure, taking into account examples, such as the US Core EPAs for Entering Residency, and recommendations to integrate and increase the length of clerkships. RESULTS In the resulting curriculum, operational from 2016, students train to be trusted with indirect supervision before graduation in five broad EPAs: the clinical consultation; general medical procedures; informing, advising and guiding patients and families; communicating and collaborating with colleagues; and extraordinary patient care. Each of these integrates smaller (nested) EPAs that receive focused training attention in integrated clerkships at various moments and must be signed off for entrustment with indirect supervision to complete the clerkship. DISCUSSION The framework of EPAs went through many iterations before it was consolidated. Among the issues that required special attention was the application of a supervision levels scale for sign-off, the necessity to cover all relevant clinical content while not labeling too many small tasks each as a separate EPA, methods of EPA-focused assessment in the workplace and the creation of an e-portfolio model to serve assessment and entrustment.
Collapse
Affiliation(s)
- Olle Ten Cate
- a Center for Research and Development of Education , University Medical Center , Utrecht , The Netherlands
| | - Lysanne Graafmans
- a Center for Research and Development of Education , University Medical Center , Utrecht , The Netherlands
- b Department of Medical Education, Education Center , University Medical Center , Utrecht , The Netherlands
| | - Indra Posthumus
- a Center for Research and Development of Education , University Medical Center , Utrecht , The Netherlands
- c Department of Dermatology , Bravis Hospital , Bergen op Zoom , The Netherlands
| | - Lisanne Welink
- d Department of General Practice, Julius Center for Health Sciences and Primary Care , University Medical Center, Utrecht , The Netherlands
| | - Marijke van Dijk
- e Department of Pathology , University Medical Center, Utrecht, The Netherlands
| |
Collapse
|
12
|
van den Broek WES, Wijnen-Meijer M, Ten Cate O, van Dijk M. Medical students' preparation for the transition to postgraduate training through final year elective rotations. GMS JOURNAL FOR MEDICAL EDUCATION 2017; 34:Doc65. [PMID: 29226233 PMCID: PMC5704611 DOI: 10.3205/zma001142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 02/20/2017] [Accepted: 05/09/2017] [Indexed: 05/27/2023]
Abstract
Objectives: This study adds to the ongoing discussion on how to ease the transition from undergraduate medical training to postgraduate training. In the Netherlands there is no central matching system for admission to residency. Medical school graduates just apply for a position in an open job market. Many choose to acquire general or specialty-specific clinical experiences after the medical degree before residency, to further explore career opportunities and to increase their chances to get into their preferred specialty. To shorten this gap between undergraduate and the start of postgraduate training, the sixth and final year of most Dutch medical schools is designed as a "transitional year". Students work with more clinical responsibilities than in the earlier clerkships, and this year includes many elective options. Our study focuses on these elective options and explores how medical students use these transitional year electives to prepare for transition to postgraduate training. Methods: In 2012-2013 we asked all 274 graduating students at one Dutch medical school to complete an open-answer questionnaire with the following topics: their preferred specialty at the start of the transitional year, electives they chose during this year and reasons for these choices, and whether the transitional year electives changed their career considerations. Questionnaire results were coded by two researchers and were discussed with all members of the research team. Results: A total of 235 students responded (86%). Answers about motivation for choices revealed that most electives where chosen for career orientation and to optimize chances to get into a residency program. Students also focused on additional experiences in specialties related to their preferred specialty. Many students chose electives logically related to each other, e.g. combinations of surgery and radiology. About two-thirds of the respondents stated that their elective experiences did confirm their specialty preferences or resulted in a more clear insight. Conclusion: We conclude that students use the transitional year electives to focus on their future postgraduate training program, i.e. for orientation and to align their curriculum vitae with their preferred specialty, resulting in spontaneous early specialty streaming. To take advantages of this streaming, and to make sure students can transfer their experiences to other specialties if their career preferences change, individual elective Entrustable Professional Activities (EPAs), next to the core EPAs for all medical students, may serve to prepare a smooth transition to a specialty of choice and should be fully documented.
