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Karami M, Hashemi N, Van Merrienboer J. From obese to lean curriculum: exploring students' experiences about developing competencies in medical education. Front Med (Lausanne) 2024; 11:1309548. [PMID: 38841567 PMCID: PMC11150563 DOI: 10.3389/fmed.2024.1309548] [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: 11/13/2023] [Accepted: 05/10/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Since the beginning of the 21st century, competency-based education has been proposed as an approach to education in many disciplines including the medical sciences and it has become a dominant approach in many countries. We aimed to explore the lived experiences of general medical students about developing competencies in the academic curriculum. Methods We conducted a phenomenology method to study lived experiences of general medical students through selecting participants via a purposeful sampling strategy. Snowballing and maximum variation samplings were also applied to recruit additional participants. The study was conducted at a Medical School in Iran. Three successive phases of qualitative data analysis, namely, data reduction by coding, data structuring by categorization, and data interpretation by discussion were applied to analyze the interviews. Results The results of the research showed that students' lived experiences fall under 4 main themes with 9 subthemes. The main themes show that (1) the compartmentalized curriculum in basic courses is experienced as the missing parts in a puzzle, (2) the physiopathology curriculum is experienced as swimming on land, (3) the externship is experienced as touring a mysterious land, (4) the internship is experienced as unleashed arrows. Discussion Our findings reveal that despite the changes already made in the curriculum, its compartmentalization is still a main obstacle to achieving competency-based medical education. A strict requirement for leaving the discipline-based curriculum behind is to use an integrated approach, in which basic science courses are connected with clinical cases, and physiopathology courses are connected with externships and internships.
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Affiliation(s)
- Morteza Karami
- Department of Curriculum Studies and Instruction, Ferdowsi University of Mashhad, Mashhad, Iran
| | | | - Jeroen Van Merrienboer
- Department of Educational Development and Research, Maastricht University, Maastricht, Netherlands
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Bußenius L, Harendza S. Development of an instrument for medical students' self-assessment of facets of competence for patient-centred care. PATIENT EDUCATION AND COUNSELING 2023; 115:107926. [PMID: 37536112 DOI: 10.1016/j.pec.2023.107926] [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: 06/12/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To develop a facets of competence self-assessment instrument (FOCSI) with operationalised items for ten competence facets required for patient-centred care at the beginning of residency. METHODS We conducted focus groups and cognitive interviews with final-year medical students to develop items that match students' clinical experience. We tested 50 items in two samples and analysed model fit and internal consistency of all possible combinations to identify the optimal ten-item-solution. Item analysis was performed as well as correlation with six personality traits. RESULTS An optimal ten-item solution for the self-assessment instrument emerged for sample 1 (n = 101, 27.2 ± 3.5 years, 75.2 % female). We validated the model fit with sample 2 (n = 135, 27.7 ± 3.9 years, 66.7 % female): χ2(35) = 49.3, p = .055, CFI = .94, RMSEA = .055, SRMR = .058, Cronbach's alpha = .78. The personality factors 'Conscientiousness' and 'Extraversion' correlate positively with most FOCSI items. CONCLUSION The operationalised FOCSI items support undergraduate medical students close to graduation in realistic self-assessment of facets of competences for patient-centred care in their transition to residency. PRACTICE IMPLICATIONS Realistic self-assessment of facets of competence will provide medical students with the opportunity to monitor their competence development as part of self-directed learning for gaining adaptive expertise in professional, patient-centred care.
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Affiliation(s)
- Lisa Bußenius
- III. Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Sigrid Harendza
- III. Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Ten Cate O, Jarrett JB. Would I Trust or Will I Trust? The Gap between Entrustment Determinations and Entrustment Decisions for Trainees in Pharmacy and Other Health Professions. PHARMACY 2023; 11:107. [PMID: 37368433 DOI: 10.3390/pharmacy11030107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023] Open
Abstract
Entrustable Professional Activities (EPAs) and entrustment decision making are rapidly becoming mainstream in competency-based education in the health professions. EPAs are the units of professional practice to entrust graduates with once they have developed the required competencies. They were conceived to enable a gradual increase in professional autonomy during training, by allowing trainees to practice activities in which they have demonstrated they have mastered well, with decreasing supervision. However, practicing health care unsupervised generally requires licensure. The question for pharmacy education, as well as for undergraduate medical education, is can students be given any autonomy in practice, even when they have fully mastered an EPA yet remain unlicensed? While entrustment decisions for licensed practitioners have autonomy consequences, some educators in undergraduate programs speak of 'entrustment determinations', to avoid decisions about students that affect patient care, in other words saying, we would trust you, rather than we will trust you. However, graduating learners without the experience of responsibility and reasonable autonomy creates a gap with full practice responsibilities, which may jeopardize patient safety after training. What can programs do to retain the power of using EPAs while at the same time guarding patient safety?
