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Liaw SY, Rusli KDB, McKenna L, Tan JZ, Lau ST. Effectiveness of an online program using telesimulation for academic-clinical collaboration in preparing nurse preceptors' roles. J Clin Nurs 2023; 32:1115-1124. [PMID: 35470506 DOI: 10.1111/jocn.16339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the effectiveness of an online program on nurse preceptors' knowledge and self-efficacy in their roles to support students' clinical education, and to examine their online experience. BACKGROUND Professional development of nurse preceptors is paramount to fostering work readiness of future graduate nurses on entering the workforce. The support from academic institutions in developing preceptors' roles in clinical teaching and assessment is pivotal. DESIGN This study employed a mixed-methods design. METHOD A total of 59 nurse preceptors from six healthcare institutions participated in an online preceptor program by collaborating with academic educators in facilitating student clinical learning and assessment through telesimulation following web-based instruction. Pre-test and post-tests were administered to evaluate the preceptors' knowledge and self-efficacy in their roles. Survey questionnaires and focus group discussions were conducted to evaluate their online experience. SQUIRE 2.0 guidelines were applied. RESULTS The preceptors demonstrated significant improvements (p < .001) in knowledge and levels of self-efficacy in their preceptor roles immediately and 1 month after the program. The following four themes emerged from their learning experiences: 'interactive learning approach', 'academic-practice collaboration', 'better understanding of clinical assessment tool' and 'application of teaching strategies'. The preceptors reported positively on their motivation to learn using the web-based instruction and on their telesimulation experience. CONCLUSION The study findings demonstrated effectiveness and feasibility of an online preceptor program to enhance preceptors' roles in supporting nursing students' transition to clinical practice, using a mix of web-based technologies to provide preceptors with self-directed and experiential learning approaches. RELEVANCE TO CLINICAL PRACTICE This study contributed to the development of an innovative online preceptor program that provided opportunity for academic-clinical collaboration and has broad applicability. The telesimulation created robust remote simulation experiences for preceptors, allowing them to collaborate with academic educators in facilitating students' clinical practice amid the COVID-19 pandemic.
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Affiliation(s)
- Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Khairul Dzakirin Bin Rusli
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lisa McKenna
- School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Jian Zhi Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Rusli KDB, Lau ST, Tan JZ, Liaw SY. Academic-Practice Collaboration Using Virtual Telesimulation to Support Students' Clinical Practice. Nurse Educ 2023; 48:E6-E10. [PMID: 35926138 DOI: 10.1097/nne.0000000000001243] [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: 12/13/2022]
Abstract
BACKGROUND Collaboration between academic institutions and clinical practice plays an important role in supporting students' learning in clinical practice. A virtual telesimulation was incorporated to provide academic-practice collaboration between academic educators and nurse preceptors to support students' clinical education. PURPOSE The purpose was to evaluate the experiences of nursing students and academic educators on the perceived impact of virtual telesimulation in clinical education. METHODS A descriptive qualitative study using focus group discussions was conducted. RESULTS Four themes emerged: "coming together to know one another" for rapport building, "learning from different perspectives" to foster clinical learning and practice, "application of learning strategy" to stimulate case-based discussion, and "reaching out to more preceptors" to optimize its impact in clinical practice. CONCLUSIONS Academic-practice collaboration using virtual telesimulation enabled students and academic educators to build rapport with clinical preceptors and learn from other practices, which in turn enhanced students' clinical learning experiences.