Collapse
Affiliation(s)
| | - Marjo Wijnen-Meijer
- University Medical Center Utrecht, Centre for Research and Development of Education, Utrecht, The Netherlands
| | - Olle Ten Cate
- University Medical Center Utrecht, Centre for Research and Development of Education, Utrecht, The Netherlands
| | - Marijke van Dijk
- University Medical Center Utrecht, School of Medicine, Utrecht, The Netherlands
| |
Collapse
|
13
|
Fürstenberg S, Harendza S. Differences between medical student and faculty perceptions of the competencies needed for the first year of residency. BMC MEDICAL EDUCATION 2017; 17:198. [PMID: 29121897 PMCID: PMC5680802 DOI: 10.1186/s12909-017-1036-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 11/02/2017] [Indexed: 05/06/2023]
Abstract
BACKGROUND Different guidelines and frameworks like the CanMEDs model or entrustable professional activities (EPAs) describe competencies required for successful and professional work of residents. Not all competencies are of equal importance for graduates when they start their residency. The aim of this study was to evaluate the relevance of different competencies for a first year resident from the perspective of physicians and medical students. METHODS In an online study, 178 of 475 surgeons and internists including residents and attendings and 102 of 728 first and last year undergraduate medical students from the University Medical Center Hamburg-Eppendorf ranked 25 competencies according to their relevance for entrustment decisions in first year residents. The rankings of the competencies by residents and attendings and by first year and last year medical student were compared. Additionally, the rankings were also compared to the literature. RESULTS Physicians and medical students rated 'Responsibility' as the most important competency for first year residents. Physicians ranked 'Teamwork and collegiality' and 'Structure, work planning and priorities' within the top 10 competencies significantly higher than medical students. The competency ranks between attendings and residents only showed one significant difference between attendings and residents, where 'Coping with mistakes', was ranked significantly higher by residents. Medical students ranked 'Active listening to patients', 'Advising patients' and 'Handling emotions of patients and their relatives' significantly higher than physicians. Final year students ranked 'Structure, work planning and priorities', 'Coping with mistakes', and 'Verbal communication with colleagues and supervisors' significantly higher than first year students. CONCLUSIONS Even though physicians and medical students agree that 'Responsibility' is the most important competency for entrustment decisions in the first year of residency, medical students rate competencies regarding patient communication very highly while physicians rate competencies required for patient managements significantly higher for entrustment decision. Undergraduate medical curricula seem to prepare students well with respect to patient-centeredness but need to be developed more specifically to prepare students equally well for patient management competencies which are required in the first year of residency for entrustment decisions from the attendings perspective.
Collapse
Affiliation(s)
- Sophie Fürstenberg
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrid Harendza
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Martinistr. 52, D-20246 Hamburg, Germany
| |
Collapse
|
14
|
Fürstenberg S, Schick K, Deppermann J, Prediger S, Berberat PO, Kadmon M, Harendza S. Competencies for first year residents - physicians' views from medical schools with different undergraduate curricula. BMC MEDICAL EDUCATION 2017; 17:154. [PMID: 28882189 PMCID: PMC5590189 DOI: 10.1186/s12909-017-0998-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/04/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND Frameworks like the CanMEDS model depicting professional roles and specific professional activities provide guidelines for postgraduate education. When medical graduates start their residency, they should possess certain competencies related to communication, management and professionalism while other competencies will be refined during postgraduate training. Our study aimed to evaluate the relevance of different competencies for a first year resident required for entrustment decision from the perspective of physicians from medical faculties with different undergraduate medical curricula. METHODS Nine hundred fifty-two surgeons and internists from three medical schools with different undergraduate medical curricula were invited to rank 25 competencies according to their relevance for first year residents. The rankings were compared between universities, specialties, physicians' positions, and gender. RESULTS Two hundred two physicians participated, 76 from Hamburg University, 44 from Oldenburg University, and 82 from Technical University Munich. No significant differences were found regarding the top 10 competencies relevant for first year residents between the universities. 'Responsibility' was the competency with the highest rank overall. Internists ranked 'Structure, work planning and priorities' higher while surgeons ranked 'Verbal communication with colleagues and supervisors' higher. Consultants evaluated 'Active listening to patients' more important than department directors and residents. Female physicians ranked 'Verbal communication with colleagues and supervisors' and 'Structure, work planning and priorities' significantly higher while male physicians ranked 'Scientifically and empirically grounded method of working' significantly higher. CONCLUSIONS Physicians from universities with different undergraduate curricula principally agreed on the competencies relevant for first year residents. Some differences between physicians from different positions, specialties, and gender were found. These differences should be taken into account when planning competence-based postgraduate education training programs.