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Affiliation(s)
- Olle Ten Cate
- Center for Research and Development of Health Professions Education, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Jennie B Jarrett
- Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, IL 60612, USA
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Bramley A, Forsyth A, McKenna L. Validity and Educational Impact of Clinical Entrustable Professional Activities Linked to the Nutrition Care Process for Work-Based Assessment of Entry-Level Dietetics Students: Evaluation of a 3-Year Implementation Study in Australia. J Acad Nutr Diet 2023; 123:614-625.e7. [PMID: 36089207 DOI: 10.1016/j.jand.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Entrustable professional activities (EPAs) describe key workplace activities and are increasingly being used for student work-based assessment. An EPA-based work-based assessment tool offers potential to increase understanding of dietetics student skill development and opportunity for standardised work-based student assessment. OBJECTIVE To determine construct validity and educational impact of an EPA work-based assessment tool for dietetics placement students in clinical settings. DESIGN Using a time series design, supervisor and student self-assessment data collected from an EPA-based assessment tool from three cohorts of dietetics students and supervisors from 2017-2019 was analyzed. PARTICIPANTS AND SETTING Dietetics students (n = 145) from an accredited dietetic training program in Australia and affiliated metropolitan and rural hospitals. MAIN OUTCOME MEASURES Construct validity was determined through analysis of supervisor evaluation of student performance against EPAs over time. Educational impact was determined through comparing student performance across EPAs to predicted milestones to identify areas of least entrustment. STATISTICAL ANALYSES PERFORMED Student performance over time and differences between student self-assessment and supervisor assessment for each EPA were investigated using Wilcoxon signed-rank tests and linear mixed-model analysis. Descriptive statistics summarised student performance against each EPA. RESULTS Performance significantly increased over time in 35 out of 37 EPAs. Significant differences between supervisor and student self-assessment were evident in 9 out of 37 EPAs. Dietetics student performance varied across EPAs with 88.2% of students achieving entrustment for nutrition management EPAs compared with 100% for professionalism EPAs. CONCLUSIONS The tool's construct validity was established. EPAs identified areas of Nutrition Care Process skills development requiring additional support. Data collected by the tool can inform teaching.
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Affiliation(s)
- Andrea Bramley
- School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, Victoria, Australia; Monash Health, Clayton, Victoria, Australia.
| | - Adrienne Forsyth
- School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, Victoria, Australia; Australian Catholic University, Melbourne, Victoria, Australia
| | - Lisa McKenna
- School of Nursing and Midwifery, College of Science, Health, and Engineering, La Trobe University, Bundoora, Victoria, Australia
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Jonker G, Booij E, Vernooij JEM, Kalkman CJ, ten Cate O, Hoff RG. In pursuit of a better transition to selected residencies: a quasi-experimental evaluation of a final year of medical school dedicated to the acute care domain. BMC MEDICAL EDUCATION 2022; 22:807. [PMID: 36419057 PMCID: PMC9684806 DOI: 10.1186/s12909-022-03871-0] [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: 02/01/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Medical schools seek the best curricular designs for the transition to postgraduate education, such as the Dutch elective-based final, 'transitional' year. Most Dutch graduates work a mean of three years as a physician-not-in-training (PNIT) before entering residency training. To ease the transition to selected specialties and to decrease the duration of the PNIT period, UMC Utrecht introduced an optional, thematic variant of the usual transitional year, that enables the development of theme-specific competencies, in addition to physicians' general competencies. METHODS We introduced an optional transitional year for interested students around the theme of acute care, called the Acute Care Transitional Year (ACTY). This study aimed to evaluate the ACTY by judging whether graduates meet postgraduate acute care expectations, indicating enhanced learning and preparation for practice. In a comprehensive assessment of acute care knowledge, clinical reasoning, skills, and performance in simulations, we collected data from ACTY students, non-ACTY students interested in acute care, and PNITs with approximately six months of acute care experience. RESULTS ACTY graduates outperformed non-ACTY graduates on skills and simulations, and had higher odds of coming up to the expectations faculty have of a PNIT, as determined by global ratings. PNITs did better on simulations than ACTY graduates. DISCUSSION ACTY graduates show better resemblance to PNITs than non-ACTY graduates, suggesting better preparation for postgraduate acute care challenges. CONCLUSION Transitional years, offering multidisciplinary perspectives on a certain theme, can enhance learning and preparedness for entering residency.
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Affiliation(s)
- Gersten Jonker
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Eveline Booij
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | | | - Cor J. Kalkman
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Olle ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Reinier G. Hoff
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands
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Bramley A, Forsyth A, McKenna L. Development and evaluation of Entrustable Professional Activities embedded in an e-portfolio for work-based assessment in community and public health dietetics. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5445-e5456. [PMID: 35942519 PMCID: PMC10087043 DOI: 10.1111/hsc.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 06/02/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
Entrustable professional activities (EPAs) is a recent concept that helps operationalise competency-based education. In this paper, we report on the development of EPAs and incorporation into an e-portfolio for work-based assessment of final year dietetics students in a community and public health professional placement. We aimed to determine the utility of the EPAs for work-based assessment in this context. We used action research methodology to conduct broad consultation with students and supervisors using anonymous surveys and focus groups to understand their beliefs and attitudes towards work-based assessment. Consequently, 40 EPAs with an accompanying four-point entrustment scale were developed and mapped to the National Competency Standards for Dietitians in Australia. The EPAs and assessment tool were piloted and evaluated via an anonymous online user survey across three cohorts of students (n = 133) and supervisors (n = 67). Following mediocre pilot year evaluation results, EPAs were revised and reduced in number. While students positively evaluated the e-portfolio, their appraisal of the EPAs and entrustment scale was less positive compared to supervisors. Supervisor evaluation of the EPA-based e-portfolio supported the validity, feasibility and acceptability of this novel assessment method in a community and public health setting. Assessment using EPAs, and the resulting educational data collected by the tool, offers potential for individual learners to identify areas needing development during placement, as well as potential to inform curriculum improvements and increase understanding of learning opportunities and outcomes for dietetic students in community and public health settings.