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Affiliation(s)
- Khairul Dzakirin Bin Rusli
- PhD Candidate & Research Assistant (Khairul), Associate Professor (Siew Tiang), Research Assistant (Jian Zhi), and Associate Professor (Sok Ying), Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Feijó LP, Pereira GA, Ruffini VMT, Valente FS, dos Santos RA, Fakhouri SA, Nunes MDPT, Augusto KL. Effectiveness of a SNAPPS in psychiatric residents assessed using objective structured teaching encounters: a case-control study. SAO PAULO MED J 2022; 141:e20211028. [PMID: 36197349 PMCID: PMC10065108 DOI: 10.1590/1516-3180.2021.1028.r1.13072022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Residents play the role of teachers in almost one-quarter of their activities in residency programs. OBJECTIVE To evaluate whether a 45-minute class using summarize, narrow, analyze, probe, plan, and select (SNAPPS) could improve psychiatry residents' case discussion skills in diverse practical learning settings. DESIGN AND SETTING This case-control, randomized, blinded study was conducted in a psychiatry hospital at Fortaleza-Ceará. METHODS Using "resident as teacher" (RaT), objective structured teaching encounters (OSTEs), and SNAPPS, we conducted a study with 26 psychiatry residents. We analyzed video footage of psychiatric cases in three settings: outpatient, nursing, and emergency. An intervention was held two months later with the residents, who were then assigned to two groups: group A (lecture on SNAPPS) and group B (lecture on a topics in psychiatry). Shortly after the lectures, they were video recorded while discussing the same cases. Three blinded examiners analyzed the videos using an instrument based on the Stanford Faculty Development Program (SFDP-26). RESULTS We found high internal consistency among external examiners and an interaction effect, group effect, and moment effect (P < 0.05). The residents who received the SNAPPS lecture scored significantly higher than their counterparts who received a traditional case presentation. CONCLUSION This study indicates the efficacy of SNAPPS over traditional case presentation in all three settings as assessed by OSTEs and supports its implementation to improve the teaching of clinical reasoning.
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Affiliation(s)
- Lorena Pinho Feijó
- MSc. Physician and Assistant Professor, Department of Social
Department, Centro Universitário Unichristus, Fortaleza (CE), Brazil
| | - Guilherme Abreu Pereira
- MD. Attending Physician, Department of Internal Medicine,
Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo,
Sao Paulo, SP, BR
| | - Vitor Maia Teles Ruffini
- MD. Physician and Associate Professor, Department of Internal
Medicine, Universidade Santo Amaro (UNISA), São Paulo (SP), Brazil; and Fellow
of Hospital Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo,
Sao Paulo, SP, BR
| | - Fernando Salvetti Valente
- MD. Physician and Assistant Professor, Department of Internal
Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP,
BR
| | - Renato Antunes dos Santos
- PhD. Physician and Assistant Professor, Department of
Psychiatry, University of Toronto, Toronto, Canada. And Adjunct Professor,
Department of Psychiatry, McMaster University, Ontario, Canada
| | - Saadallah Azor Fakhouri
- PhD. Physician and Professor, Department of Internal Medicine,
Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil
| | - Maria do Patrocínio Tenório Nunes
- PhD. Physician and Associate Professor, Department of Internal
Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP,
BR
| | - Kristopherson Lustosa Augusto
- PhD. Physician and Assistant Professor, Department of
Internal Medicine, Faculdade de Medicina, Universidade de Fortaleza (UNIFOR),
Fortaleza (CE), Brazil; Postgraduate Professor at master's level, Centro
Universitário Christus-Unichristus Fortaleza (CE), Brazil; and Assistant
Professor, Department of Internal Medicine, Faculdade de Medicina da
Universidade Federal do Ceará (UFC), Fortaleza (CE), Brazil
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4
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O'Neill LB, Bhansali P, Bost JE, Chamberlain JM, Ottolini MC. "Sick or not sick?" A mixed methods study evaluating the rapid determination of illness severity in a pediatric emergency department. Diagnosis (Berl) 2021; 9:207-215. [PMID: 34890171 DOI: 10.1515/dx-2021-0093] [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: 07/13/2021] [Accepted: 10/29/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Experienced physicians must rapidly identify ill pediatric patients. We evaluated the ability of an illness rating score (IRS) to predict admission to a pediatric hospital and explored the underlying clinical reasoning of the gestalt assessment of illness. METHODS We used mixed-methods to study pediatric emergency medicine physicians at an academic children's hospital emergency department (ED). Physicians rated patients' illness severity with the IRS, anchored by 0 (totally well) and 10 (critically ill), and shared their rationale with concurrent think-aloud responses. The association between IRS and need for hospitalization, respiratory support, parenteral antibiotics, and resuscitative intravenous (IV) fluids were analyzed with mixed effects linear regression. Area under the curve (AUC) receiver operator characteristic (ROC) curve and test characteristics at different cut-points were calculated for IRS as a predictor of admission. Think-aloud responses were qualitatively analyzed via inductive process. RESULTS A total of 141 IRS were analyzed (mean 3.56, SD 2.30, range 0-9). Mean IRS were significantly higher for patients requiring admission (4.32 vs. 3.13, p<0.001), respiratory support (6.15 vs. 3.98, p = 0.033), IV fluids (4.53 vs. 3.14, p < 0.001), and parenteral antibiotics (4.68 vs. 3.32, p = 0.009). AUC for IRS as a predictor of admission was 0.635 (95% CI: 0.534-0.737). Analysis of 95 think-aloud responses yielded eight categories that describe the underlying clinical reasoning. CONCLUSIONS Rapid assessments as captured by the IRS differentiated pediatric patients who required admission and medical interventions. Think-aloud responses for the rationale for rapid assessments may form the basis for teaching the skill of identifying ill pediatric patients.