Collapse
Affiliation(s)
- Sophie Fürstenberg
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristina Schick
- TUM Medical Education Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jana Deppermann
- Department of Medical Education and Education Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Sarah Prediger
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pascal O. Berberat
- TUM Medical Education Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Martina Kadmon
- Department of Medical Education and Education Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Sigrid Harendza
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Martinistr, 52 D-20246 Hamburg, Germany
| |
Collapse
|
15
|
Fazio SB, Demasi M, Farren E, Frankl S, Gottlieb B, Hoy J, Johnson A, Kasper J, Lee P, McCarthy C, Miller K, Morris J, O'Hare K, Rosales R, Simmons L, Smith B, Treadway K, Goodell K, Ogur B. Blueprint for an Undergraduate Primary Care Curriculum. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1628-1637. [PMID: 27415445 DOI: 10.1097/acm.0000000000001302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In light of the increasing demand for primary care services and the changing scope of health care, it is important to consider how the principles of primary care are taught in medical school. While the majority of schools have increased students' exposure to primary care, they have not developed a standardized primary care curriculum for undergraduate medical education. In 2013, the authors convened a group of educators from primary care internal medicine, pediatrics, family medicine, and medicine-pediatrics, as well as five medical students to create a blueprint for a primary care curriculum that could be integrated into a longitudinal primary care experience spanning undergraduate medical education and delivered to all students regardless of their eventual career choice.The authors organized this blueprint into three domains: care management, specific areas of content expertise, and understanding the role of primary care in the health care system. Within each domain, they described specific curriculum content, including longitudinality, generalism, central responsibility for managing care, therapeutic alliance/communication, approach to acute and chronic care, wellness and prevention, mental and behavioral health, systems improvement, interprofessional training, and population health, as well as competencies that all medical students should attain by graduation.The proposed curriculum incorporates important core features of doctoring, which are often affirmed by all disciplines but owned by none. The authors argue that primary care educators are natural stewards of this curriculum content and can ensure that it complements and strengthens all aspects of undergraduate medical education.