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Affiliation(s)
- Andrea Bramley
- Department of Dietetics and Human NutritionLa Trobe UniversityBundooraVictoriaAustralia
- Monash HealthClayton RoadClaytonVictoriaAustralia
| | - Adrienne Forsyth
- Dietetics and Nutrition at Australian Catholic University, School of Allied Health, Human Services and SportLa Trobe UniversityBundooraVictoriaAustralia
| | - Lisa McKenna
- School of Nursing and Midwifery, College of Science, Health and EngineeringLa Trobe UniversityBundooraVictoriaAustralia
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Brätz J, Bußenius L, Brätz I, Grahn H, Prediger S, Harendza S. Assessment of final-year medical students' entrustable professional activities after education on an interprofessional training ward: A case-control study. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:266-272. [PMID: 35864296 PMCID: PMC9302559 DOI: 10.1007/s40037-022-00720-0] [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: 02/01/2022] [Revised: 06/12/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Interprofessional training wards (ITWs) are implemented to provide medical students with a holistic and authentic health care experience to improve their clinical competencies. Controlled outcome studies assessing students' competencies after ITW-training are uncommon. In this case-control study, we assessed final-year medical students who received ITW-training regarding entrustable professional activities (EPAs) and communicative as well as social competencies. METHODS In March 2021, 32 final-year students, 16 with (ITW group) and 16 without (control group) a previous four-week placement on an ITW participated in a training simulating the first day of residency. The simulated patients assessed students' communication and interpersonal skills for history taking with the ComCare index after every consultation. Twelve prospective EPAs were assessed by three senior physicians after watching videos of the students' case presentations. RESULTS While baseline characteristics and ComCare index ratings were not significantly different between the two groups, the overall mean entrustment level for the 12 EPAs was significantly higher (p < 0.001) in the ITW group compared to the control group (median = 3.15 versus 2.22). The interrater reliability for all EPAs was high and entrustment in students from the ITW group was significantly higher in 10 out of 12 EPAs. DISCUSSION ITW training seems to prepare medical students well to practice competencies which are relevant for prospective entrustment decisions and can be deduced by senior physicians from case presentations. Further studies with larger student cohorts are needed to corroborate this finding and observable EPAs could also be defined to assess students' competencies after ITW training.
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Affiliation(s)
- Julian Brätz
- Heart Center, Cardiology Division, Albertinen Hospital, Hamburg, Germany.
| | - Lisa Bußenius
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Irina Brätz
- Heart Center, Cardiology Division, Albertinen Hospital, Hamburg, Germany
| | - Hanno Grahn
- Department for Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Sarah Prediger
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrid Harendza
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bachmann C, Pettit J, Rosenbaum M. Developing communication curricula in healthcare education: An evidence-based guide. PATIENT EDUCATION AND COUNSELING 2022; 105:2320-2327. [PMID: 34887158 DOI: 10.1016/j.pec.2021.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To present a guide for communication curriculum development in healthcare professions for educators and curriculum planners. METHODS We collated a selection of theories, frameworks and approaches to communication curriculum development to provide a roadmap of the main factors to consider when developing or enhancing communication skills curricula. RESULTS We present an evidence-based guide for developing and enhancing communication curriculum that can be applied to undergraduate and postgraduate healthcare education. Recommended steps to consider during the communication curricula development process include thoughtful examination of current communication education, needs assessment, focused learning goals and objectives, incorporation of experiential educational strategies allowing for skills practice and feedback and use of formative and summative assessment methods. A longitudinal, developmental and helical implementation approach contributes to reinforcement and sustainment of learners' knowledge and skills. CONCLUSION AND PRACTICE IMPLICATIONS Drawing on best practices in developing communication curricula can be helpful in ensuring successful approaches to communication skills training for any level of learner or healthcare profession. This position paper provides a guide and identifies resources for new and established communication curriculum developers to reflect on strengths and opportunities in their own approaches to addressing the communication education needs of their learners.
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Affiliation(s)
- Cadja Bachmann
- Office of the Dean of Education, Medical Faculty, University of Rostock, Germany.
| | - Jeffrey Pettit
- Department of Family Medicine, Office of Consultation and Research in Medical Education, University of Iowa Carver College of Medicine, USA
| | - Marcy Rosenbaum
- Department of Family Medicine, Office of Consultation and Research in Medical Education, University of Iowa Carver College of Medicine, USA
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Dale MacLaine T, Lowe N, Dale J. The use of simulation in medical student education on the topic of breaking bad news: A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:2670-2681. [PMID: 33926808 DOI: 10.1016/j.pec.2021.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Simulated patients (SPs) are widely used, but the most effective way of utilising them in undergraduate breaking bad news (BBN) medical education is unknown. OBJECTIVES To conduct a systematic review into SP's use in developing BBN skills in medical students. METHODS 14 databases searched with the terms "Medical education", "Patient simulation", "Bad news". Data was systematically extracted, and thematic analysis undertaken. RESULTS Of 2117 articles screened, 29 publications met the inclusion criteria. These demonstrated a variety of SP models, including actors as patients (65.5%), peers (7.0%), and cancer survivors (3.5%). with delivery at varying times in the curricula. SPs are uniformly reported as having positive impact, but there is a lack of high-quality evidence comparing the use of differing forms of training. There was some evidence that virtual SPs were as useful as in-person SPs. CONCLUSIONS SPs allow students to practise vital BBN communication skills without risking detriment to patient care. Despite the heterogeneity of ways in which SPs have been used, the benefits of different approaches and when and how these should be delivered remains unclear. PRACTICE IMPLICATIONS Further educational development and research is needed about the use of SPs to support undergraduate BBN communication skills development.