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Affiliation(s)
- Laura B O'Neill
- Division of Hospital Medicine at Children's National Hospital, and George Washington University of Medicine and Health Sciences, Washington, DC, USA
| | - Priti Bhansali
- Division of Hospital Medicine at Children's National Hospital, and George Washington University of Medicine and Health Sciences, Washington, DC, USA
| | - James E Bost
- Department of Biostatistics and Study Methodology at Children's National Hospital, and George Washington University of Medicine and Health Sciences, Washington, DC, USA
| | - James M Chamberlain
- Division of Emergency Medicine at Children's National Hospital, and George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Mary C Ottolini
- Tufts University School of Medicine and the George W. Hallett MD Chair of Pediatrics at the Barbara Bush Children's Hospital, Portland, ME, USA
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5
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Fagundes EDT, Ibiapina CC, Alvim CG, Fernandes RAF, Carvalho-Filho MA, Brand PLP. Case presentation methods: a randomized controlled trial of the one-minute preceptor versus SNAPPS in a controlled setting. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:245-250. [PMID: 32430879 PMCID: PMC7458993 DOI: 10.1007/s40037-020-00588-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION One-minute preceptor (OMP) and SNAPPS (a mnemonic for Summarize history and findings; Narrow the differential; Analyze the differential; Probe the preceptor about uncertainties; Plan management; and Select case-related issues for self-study) are educational techniques developed to promote learners' expression of clinical reasoning during the case presentation in the workplace. The aim of this present study was to compare the content of the case presentation between the SNAPPS and the OMP methods. METHODS This was a randomized controlled trial comparing SNAPPS and OMP in 60 medical students at the beginning of their fifth year of medical school. After an introduction session, students presented and discussed two cases based on real patients and provided in written format. All case presentations were recorded and evaluated by two researchers. The assessed elements of the case presentations were divided into three subgroups related to expression of clinical reasoning, time and initiative to guide the presentation. RESULTS There were 30 participants in each group. There was no difference in the expression of clinical reasoning between OMP and SNAPPS groups (number of differential diagnoses, justification of most likely diagnosis and differential diagnosis, expression of comparing and contrasting hypotheses). However, students in the SNAPPS group expressed significantly more questions and uncertainties (p < 0.001), and more often took the initiative to present and justify the most likely diagnosis, differential diagnosis and management plan than students in the OMP group, both in simple and complex cases (all p values <0.001) without extending the length of the teaching session. CONCLUSION OMP and SNAPPS equally promote medical students' expression of clinical reasoning. The SNAPPS technique was more effective than the OMP technique in helping students to take on an active role during case presentation. We propose SNAPPS as an effective learning tool, engaging students and promoting the expression of their clinical reasoning as part of a case presentation.
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Affiliation(s)
- Eleonora D T Fagundes
- Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | - Cássio C Ibiapina
- Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cristina G Alvim
- Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rachel A F Fernandes
- Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marco Antônio Carvalho-Filho
- Department of Clinical Medicine, University of Campinas, Campinas, Brazil
- Center for Education Development and Research in Health Professions, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Paul L P Brand
- Center for Education Development and Research in Health Professions, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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Natesan S, Bailitz J, King A, Krzyzaniak SM, Kennedy SK, Kim AJ, Byyny R, Gottlieb M. Clinical Teaching: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors. West J Emerg Med 2020; 21:985-998. [PMID: 32726274 PMCID: PMC7390547 DOI: 10.5811/westjem.2020.4.46060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/30/2020] [Accepted: 04/09/2020] [Indexed: 01/28/2023] Open
Abstract
Clinical teaching is the primary educational tool use to train learners from day one of medical school all the way to the completion of fellowship. However, concerns over time constraints and patient census have led to a decline in bedside teaching. This paper provides a critical review of the literature on clinical teaching with a focus on instructor teaching strategies, clinical teaching models, and suggestions for incorporating technology. Recommendations for instructor-related teaching factors include adequate preparation, awareness of effective teacher attributes, using evidence-based-knowledge dissemination strategies, ensuring good communication, and consideration of environmental factors. Proposed recommendations for potential teaching strategies include the Socratic method, the One-Minute Preceptor model, SNAPPS, ED STAT, teaching scripts, and bedside presentation rounds. Additionally, this article will suggest approaches to incorporating technology into clinical teaching, including just-in-time training, simulation, and telemedical teaching. This paper provides readers with strategies and techniques for improving clinical teaching effectiveness.