Collapse
Affiliation(s)
- Sara B Fazio
- S.B. Fazio is associate professor, Department of Internal Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts. M. Demasi is instructor of population health (family medicine), Cambridge Health Alliance, and Harvard Medical School, Boston, Massachusetts. E. Farren is education program director, Center for Primary Care, Harvard Medical School, Boston, Massachusetts. S. Frankl is assistant professor, Department of Internal Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts. B. Gottlieb is associate professor, Department of Internal Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts. J. Hoy is resident physician, Department of Internal Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts. A. Johnson is resident physician, Department of Internal Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. J. Kasper is instructor, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. P. Lee is assistant professor, Department of Internal Medicine, Cambridge Health Alliance, and Harvard Medical School, Boston, Massachusetts. C. McCarthy is assistant professor, Department of Pediatrics, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts. K. Miller is assistant professor of population medicine (family medicine), Cambridge Health Alliance, and Harvard Medical School, Boston, Massachusetts. J. Morris is resident physician, Department of Family & Community Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. K. O'Hare is assistant professor, Department of Internal Medicine, Brigham and Women's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. R. Rosales is a medical student, Harvard Medical School, Boston, Massachusetts. L. Simmons is assistant professor, Department of Internal Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts. B. Smith is resident physician, Fort Collins Family Medicine Residency, Fort Collins, Colorado. K. Treadway is associate professor, Department of Internal Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts. K. Goodell is director for innovation in medical education (family medicine), Center for Primary Care, Harvard Medical School, Boston, Massachusetts. B. Ogur is associate professor of medicine, Department of Internal Medicine, Cambridge Health Alliance, and Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Wijnen-Meijer M, Ten Cate O, van der Schaaf M, Burgers C, Borleffs J, Harendza S. Vertically integrated medical education and the readiness for practice of graduates. BMC MEDICAL EDUCATION 2015; 15:229. [PMID: 26689282 PMCID: PMC4687104 DOI: 10.1186/s12909-015-0514-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 12/14/2015] [Indexed: 05/18/2023]
Abstract
BACKGROUND Medical curricula become more and more vertically integrated (VI) to prepare graduates better for clinical practice. VI curricula show early clinical education, integration of biomedical sciences and focus on increasing clinical responsibility levels for trainees. Results of earlier questionnaire-based studies indicate that the type of the curriculum can affect the perceived preparedness for work as perceived by students or supervisors. The aim of the present study is to determine difference in actual performance of graduates from VI and non-VI curricula. METHODS We developed and implemented an authentic performance assessment based on different facets of competence for medical near-graduates in the role of beginning residents on a very busy day. Fifty nine candidates participated: 30 VI (Utrecht, The Netherlands) and 29 non-VI (Hamburg, Germany). Two physicians, one nurse and five standardized patients independently assessed each candidate on different facets of competence. Afterwards, the physicians indicated how much supervision they estimated each candidate would require on nine so called "Entrustable Professional Activities (EPAs)" unrelated to the observed scenarios. RESULTS Graduates from a VI curriculum received significantly higher scores by the physicians for the facet of competence "active professional development", with features like 'reflection' and 'asking for feedback'. In addition, VI graduates scored better on the EPA "solving a management problem", while the non-VI graduates got higher scores for the EPA "breaking bad news". CONCLUSIONS This study gives an impression of the actual performance of medical graduates from VI and non-VI curricula. Even though not many differences were found, VI graduates got higher scores for features of professional development, which is important for postgraduate training and continuing education.
Collapse
Affiliation(s)
- Marjo Wijnen-Meijer
- Department of Education and Training, Leiden University Medical Center, Leiden, The Netherlands.
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands.
- Department of Medicine, University of California, San Francisco, USA.
| | | | - Chantalle Burgers
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Jan Borleffs
- Center for Innovation and Research in Medical Education, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
| | - Sigrid Harendza
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| |
Collapse
|
17
|
Murphy KP, Crush L, O'Malley E, Daly FE, Twomey M, O'Tuathaigh CMP, Maher MM, Cryan JF, O'Connor OJ. Medical student perceptions of radiology use in anatomy teaching. ANATOMICAL SCIENCES EDUCATION 2015; 8:510-7. [PMID: 25516061 DOI: 10.1002/ase.1502] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 09/17/2014] [Accepted: 10/08/2014] [Indexed: 05/16/2023]
Abstract
The use of radiology in the teaching of anatomy to medical students is gaining in popularity; however, there is wide variation in how and when radiology is introduced into the curriculum. The authors sought to investigate students' perceptions regarding methods used to depict and teach anatomy and effects of integrated radiology instruction on students' abilities to correctly identify imaging modalities and anatomical structures on radiological images. First-year medical students completed questionnaires at the beginning and end of the first academic year that incorporated ten hours of radiologic anatomy teaching in the anatomy curriculum. Questions used a combination of Likert scales, rankings, and binary options. Students were tested on their ability to identify radiology modalities and anatomical structures on radiology images. Preresponse and postresponse rates were 93% (157/168) and 85% (136/160), respectively. Postmodule, 96.3% of students wanted the same or more radiology integration. Furthermore, 92.4% premodule and 96.2% postmodule agreed that "Radiology is important in medical undergraduate teaching." Modality and structure identification scores significantly increased from 59.8% to 64.3% (P < 0.001) and from 47.4% to 71.2% (P < 0.001), respectively. The top three preferred teaching formats premodule and postmodule were (1) anatomy laboratory instruction, (2) interactive sessions combining radiology with anatomy, and (3) anatomy lectures. Postmodule, 38.3% of students were comfortable reviewing radiology images. Students were positive about integrating radiology into anatomy teaching and most students wanted at least the same level of assimilation but that it is used as an adjunct rather than primary method of teaching anatomy.