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Affiliation(s)
| | - Nicholas Lowe
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK.
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Piotrkowicz A, Wang K, Hallam J, Dimitrova V. Data-driven Exploration of Engagement with Workplace-based Assessment in the Clinical Skills Domain. INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE IN EDUCATION 2021. [DOI: 10.1007/s40593-021-00264-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractThe paper presents a multi-faceted data-driven computational approach to analyse workplace-based assessment (WBA) of clinical skills in medical education. Unlike formal university-based part of the degree, the setting of WBA can be informal and only loosely regulated, as students are encouraged to take every opportunity to learn from the clinical setting. For clinical educators and placement coordinators it is vital to follow and analyse students’ engagement with WBA while on placements, in order to understand how students are participating in the assessment, and what improvements can be made. We analyse digital data capturing the students’ WBA attempts and comments on how the assessments went, using process mining and text analytics. We compare Year 1 cohorts across three years, focusing on differences between primary vs. secondary care placements. The main contribution of the work presented in this paper is the exploration of computational approaches for multi-faceted, data-driven assessment analytics for workplace learning which includes:(i) a set of features for analysing clinical skills WBA data, (ii) analysis of the temporal aspects ofthat data using process mining, and (iii) utilising text analytics to compare student reflections on WBA. We show how assessment data captured during clinical placements can provide insights about the student engagement and inform the medical education practice. Our work is inspired by Jim Greer’s vision that intelligent methods and techniques should be adopted to address key challenges faced by educational practitioners in order to foster improvement of learning and teaching. In the broader AI in Education context, the paper shows the application of AI methods to address educational challenges in a new informal learning domain - practical healthcare placements in higher education medical training.
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Bramley AL, McKenna L. Entrustable professional activities in entry-level health professional education: A scoping review. MEDICAL EDUCATION 2021; 55:1011-1032. [PMID: 33884655 DOI: 10.1111/medu.14539] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
Entrustable professional activities (EPAs) are a recent enhancement to competency-based health professional education that describe the observable work done by a competent health professional. Through defining education outcomes in a work-based context, EPAs offer potential to identify skill gaps in individual or student cohorts and focus improvements. Entrustable professional activities have been pioneered and gained rapid acceptance in postgraduate medical education; however, less is known about their application and use in undergraduate or entry-level health professional education. The Joanna Briggs Institute scoping review methodology was used to explore how and in what context EPAs are being used in entry-level health professional education. Databases searched include CINAHL, EMBASE, MEDLINE, Web of Science and PsycINFO. A total of 748 abstracts were returned after duplicates removed, and 127 full-text articles were screened with 30 included for data extraction. Publications in this area have recently accelerated with disciplines of professions of medicine, pharmacy, dietetics and physician assistants reporting on EPA development, implementation and evaluation. EPA use has been reported in the United States, Canada, Europe Australia and Central America. Major motivation reported for EPA use is to improve patient safety by aligning performance and expectations and to improve student assessment. Several studies report on the use of EPAs to evaluate different curriculum models or identify curriculum gaps representing potential application in education research.
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Affiliation(s)
- Andrea Louise Bramley
- Department of Nutrition and Dietetics, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Lisa McKenna
- School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
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12
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Uraiby H, Grafton-Clarke C, Gordon M, Sereno M, Powell B, McCarthy M. Fostering intrinsic motivation in remote undergraduate histopathology education. J Clin Pathol 2021; 75:837-843. [PMID: 34429354 DOI: 10.1136/jclinpath-2021-207640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/30/2021] [Indexed: 11/04/2022]
Abstract
AIMS The levels of abstraction, vast vocabulary and high cognitive load present significant challenges in undergraduate histopathology education. Self-determination theory describes three psychological needs which promote intrinsic motivation. This paper describes, evaluates and justifies a remotely conducted, post-COVID-19 histopathology placement designed to foster intrinsic motivation. METHODS 90 fourth-year medical students took part in combined synchronous and asynchronous remote placements integrating virtual microscopy into complete patient narratives through Google Classroom, culminating in remote, simulated multidisciplinary team meeting sessions allowing participants to vote on 'red flag' signs and symptoms, investigations, histological diagnoses, staging and management of simulated virtual patients. The placement was designed to foster autonomy, competence and relatedness, generating authenticity, transdisciplinary integration and clinical relevance. A postpositivistic evaluation was undertaken with a validated preplacement and postplacement questionnaire capturing quantitative and qualitative data. RESULTS There was a significant (p<0.001) improvement in interest, confidence and competence in histopathology. Clinical integration and relevance, access to interactive resources and collaborative learning promoted engagement and sustainability post-COVID-19. Barriers to online engagement included participant lack of confidence and self-awareness in front of peers. CONCLUSIONS Fostering autonomy, competence and relatedness in post-COVID-19, remote educational designs can promote intrinsic motivation and authentic educational experiences. Ensuring transdisciplinary clinical integration, the appropriate use of novel technology and a focus on patient narratives can underpin the relevance of undergraduate histopathology education. The presentation of normal and diseased tissue in this way can serve as an important mode for the acquisition and application of clinically relevant knowledge expected of graduates.