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Affiliation(s)
- Sreeja Natesan
- Duke University, Division of Emergency Medicine, Durham, North Carolina
| | - John Bailitz
- Northwestern University, Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Andrew King
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Sara M. Krzyzaniak
- University of Illinois College of Medicine at Peoria/OSF Healthcare, Department of Emergency Medicine, Peoria, Illinois
| | - Sarah K. Kennedy
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Albert J. Kim
- Washington University in Saint Louis School of Medicine, Department of Emergency Medicine, St. Louis, Missouri
| | - Richard Byyny
- Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado
| | - Michael Gottlieb
- Rush Medical Center, Department of Emergency medicine, Chicago, Illinois
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7
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Horner P, Hunukumbure D, Fox J, Leedham-Green K. Outpatient learning perspectives at a UK hospital. CLINICAL TEACHER 2020; 17:680-687. [PMID: 32578389 DOI: 10.1111/tct.13189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Undergraduate students spend much of their training in the clinical workplace, increasingly in hospital outpatient settings; however, they report that this does not always yield the educational value that they expect. This study investigates ways in which outpatient learning can be enhanced from the perspectives of students and teachers, exploring which approaches may be most appropriate in different circumstances. METHODS We conducted 14 semi-structured interviews with medical students from one UK medical school and consultants (specialists) at a single teaching hospital. We explored their experiences and perceptions of clinical teaching and learning in this outpatient setting. Transcripts were analysed through a consensual qualitative research approach. An evaluation of established frameworks for outpatient teaching was conducted and strategies were matched to stakeholder needs. FINDINGS A total of 24 core ideas were identified, which were categorised into: individual factors (student, doctor and patient), interpersonal factors, team factors and organisational factors. Teaching strategies that address stakeholder needs included: student-led clinics, case-based discussions, one-minute preceptor, the SNAPPS tool (summarize, narrow differential, analyse, probe preceptor, plan and select issues for self-learning), advanced organisers and supplementing. DISCUSSION There is a complex interplay between personal, interpersonal, team and organisational factors that contribute to the effectiveness of the outpatient setting as a learning environment. Strategies at the personal and interpersonal levels are unlikely to be successful or sustained without organisational resourcing and support. Further research is needed to implement and evaluate these suggested strategies.
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Affiliation(s)
| | | | - Jonathan Fox
- Kingston Hospital NHS Foundation Trust, London, UK
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8
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Pierce C, Corral J, Aagaard E, Harnke B, Irby DM, Stickrath C. A BEME realist synthesis review of the effectiveness of teaching strategies used in the clinical setting on the development of clinical skills among health professionals: BEME Guide No. 61. MEDICAL TEACHER 2020; 42:604-615. [PMID: 31961206 DOI: 10.1080/0142159x.2019.1708294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Literature describing the effectiveness of teaching strategies in the clinical setting is limited. This realist synthesis review focuses on understanding the effectiveness of teaching strategies used in the clinical setting.Methods: We searched ten databases for English language publications between 1 January 1970 and 31 May 2017 reporting effective teaching strategies, used in a clinical setting, of non-procedural skills. After screening, we used consensus to determine inclusion and employed a standardised instrument to capture study populations, methodology, and outcomes. We summarised what strategies worked, for whom, and in what settings.Results: The initial search netted 53,642 references after de-duplication; 2037 were retained after title and abstract review. Full text review was done on 82 references, with ultimate inclusion of 25 publications. Three specific teaching strategies demonstrated impact on educational outcomes: the One Minute Preceptor (OMP), SNAPPS, and concept mapping. Most of the literature involves physician trainees in an ambulatory environment. All three have been shown to improve skills in the domains of medical knowledge and clinical reasoning.Discussion/conclusions: Apart from the OMP, SNAPPS, and concept mapping, which target the formation of clinical knowledge and reasoning skills, the literature establishing effective teaching strategies in the clinical setting is sparse.