Collapse
Affiliation(s)
- Kevin P Murphy
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
| | - Lee Crush
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
| | - Eoin O'Malley
- Department of Radiology, University College Cork, Cork, Ireland
| | - Fergus E Daly
- Department of Radiology, University College Cork, Cork, Ireland
| | - Maria Twomey
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
| | | | - Michael M Maher
- Department of Radiology, University College Cork, Cork, Ireland
| | - John F Cryan
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, University College Cork, Cork, Ireland
| |
Collapse
|
18
|
Chen HC, van den Broek WES, ten Cate O. The case for use of entrustable professional activities in undergraduate medical education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:431-6. [PMID: 25470310 DOI: 10.1097/acm.0000000000000586] [Citation(s) in RCA: 248] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Many graduate medical education (GME) programs have started to consider and adopt entrustable professional activities (EPAs) in their competency frameworks. Do EPAs also have a place in undergraduate medical education (UME)? In this Perspective article, the authors discuss arguments in favor of the use of EPAs in UME. A competency framework that aligns UME and GME outcome expectations would allow for better integration across the educational continuum. The EPA approach would be consistent with what is known about progressive skill development. The key principles underlying EPAs, workplace learning and trust, are generalizable and would also be applicable to UME learners. Lastly, EPAs could increase transparency in the workplace regarding student abilities and help ensure safe and quality patient care. The authors also outline what UME EPAs might look like, suggesting core, specialty-specific, and elective EPAs related to core clinical residency entry expectations and learner interest. UME EPAs would be defined as essential health care activities with which one would expect to entrust a resident at the beginning of residency to perform without direct supervision. Finally, the authors recommend a refinement and expansion of the entrustment and supervision scale previously developed for GME to better incorporate the supervision expectations for UME learners. They suggest that EPAs could be operationalized for UME if UME-specific EPAs were developed and the entrustment scale were expanded.