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Affiliation(s)
- Hussein Uraiby
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK .,Leicester Medical School, University of Leicester, Leicester, UK
| | - Ciaran Grafton-Clarke
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK.,Leicester Medical School, University of Leicester, Leicester, UK
| | - Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Marco Sereno
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Barbara Powell
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Mark McCarthy
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK.,Leicester Medical School, University of Leicester, Leicester, UK
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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.
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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
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14
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Hernandez MJ. A Comparison of Selected Items Found in Graduation Survey Instruments from MD and DO Schools. What It Reveals About Satisfaction with Career Choice. MEDICAL SCIENCE EDUCATOR 2020; 30:1413-1418. [PMID: 34457808 PMCID: PMC8368404 DOI: 10.1007/s40670-020-01045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Selected items in graduation survey instruments from MD and DO schools were compared using a novel combined approach which revealed meaningful information about career choice. Although the student satisfaction with medical education had remained steady during the past decade for both MD and DO programs, the dissatisfaction with medical programs at time of graduation was different (p < 0.001). The level of unhappiness with career choice was also different (p < 0.001). An analysis of the Year Two Questionnaire, introduced in 2015 by the American Association of Medical Colleges, showed dissatisfaction with career choice in MD programs increased after graduation.
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Affiliation(s)
- Mark J. Hernandez
- Alabama College of Osteopathic Medicine, 445 Health Sciences Boulevard, Dothan, AL USA
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15
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Warrier V, Pradhan A. A Narrative Review of Interventions to Teach Medical Students How to Break Bad News. MEDICAL SCIENCE EDUCATOR 2020; 30:1299-1312. [PMID: 34457793 PMCID: PMC8368663 DOI: 10.1007/s40670-020-01015-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Breaking bad news (BBN) is a key advanced communication skill that physicians must learn. Despite the breadth of literature describing patients' preferences and data citing poor physician competency in this arena, there remains significant dissatisfaction with how doctors deliver bad news. One way to solve this dilemma is to ensure that we are using the best evidence-based educational approaches to train the cadre of medical students who graduate from medical school each year. This article provides a 15-year review of articles on BBN in the undergraduate medical education curriculum that have been validated using the Medical Education Research Quality Instrument (MERSQI) (Acad Med 90:1067-76, 2015). This narrative review aims to identify articles which describe undergraduate medical education curriculum that evaluate how to best teach students to communicate bad news to patients. In the process, the authors reviewed 179 abstracts in 118 academic journals. Articles that met the inclusion criteria were evaluated using the MERSQI and those that scored higher than 11.3 were chosen for analysis. This paper summarizes the 15 articles that met the criteria. The review reveals (1) standard components which should be included in an undergraduate BBN curriculum, (2) a pressing need for utilizing a teaching and evaluation tool that incorporates nonverbal communication, and (3) a further need to test long-term curriculum retention.
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Affiliation(s)
| | - Archana Pradhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ USA
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16
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Fincke F, Prediger S, Schick K, Fürstenberg S, Spychala N, Berberat PO, Harendza S, Kadmon M. Entrustable professional activities and facets of competence in a simulated workplace-based assessment for advanced medical students. MEDICAL TEACHER 2020; 42:1019-1026. [PMID: 32579039 DOI: 10.1080/0142159x.2020.1779204] [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: 06/11/2023]
Abstract
Background: Competence-based assessment formats in medical education usually focus on individual facets of competence (FOCs). The concept of 'Entrustable Professional Activities' (EPAs) encompasses supervisors' decisions on which level of supervision a trainee requires to perform a professional activity including several FOCs. How the different FOCs as perceived by clinician raters contribute to entrustment decisions is yet unclear.Objective: How do FOC perceptions relate to entrustment-decisions?Methods: Sixty-seven advanced medical students participated in an assessment simulating the first day of a resident physician. Participants were rated by supervisors for seven FOCs and twelve EPAs.Results: There was a positive correlation between FOC and EPA scores. Each EPA displayed a different correlation pattern with FOC ratings.Discussion: For most EPAs high levels of entrustment were associated with high ratings for selected FOCs. The results are in alignment with the assumption that each EPA encompasses a different set of FOCs.Conclusions: In our simulated workplace-based assessment, entrustment decisions for EPAs reflect the FOCs observed in a trainee. Thus, assessment of FOCs alongside with EPA ratings could add to the understanding of factors contributing to entrustment decisions.
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Affiliation(s)
- Fabian Fincke
- Department of Medical Education and Educational Research, Faculty of Medicine and Health Science, University of Oldenburg, Oldenburg, Germany
| | - Sarah Prediger
- 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
| | - Sophie Fürstenberg
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nadine Spychala
- Department of Medical Education and Educational Research, Faculty of Medicine and Health Science, University of Oldenburg, Oldenburg, Germany
| | - Pascal O Berberat
- TUM Medical Education Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sigrid Harendza
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Kadmon
- Department of Medical Education Augsburg, Faculty of Medicine, University of Augsburg, Augsburg, Germany
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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.
