Simulation and the Prognosis for the Apprenticeship Model of Health Care Education

Teaching the technical performance of bronchoscopy to residents in a step-wise simulated approach: factors supporting learning and impacts on clinical work - a qualitative analysis

BACKGROUND

The ability to perform a bronchoscopy is a valuable clinical skill for many medical specialities. Learning this skill is demanding for residents, due to the high cognitive load. Lessons learned from cognitive load theory might provide a way to facilitate this learning. The aim of this study was to investigate residents' perception of factors that support and hinder learning, as well as outcome and acceptance of a workshop on flexible bronchoscopy.

METHODS

Three half-day workshops were designed to teach 12 residents the basics of handling a flexible bronchoscope. They consisted of four phases that alternated between short theoretical aspects and longer practical situations. The practical phases focussed initially on manoeuvring a bronchoscope through holes in panels inside a box, and then on examination and practice using a three-dimensional printed model of the bronchial tree. Afterwards, three audio- and video-recorded focus groups were conducted, transcribed and coded, and underwent reflexive thematic analysis.

RESULTS

Analysis of the focus groups defined two themes: (1) factors that supported a safe and positive learning environment were optimised for intrinsic load, simulated setting, absence of pressure, dyad practice (working in pairs), small group sizes and playful learning; and (2) impacts on clinical work were perceived as high levels of learning and improved patient safety. The residents did not report factors that hindered their learning. Some suggestions were made to improve the set-up of the wooden box.

CONCLUSIONS

The half-day workshop was designed according to several factors, including cognitive load theory in a simulated setting, and creation of a safe and positive learning environment. The residents perceived this as supporting learning and patient safety. Further studies can be designed to confirm these results in a quantitative setting.

TRIAL REGISTRATION

This study was not interventional, therefore was not registered.

How we created a targeted teaching tool using blog architecture for anesthesia and critical care education--the A/e anesthesia exchange blog

BACKGROUND

The time constraints on a clinical educator have increased immensely over the past decade. Technology has served to significantly bridge the challenge over the past decade. WHAT WE DID: We created a method of delivering targeted educational content for point of care learning in anesthesia and critical care. Our blog platform allows clinician-educators to deliver content as videopodcasts and presentations to learners in a straightforward and easily accessible manner both on the web and through mobile platforms. The A/e Anesthesia exchange "pushed" content at predetermined time intervals to learners and content was based on timely topics that were clinically relevant to their daily practice. The A/e Blog allowed multiple authors across disciplines to contribute content, thus providing learners potentially access to resources of knowledge from the entire team of clinician-educators at an institution. During the pilot phase of A/e blog implementation, the authors gained valuable insights into the use and limitations of web-based technology as a teaching tool. These included challenges with faculty and student participation, managing techno stress of faculty not fluent with the technology, tailoring content based on analytics data and web platform robustness and spam protection.

CONCLUSION

With these insights in hand, we anticipate the launch of an even more robust A/e: Anesthesia Exchange (version 2.0) by the end of 2013.

How we make good doctors into good teachers: a short course to support busy clinicians to improve their teaching skills

BACKGROUND

Doctors are expected to teach but many are reluctant through lack of training. Busy clinicians have little time to attend faculty development initiatives. We wanted to increase clinical teaching capacity locally. WHAT WE DID: In response to requests from doctors lacking confidence in their teaching skills, we developed a programme tailored to the needs of working clinical teachers. The emphasis is on teaching effectively in a busy clinical environment. There are five 90 min modules: bedside teaching, effective supervision and feedback, teaching physical examination and procedures, effective lectures and facilitating development of clinical reasoning skills. The course is practical, interactive and takes place in a supportive learning environment adjacent to the workplace. A total of 81 clinicians participated in the course.

EVALUATION

The main outcomes were increased confidence in bedside teaching, teaching more effectively on ward rounds and reduction in need for support with teaching. Participants reported a better understanding of basic educational theory and its relevance to clinical teaching. There is increased activity in clinical teaching among past participants.

CONCLUSIONS

All clinical teachers require guidance and encouragement in developing their teaching skills. An accessible, practical focused teaching course run locally by colleagues with education expertise can improve clinicians' skills and motivation to teach.