Collapse
Affiliation(s)
- H Carrie Chen
- Dr. Chen is professor of clinical pediatrics, Department of Pediatrics, University of California, San Francisco, School of Medicine, San Francisco, California. Dr. van den Broek is a PhD candidate in medical education, University Medical Center Utrecht, Utrecht, the Netherlands. Dr. ten Cate is professor of medical education and director, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands, and adjunct professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California
| | | | | |
Collapse
|
19
|
Murphy KP, Crush L, O'Malley E, Daly FE, O'Tuathaigh CMP, O'Connor OJ, Cryan JF, Maher MM. Medical student knowledge regarding radiology before and after a radiological anatomy module: implications for vertical integration and self-directed learning. Insights Imaging 2014; 5:629-34. [PMID: 25107581 PMCID: PMC4195841 DOI: 10.1007/s13244-014-0346-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/06/2014] [Accepted: 07/03/2014] [Indexed: 11/25/2022] Open
Abstract
Objectives To examine the impact that anatomy-focused radiology teaching has on non-examined knowledge regarding radiation safety and radiology as a specialty. Methods First-year undergraduate medical students completed surveys prior to and after undertaking the first-year anatomy programme that incorporates radiological anatomy. Students were asked opinions on preferred learning methodology and tested on understanding of radiology as a specialty and radiation safety. Results Pre-module and post-module response rates were 93 % (157/168) and 85 % (136/160), respectively. Pre-module and post-module, self-directed learning (SDL) ranked eighth (of 11) for preferred gross-anatomy teaching formats. Correct responses regarding radiologist/radiographer roles varied from 28-94 % on 16 questions with 4/16 significantly improving post-module. Identification of modalities that utilise radiation significantly improved for five of eight modalities post-module but knowledge regarding relative amount of modality-specific radiation use was variable pre-module and post-module. Conclusions SDL is not favoured as an anatomy teaching method. Exposure of students to a radiological anatomy module delivered by senior clinical radiologists improved basic knowledge regarding ionising radiation use, but there was no improvement in knowledge regarding radiation exposure relative per modality. A possible explanation is that students recall knowledge imparted in didactic lectures but do little reading around the subject when the content is not examined. Teaching Points • Self-directed learning is not favoured as a gross anatomy teaching format amongst medical students. • An imaging anatomy-focused module improved basic knowledge regarding ionising radiation use. • Detailed knowledge of modality-specific radiation exposure remained suboptimal post-module. • Knowledge of roles within a clinical radiology department showed little change post-module.
Collapse
Affiliation(s)
- Kevin P Murphy
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Harendza S, Alofs L, Huiskes J, Wijnen-Meijer M. Ordering patterns for laboratory and radiology tests by students from different undergraduate medical curricula. BMC MEDICAL EDUCATION 2013; 13:109. [PMID: 23945311 PMCID: PMC3751874 DOI: 10.1186/1472-6920-13-109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 08/12/2013] [Indexed: 05/28/2023]
Abstract
BACKGROUND The overuse of laboratory tests and radiology imaging and their possible hazards to patients and the health care system is observed with growing concern in the medical community. With this study the authors wished to determine whether ordering patterns for laboratory and radiology tests by medical students close to their graduation are related to undergraduate training. METHODS We developed an assessment for near graduates in the setting of a resident's daily routine including a consultation hour with five simulated patients, three hours for patient work up with simulated distracting tasks, and thirty minutes for reporting of patient management to a supervisor. In 2011, 60 students participated in this assessment: 30 from a vertically integrated (VI) curriculum (Utrecht, The Netherlands) and 30 from a traditional, non-VI curriculum (Hamburg, Germany). We assessed and compared the number of laboratory and radiology requests and correlated the results with the scores participants received from their supervisors for the facet of competence "scientifically and empirically grounded method of working". RESULTS Students from a VI curriculum used significantly (p < .01) less total laboratory requests (N = 283 versus N = 466) which correlated with their scores for a "scientifically and empirically grounded method of working" (Pearson's r = .572). A significantly (p < .01) higher number of radiology imaging was ordered with a large effect size (V = .618) by near graduates from a non-VI curriculum (N = 156 versus N = 97) even when this was not supporting the diagnostic process. CONCLUSION The focused ordering patterns from VI students might be a result of their early exposure to the clinical environment and a different approach to clinical decision making during their undergraduate education which further studies should address in greater detail.
Collapse
Affiliation(s)
- Sigrid Harendza
- Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Lonneke Alofs
- Center for Research and Development of Education, UMC Utrecht, P.O. Box 85500, Utrecht, GA 3508 The Netherlands
| | - Jorike Huiskes
- Center for Research and Development of Education, UMC Utrecht, P.O. Box 85500, Utrecht, GA 3508 The Netherlands
| | - Marjo Wijnen-Meijer
- Center for Research and Development of Education, UMC Utrecht, P.O. Box 85500, Utrecht, GA 3508 The Netherlands
| |
Collapse
|