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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
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18
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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.
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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
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Meyer EG, Chen HC, Uijtdehaage S, Durning SJ, Maggio LA. Scoping Review of Entrustable Professional Activities in Undergraduate Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1040-1049. [PMID: 30946134 DOI: 10.1097/acm.0000000000002735] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE Entrustable professional activities (EPAs) are a hot topic in undergraduate medical education (UME); however, the usefulness of EPAs as an assessment approach remains unclear. The authors sought to better understand the literature on EPAs in UME through the lens of the 2010 Ottawa Conference Criteria for Good Assessment. METHOD The authors conducted a scoping review of the health professions literature (search updated February 2018), mapping publications to the Ottawa Criteria using a collaboratively designed charting tool. RESULTS Of the 1,089 publications found, 71 (6.5%) met inclusion criteria. All were published after 2013. Forty-five (63.4%) referenced the 13 Core Entrustable Professional Activities for Entering Residency developed by the Association of American Medical Colleges (AAMC). Forty (56.3%) were perspectives, 5 (7.0%) were reviews, and 26 (36.6%) were prospective empirical studies. The publications mapped to the Ottawa Criteria 158 times. Perspectives mapped more positively (83.7%) than empirical studies (76.7%). Reproducibility did not appear to be a strength of EPAs in UME; however, reproducibility, equivalence, educational effect, and catalytic effect all require further study. Inconsistent use of the term "EPA" and conflation of concepts (activity vs assessment vs advancement decision vs curricular framework) limited interpretation of published results. Overgeneralization of the AAMC's work on EPAs has influenced the literature. CONCLUSIONS Much has been published on EPAs in UME in a short time. Now is the time to move beyond opinion, clarify terms, and delineate topics so that well-designed empirical studies can demonstrate if and how EPAs should be implemented in UME.
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Affiliation(s)
- Eric G Meyer
- E.G. Meyer is assistant professor, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0002-0538-4344. H.C. Chen is professor, Department of Pediatrics, Georgetown University School of Medicine, Washington, D.C.; ORCID: https://orcid.org/0000-0003-1663-1598. S. Uijtdehaage is professor, Department of Medicine, Division of Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0001-8598-4683. S.J. Durning is professor, Department of Medicine, Division of Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland. L.A. Maggio is associate professor, Department of Medicine, Division of Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0002-2997-6133
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Rhodes LA, Marciniak MW, McLaughlin J, Melendez CR, Leadon KI, Pinelli NR. Exploratory Analysis of Entrustable Professional Activities as a Performance Measure During Early Pharmacy Practice Experiences. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:6517. [PMID: 30962638 PMCID: PMC6448523 DOI: 10.5688/ajpe6517] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/03/2017] [Indexed: 05/02/2023]
Abstract
Objective. To examine entrustable professional activities (EPAs) as an assessment tool for student pharmacists completing early practice experiences. Methods. Students completed a 2-month practice experience upon conclusion of their first year. Student performance on EPAs was assessed by preceptors and students at the midpoint and conclusion of the experience using a scale that ranged from dependent (1.0) to independent (5.0). Wilcoxon Signed-Rank Test assessed for differences between the midpoint and final evaluations on student self-evaluations and between the midpoint and final evaluation on preceptor-student evaluations. Cronbach's α assessed reliability of the EPAs. Results. From May to August 2016, 147 students completed a practice experience. Student-self and preceptor-student evaluations at the midpoint and final approximated a median score of 3.0 (IQR 2) and 4.0 (IQR 3), respectively, on EPAs 1-14. Analyses revealed statistically significant increases from midpoint to final evaluation for all constructs on both evaluations. Cronbach's α yielded scores of 0.98 for the preceptor evaluations and 0.95 for the student self-evaluation. Conclusion. There was an increase in student performance over time. The EPA statements may be a reliable assessment tool for student performance in pharmacy education.
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Affiliation(s)
- Laura A Rhodes
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Macary Weck Marciniak
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jacqueline McLaughlin
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carlos R Melendez
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kim I Leadon
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nicole R Pinelli
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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21
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Fürstenberg S, Prediger S, Kadmon M, Berberat PO, Harendza S. Perceived strain of undergraduate medical students during a simulated first day of residency. BMC MEDICAL EDUCATION 2018; 18:322. [PMID: 30594177 PMCID: PMC6310964 DOI: 10.1186/s12909-018-1435-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/17/2018] [Indexed: 05/24/2023]
Abstract
BACKGROUND Residents face demanding situations on the job and have been found to perceive high levels of strain. Medical students also reported a high degree of strain and even depressive tendencies when entering their clinical rotations. The aim of this study was to explore the perceived strain of medical students from different undergraduate curricula and at different stages of academic advancement during different phases of an assessment simulating a resident's first day in hospital. METHODS Sixty-seven undergraduate medical students participated in the following three phases of the assessment in the role of a resident: a consultation hour with five simulated patients, a management phase with interprofessional contact, and a patient handover with a colleague. They completed the Strain Perception Questionnaire (STRAIPER) after each phase. Students from different undergraduate curricula (VI: vertically integrated, n = 35 versus non-VI: not vertically integrated, n = 26) and different academic advancement (semester 10, n = 26 versus final year, n = 41) were compared. RESULTS All students showed the highest strain level after the management phase compared to the consultation hour and the handover. Medical students from a non-VI curriculum felt significantly more strain in the dimension of agitation (p < .05) after the consultation hour compared to students from a VI curriculum and compared to the management phase and the handover. No significant difference in perceived strain was found between students from semester 10 compared to final year students. CONCLUSIONS During the consultation hour and the handover with a colleague medical students faced tasks which are familiar to them from undergraduate education. Their higher strain levels during the management phase might occur because they are confronted with unfamiliar tasks and decisions. Feeling responsible for the right actions in this phase of multitasking and professional interaction might have added to the strain students perceived during this phase. Patient management should be emphasized more in any type of undergraduate medical curriculum.