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Affiliation(s)
- Cason Pierce
- Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
| | - Janet Corral
- Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
| | - Eva Aagaard
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado Anschutz, Aurora, CO, USA
| | - David M Irby
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Chad Stickrath
- Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
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Use of Role-Play Simulation to Improve Nurse Practitioner Students' Case Presentation: An Innovative Educational Approach for the Distance Learner. Nurse Educ 2020; 46:63-64. [PMID: 32433380 DOI: 10.1097/nne.0000000000000862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Gagnon N, Bernier C, Houde S, Xhignesse M. Teaching and learning clinical reasoning: a teacher's toolbox to meet different learning needs. Br J Hosp Med (Lond) 2020; 81:1-8. [PMID: 32239995 DOI: 10.12968/hmed.2019.0406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical reasoning is an essential part of medical practice and therefore should be an important part of clinical teaching. However, it has been and is still a challenge for clinical teachers to support learners in the development of their clinical reasoning skills. As learners progress in clerkship, so do their learning needs. As a result, teachers need multiple tools to foster the development of clinical reasoning and should know when and why to use them. This article presents tools gathered as part of a clinical teacher's toolbox aimed at coaching learners towards the next step in their clinical reasoning development as well as helping teachers diagnose clinical reasoning difficulties and meet the diverse learning needs of their learners. The article focuses on three tools that were developed by faculty at the University of Sherbrooke Faculty of Medicine and Health Sciences: the iSNAPPS-OMP Technique, the Anticipatory Supervision Technique and the Clinical Sudoku or table of discriminating clues. This article uses the term 'tools' as a generic expression to signify 'items in a toolbox'. It includes all kinds of resources (techniques, strategies, models) that were gathered to help clinical teachers with the teaching of clinical reasoning.
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Affiliation(s)
- Nathalie Gagnon
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Carolle Bernier
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Sylvie Houde
- Centre de Pédagogie des Sciences de la Santé, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marianne Xhignesse
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Black CC. Experiential Teaching Paradigms: Adapting the Medical Education Literature to Academic Pathology Practice. Acad Pathol 2019; 6:2374289519892553. [PMID: 31840045 PMCID: PMC6900603 DOI: 10.1177/2374289519892553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/02/2019] [Indexed: 11/15/2022] Open
Abstract
The medical education literature has presented many experiential teaching paradigms to help faculty teach more effectively in busy clinical settings. Three prominent teaching models are The Aunt Minnie model, the SNAPPS model, and the One-Minute Preceptor. Teaching paradigms can help faculty to develop into effective teachers. Each of these models can be adapted to a busy academic pathology practice. The Aunt Minnie model is effective in cases with high pattern recognition, such as repetitive trays of biopsies. The SNAPPS model is learner directed and is easily adapted for an advanced learner with complex cases requiring ancillary testing. The One-Minute Preceptor method is effective for teachers with groups of learners, such as multiheaded scope sessions.
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Affiliation(s)
- Candice C. Black
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical
Center, Lebanon, NH, USA
- Candice C. Black, Department of Pathology and
Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical center Drive,
Lebanon, NH 03756, USA.