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Affiliation(s)
- Sophie Fürstenberg
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Prediger
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Kadmon
- Faculty of Medicine, University of Augsburg, Deanery, Augsburg, Germany
| | - Pascal O. Berberat
- TUM Medical Education Center, School of Medicine, Technical University of Munich, Munich, 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
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Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-Added Activities in Medical Education: A Multisite Survey of First- and Second-Year Medical Students' Perceptions and Factors Influencing Their Potential Engagement. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1560-1568. [PMID: 29794526 DOI: 10.1097/acm.0000000000002299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To describe attitudes of first- and second-year U.S. medical students toward value-added medical education, assess their self-reported desire to participate in value-added activities, and identify potentially modifiable factors influencing their engagement. METHOD The authors conducted a cross-sectional survey of first- and second-year students at nine U.S. medical schools in 2017. Survey items measured students' attitudes toward value-added medical education (n = 7), desire to participate in value-added activities (n = 20), and factors influencing potential engagement (n = 18). RESULTS Of 2,670 students invited to participate, 1,372 (51%) responded. Seventy-six percent (1,043/1,368) moderately or strongly agreed they should make meaningful contributions to patient care. Students' desire to participate was highest for patient care activities approximating those traditionally performed by physicians, followed by systems improvement activities and lowest for activities not typically performed by physicians. Factors increasing desire to participate included opportunities to interact with practicing physicians (1,182/1,244; 95%), patients (1,177/1,246; 95%), and residents or fellows (1,166/1,246; 94%). Factors decreasing desire to participate included making changes to the health care system (365/1,227; 30%), interacting with patients via phone or electronic communication (410/1,243; 33%), and lack of curricular time (634/1,233; 51%). CONCLUSIONS First- and second-year medical students agree they should add value to patient care, but their desire to participate in value-added activities varies depending on the nature of the tasks. Medical schools may be able to increase students' desire to participate by enabling face-to-face interactions with patients, embedding students in health care teams, and providing dedicated curricular time.
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Affiliation(s)
- Andrea N Leep Hunderfund
- A.N. Leep Hunderfund is assistant professor of neurology, Mayo Clinic, and associate director, Mayo Clinic Program in Professionalism and Values, Rochester, Minnesota. S.R. Starr is associate professor of pediatrics and director, Science of Health Care Delivery Education, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota. L.N. Dyrbye is professor of medical education and medicine, Mayo Clinic, Rochester, Minnesota. J.D. Gonzalo is associate professor of medicine and public health sciences and associate dean, Health Systems Education, Pennsylvania State University College of Medicine, Hershey, Pennsylvania. P. George is associate professor of family medicine and associate professor of medical science, Alpert Medical School, Brown University, Providence, Rhode Island. B.M. Miller is professor of medical education and administration and professor of clinical surgery, associate vice chancellor, Health Affairs, and senior associate dean, Health Sciences Education, Vanderbilt University School of Medicine, Nashville, Tennessee. H.K. Morgan is associate clinical professor of obstetrics and gynecology and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan. A. Hoffman is assistant clinical professor of medicine, Division of Hospital Medicine, University of California, San Francisco School of Medicine, San Francisco, California. E.G. Baxley is professor of family medicine and senior associate dean, Academic Affairs, Brody School of Medicine, East Carolina University, Greenville, North Carolina. B.L. Allen is associate professor of clinical medicine and senior associate dean, Medical Student Education, Indiana University School of Medicine, Indianapolis, Indiana. T.L. Fancher is associate professor of medicine, University of California, Davis School of Medicine, Sacramento, California. J. Mandrekar is professor of biostatistics and neurology, Mayo Clinic, Rochester, Minnesota. S.E. Skochelak is group vice president for medical education, American Medical Association, Chicago, Illinois. D.A. Reed is associate professor of medical education and medicine and senior associate dean, Academic Affairs, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota
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Johnson J, Panagioti M. Interventions to Improve the Breaking of Bad or Difficult News by Physicians, Medical Students, and Interns/Residents: A Systematic Review and Meta-Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1400-1412. [PMID: 29877913 DOI: 10.1097/acm.0000000000002308] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To assess the effectiveness of news delivery interventions to improve observer-rated skills, physician confidence, and patient-reported depression/anxiety. METHOD MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Register of Controlled Trials databases were searched from inception to September 5, 2016 (updated February 2017). Eligible studies included randomized controlled trials (RCTs), non-RCTs, and controlled before-after studies of interventions to improve the communication of bad or difficult news by physicians, medical students, and residents/interns. The EPOC risk of bias tool was used to conduct a risk of bias assessment. Main and secondary meta-analyses examined the effectiveness of the identified interventions for improving observer-rated news delivery skills and improving physician confidence in delivering news and patient-reported depression/anxiety, respectively. RESULTS Seventeen studies were included in the systematic review and meta-analysis, including 19 independent comparisons on 1,322 participants and 9 independent comparisons on 985 participants for the main and secondary (physician confidence) analyses (mean [SD] age = 35 [7] years; 46% male), respectively. Interventions were associated with large, significant improvements in observer-rated news delivery skills (19 comparisons: standardized mean difference [SMD] = 0.74; 95% CI = 0.47-1.01) and moderate, significant improvements in physician confidence (9 comparisons: SMD = 0.60; 95% CI = 0.26-0.95). One study reported intervention effects on patient-reported depression/anxiety. The risk of bias findings did not influence the significance of the results. CONCLUSIONS Interventions are effective for improving news delivery and physician confidence. Further research is needed to test the impact of interventions on patient outcomes and determine optimal components and length.