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12
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Jain V, Rao S, Jinadani M. Effectiveness of SNAPPS for improving clinical reasoning in postgraduates: randomized controlled trial. BMC MEDICAL EDUCATION 2019; 19:224. [PMID: 31226996 PMCID: PMC6588865 DOI: 10.1186/s12909-019-1670-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/12/2019] [Indexed: 05/12/2023]
Abstract
BACKGROUND In-patient postgraduate teaching suffers with issues like long and unstructured presentations inclusive of a lot of historical information and time constraints due to increasing workload. A six-step pneumonic SNAPPS a learner-centered model modifies the learning encounter by condensing the reporting of facts while encouraging clinical reasoning. This study was planned with the aim to evaluate the effectiveness of SNAPPS as compared to traditional case presentation for facilitating clinical reasoning in inpatient setting. We also wanted to understand perceptions of postgraduates and teachers about this new method of case presentation. METHODS This open labeled randomized controlled trial was carried amongst the 18 residents of department of Medicine, MGIMS. The teachers and residents in the SNAPPS were sensitized to SNAPPS technique by using videos, role plays and handouts over 2 sessions of 30 min each. Twenty-seven case presentations (3/resident) were carried out in each group (total 54 case presentations). Data was recorded into validated data recording sheet after each presentation and feedback was taken from the teacher as well as residents regarding their perception. RESULTS The SNAPPS model heralds a change in the preceptor training, pairing faulty development and learner development as companions in education. Guided by the SNAPPS technique, students summarized patient findings concisely (7 vs. 2.7 vs. 5.22vs. 2.33, p = 0.0057) while maintaining the same degree of thoroughness as in traditional case presentations. The students in the SNAPPS group were clearer about their diagnostic hypothesis and compared and contrasted their different diagnosis well (2.56 vs. 1.74, p value =0.002). The students in the SNAPPS group initiated patient management discussion almost 20% more times as compared to the control group. CONCLUSION We conclude that SNAPPS a learner centered technique for case presentations facilitated the expression of clinical diagnostic reasoning and case based uncertainties in the inpatient setting without extending the unusual length of the student case presentations. It also paved way for enhanced self-directed learning.
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Affiliation(s)
- Vishakha Jain
- Department of Medicine, Mahatma Gandhi Institute of Medical sciences, Sewagram, Wardha, Maharashtra 442102 India
| | - Siddharth Rao
- Department of Surgery, Mahatma Gandhi Institute of Medical sciences, Sewagram, Wardha, Maharashtra 442102 India
| | - Mariya Jinadani
- Department of Physiotherapy, Seth GS medical college and KEM hospital, Mumbai, India
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Sidhu NS, Edwards M. Deliberate teaching tools for clinical teaching encounters: A critical scoping review and thematic analysis to establish definitional clarity. MEDICAL TEACHER 2019; 41:282-296. [PMID: 29703088 DOI: 10.1080/0142159x.2018.1463087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE AND METHOD We conducted a scoping review of tools designed to add structure to clinical teaching, with a thematic analysis to establish definitional clarity. RESULTS Six thousand and forty nine citations were screened, 434 reviewed for eligibility, and 230 identified as meeting study inclusion criteria. Eighty-nine names and 51 definitions were identified. Based on a post facto thematic analysis, we propose that these tools be named "deliberate teaching tools" (DTTs) and defined as "frameworks that enable clinicians to have a purposeful and considered approach to teaching encounters by incorporating elements identified with good teaching practice." We identified 46 DTTs in the literature, with 38 (82.6%) originally described for the medical setting. Forty justification articles consisted of 16 feedback surveys, 13 controlled trials, seven pre-post intervention studies with no control group, and four observation studies. Current evidence of efficacy is not entirely conclusive, and many studies contain methodology flaws. Forty-nine clarification articles comprised 12 systematic reviews and 37 narrative reviews. The most number of DTTs described by any review was four. A common design theme was identified in approximately three-quarters of DTTs. CONCLUSIONS Applicability of DTTs to specific alternate settings should be considered in context, and appropriately designed justification studies are warranted to demonstrate efficacy.
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Affiliation(s)
- Navdeep S Sidhu
- a Department of Anaesthesia and Perioperative Medicine , North Shore Hospital , Auckland , New Zealand
- b Department of Anaesthesiology , University of Auckland , Auckland , New Zealand
| | - Morgan Edwards
- a Department of Anaesthesia and Perioperative Medicine , North Shore Hospital , Auckland , New Zealand
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14
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Abstract
BACKGROUND AND PURPOSE Teaching models provide a systemic framework for didactic and clinical teaching. The One-Minute Preceptor (OMP) is one teaching model, providing five microskills to organize a learning experience for students in the clinical environment. This review aims to integrate the literature on the OMP model by highlighting potential use for nurse practitioners while identifying directions for future research. METHODS Electronic databases were searched from December 2017 to January 2018 for articles published in English. The databases included PubMed, CINAHL, and MEDLINE using terms including "preceptor," "clinical teaching," "time-efficient teaching," and "precepting." Of 32 articles in the final search, only 12 experimental quantitative studies were included in the synthesis and 20 descriptive studies in the discussion. CONCLUSIONS The OMP model is supported by literature for its effectiveness as a teaching model and preference by students and preceptors. It has been shown to increase teaching techniques including feedback and assessment of students' clinical reasoning. IMPLICATIONS FOR PRACTICE The OMP model has the potential to overcome clinicians' barriers to precepting nurse practitioner students. Future research may evaluate the use of this model specific to nurse practitioner preceptors and students, perceived time benefits in clinical teaching, overall improvement in clinical teaching, and use in interprofessional precepting.
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15
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Stuart MK. Implementation of Oral Case Presentations in an Immunology Course. MISSOURI MEDICINE 2018; 115:66-70. [PMID: 30228686 PMCID: PMC6139796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Implementation of oral case presentations (OCP) in the Immunology course at A.T. Still University-Kirksville College of Osteopathic Medicine has significantly improved written examination scores and student satisfaction with the course by enhancing its clinical relevance. With six faculty facilitators, an average class size of 172 students can complete the exercise in a single day. The exercise requires small group meeting rooms, each equipped with a computer and wall-mounted monitor, but no other physical resources.
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16
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Chinai SA, Guth T, Lovell E, Epter M. Taking Advantage of the Teachable Moment: A Review of Learner-Centered Clinical Teaching Models. West J Emerg Med 2017; 19:28-34. [PMID: 29383053 PMCID: PMC5785198 DOI: 10.5811/westjem.2017.8.35277] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 06/15/2017] [Accepted: 08/27/2017] [Indexed: 12/04/2022] Open
Abstract
When working in a chaotic Emergency Department (ED) with competing priorities, clinical teaching may be sacrificed for the sake of patient flow and throughput. An organized, efficient approach to clinical teaching helps focus teaching on what the learner needs at that moment, incorporates regular feedback, keeps the department on track, and prevents over-teaching. Effective clinical teaching in a busy environment is an important skill for senior residents and faculty to develop. This review will provide a critique and comparison of seven structured teaching models to better prepare readers to seize the teachable moment.
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Affiliation(s)
- Sneha A Chinai
- University of Massachusetts School of Medicine, Department of Emergency Medicine, Worcester, Massachusetts
| | - Todd Guth
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Elise Lovell
- University of Illinois at Chicago School of Medicine, Department of Emergency Medicine, Chicago, Illinois.,Advocate Christ Medical Center, Department of Emergency Medicine, Oak Lawn, Illinois
| | - Michael Epter
- Maricopa Medical Center, Department of Emergency Medicine, Phoenix, Arizona
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17
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Reyes I, Close S, Rodriguez J, Evans D. Progressive Dosing of Observed Real-Life Clinical Exposure for Nurse Practitioner Training. J Nurs Educ 2017; 56:552-555. [PMID: 28876442 DOI: 10.3928/01484834-20170817-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/06/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND In most advanced practice programs, preceptors are relied on for providing student clinical experiences. Preceptor feedback often indicates that many students show competency deficits in well child care, case presentation, and clinical skills. METHOD An innovative preclinical experience was developed using nonscripted pediatric patient and family volunteers from the local community. During the three 4-hour experiences, students obtained a health history, performed a full physical examination, and presented their findings using a standardized case presentation format. Student anxiety and levels of confidence were assessed before and after each experience. RESULTS Student anxiety decreased, and self-confidence and clinical skill competencies improved. Students who participated in the experiences with faculty demonstrated improved entry-level competencies, compared with previous cohorts who had not received the intervention. CONCLUSION Preclinical experiences using pediatric patients improved advanced practice nursing student confidence and competencies and reduced anxiety, improving overall entry-level clinical performance. [J Nurs Educ. 2017;56(9):552-555.].
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18
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Connor DF, Pearson GS. Feasibility and Implementation of SNAPPS in an Outpatient Child Psychiatry Clinic. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:299-300. [PMID: 27837453 DOI: 10.1007/s40596-016-0635-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/25/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Daniel F Connor
- University of Connecticut Health Care and School of Medicine, Farmington, CT, USA.
| | - Geraldine S Pearson
- University of Connecticut Health Care and School of Medicine, Farmington, CT, USA
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