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Affiliation(s)
- Judith Johnson
- J. Johnson is joint lecturer, School of Psychology, University of Leeds, Leeds, United Kingdom, and Bradford Institute for Health Research, Bradford, United Kingdom; ORCID: https://orcid.org/0000-0003-0431-013X. M. Panagioti is senior research fellow, National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; ORCID: https://orcid.org/0000-0002-7153-5745
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McClintic JA, Snyder CL, Brown KM. Curricular Innovation in the Surgery Clerkship: Can Assessment Methods Influence Development of Critical Thinking and Clinical Skills? JOURNAL OF SURGICAL EDUCATION 2018; 75:1236-1244. [PMID: 29545129 DOI: 10.1016/j.jsurg.2018.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/14/2018] [Accepted: 02/20/2018] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Although key clinical skills have been defined in the Core Entrustable Professional Activities, there is a need to improve medical school curricula with standardized training opportunities and assessments of these skills. Thus, we aimed to develop an innovative curriculum that emphasized critical thinking and clinical skills. We hypothesized that we would be able to observe measurable improvement on assessments of students' critical thinking and clinical skills after the implementation of the new curriculum. DESIGN Prospective, Quasi-Experimental study with the use of historical controls. SETTING This study took place through the third-year surgical clerkship at the University of Texas Medical Branch at the Galveston, Houston, and Austin, Texas, locations. PARTICIPANTS A total of 214 students taking the third-year surgical clerkship for the first time during the periods of interest were included. RESULTS Although the students with traditional curriculum improved 9.5% on a short answer exam from preclerkship to postclerkship completion, the students with new curriculum improved by 40%. Students under the new curriculum performed significantly better on the Objective Structured Clinical Exam; however, their shelf scores were lower. CONCLUSIONS Under this new curriculum and grading system, we demonstrated that students can be incentivized to improve critical thinking and clinical skills, but this needs to be balanced with knowledge-based incentives.
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Affiliation(s)
- James A McClintic
- Department of Surgery, The University of Texas Medical Branch, Galveston, Texas.
| | - Clifford L Snyder
- Department of Surgery, The University of Texas Medical Branch, Galveston, Texas
| | - Kimberly M Brown
- Department of Surgery, The University of Texas Medical Branch, Galveston, Texas
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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.
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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
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Bachmann C, Roschlaub S, Harendza S, Keim R, Scherer M. Medical students' communication skills in clinical education: Results from a cohort study. PATIENT EDUCATION AND COUNSELING 2017; 100:1874-1881. [PMID: 28601262 DOI: 10.1016/j.pec.2017.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 05/19/2017] [Accepted: 05/21/2017] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess students' communication skills during clinical medical education and at graduation. METHODS We conducted an observational cohort study from 2007 to 2011 with 26 voluntary undergraduate medical students at Hamburg University based on video-taped consultations in year four and at graduation. 176 consultations were analyzed quantitatively with validated and non-validated context-independent communication observation instruments (interrater reliability ≥0.8). Based on observational protocols each consultation was also documented in free-text comments, salient topics were extracted afterwards. RESULTS 26 students, seven males, were enrolled in the survey. On average, graduates scored higher in differential-diagnostic questioning and time management but showed deficiencies in taking systematic and complete symptom-oriented histories, in communication techniques, in structuring consultations and in gathering the patients' perspectives. Patient-centeredness and empathy were rather low at graduation. Individual deficiencies could barely be eliminated. CONCLUSION Medical students were able to enhance their clinical reasoning skills and their time management. Still, various communication deficiencies in final year students became evident regarding appropriate history taking, communication skills, empathy and patient-centeredness. PRACTICE IMPLICATIONS The necessity of developing a longitudinal communication curriculum with enhanced communication trainings and assessments became evident. A curriculum should ensure that students' communication competencies are firmly achieved at graduation.
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Affiliation(s)
- Cadja Bachmann
- Institute of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Medical Education, Faculty of Medicine, University of Bern, Switzerland.
| | | | - Sigrid Harendza
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Keim
- Institute of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Institute of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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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.
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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
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