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Nicholson J, Plovnick C, van der Vleuten C, de Bruin ABH, Kalet A. Librarian-Led Assessment of Medical Students' Evidence-Based Medicine Competency: Facilitators and Barriers. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:160-168. [PMID: 38464960 PMCID: PMC10921970 DOI: 10.5334/pme.1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/08/2024] [Indexed: 03/12/2024]
Abstract
Introduction We must ensure, through rigorous assessment that physicians have the evidence-based medicine (EBM) skills to identify and apply the best available information to their clinical work. However, there is limited guidance on how to assess EBM competency. With a better understanding of their current role in EBM education, Health Sciences Librarians (HSLs), as experts, should be able to contribute to the assessment of medical student EBM competence. The purpose of this study is to explore the HSLs perspective on EBM assessment practices, both current state and potential future activities. Methods We conducted focus groups with librarians from across the United States to explore their perceptions of assessing EBM competence in medical students. Participants had been trained to be raters of EBM competence as part of a novel Objective Structured Clinical Examination (OSCE). This OSCE was just the starting point and the discussion covered topics of current EBM assessment and possibility for expanded responsibilities at their own institutions. We used a reflexive thematic analysis approach to construct themes from our conversations. Results We constructed eight themes in four broad categories that influence the success of librarians being able to engage in effective assessment of EBM: administrative, curricular, medical student, and librarian. Conclusion Our results inform medical school leadership by pointing out the modifiable factors that enable librarians to be more engaged in conducting effective assessment. They highlight the need for novel tools, like EBM OSCEs, that can address multiple barriers and create opportunities for deeper integration of librarians into assessment processes.
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Affiliation(s)
- Joey Nicholson
- NYU Health Sciences Library, NYU Grossman School of Medicine, NYU Langone Health, US
| | - Caitlin Plovnick
- NYU Health Sciences Library, NYU Grossman School of Medicine, NYU Langone Health, New York, US
| | - Cees van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, NL
| | - Anique B. H. de Bruin
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, NL
| | - Adina Kalet
- Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Wauwatosa, Wisconsin, US
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Nicholson J, Ark TK, Wargo E, Zabar S, Kalet A. Observing and Assessing Competence in Evidence-Based Medicine in Graduating Medical Students: A 5-Year Multi-Institution Report. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S186. [PMID: 37983430 DOI: 10.1097/acm.0000000000005396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Joey Nicholson
- Author affiliations: J. Nicholson, NYU Langone Health, NYU Grossman School of Medicine, NYU Health Sciences Library; T.K. Ark, A. Kalet, Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin; E. Wargo, S. Zabar, NYU Langone Health, NYU Grossman School of Medicine
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Eliasz KL, Nick MW, Zabar S, Buckvar-Keltz L, Ng GM, Riles TS, Kalet AL. Viewing Readiness-for-Residency through Binoculars: Mapping Competency-Based Assessments to the AAMC's 13 Core Entrustable Professional Activities (EPAs). TEACHING AND LEARNING IN MEDICINE 2023; 35:436-441. [PMID: 35668557 DOI: 10.1080/10401334.2022.2082432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
Construct: The construct being assessed is readiness-for-residency of graduating medical students, as measured through two assessment frameworks. Background: Readiness-for-residency of near-graduate medical students should be but is not consistently assessed. To address this, the Association of American Medical Colleges (AAMC), in 2014, identified and described 13 core Entrustable Professional Activities (EPAs), which are tasks that all residents should be able to perform unsupervised upon entering residency. However, the AAMC did not initially provide measurement guidelines or propose standardized assessments. We designed Night-onCall (NOC), an immersive simulation for our near-graduating medical students to assess and address their readiness-for-residency, framed around tasks suggested by the AAMC's core EPAs. In adopting this EPA assessment framework, we began by building upon an established program of competency-based clinical skills assessments, repurposing competency-based checklists to measure components of the EPAs where possible, and designing new checklists, when necessary. This resulted in a blended suite of 14 checklists, which theoretically provide substantive assessment of all 13 core EPAs. In this paper, we describe the consensus-based mapping process conducted to ensure we understood the relationship between competency and EPA-based assessment lenses and could therefore report meaningful feedback on both to transitioning students in the NOC exercise. Approach: Between January-November 2017, five clinician and two non-clinician health professions educators at NYU Grossman School of Medicine conducted a rigorous consensus-based mapping process, which included each rater mapping each of the 310 NOC competency-based checklist items to lists of entrustable behaviors expected of learners according to the AAMC 13 core EPAs. Findings: All EPAs were captured to varying degrees by the 14 NOC checklists (overall Intraclass Correlation Coefficient (ICC) = 0.77). Consensus meetings resolved discrepancies and improved ICC values for three (EPA-9, EPA-10, EPA-12) of the four EPAs that initially showed poor reliability. Conclusions: Findings suggest that with some limitations (e.g., EPA-7 "form clinical questions/retrieve evidence") established competency-based assessments can be repurposed to measure readiness-for-residency through an EPA lens and both can be reported to learners and faculty.
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Affiliation(s)
- Kinga L Eliasz
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Michael W Nick
- Program on Medical Education and Technology, New York University Grossman School of Medicine, New York, New York, USA
| | - Sondra Zabar
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Lynn Buckvar-Keltz
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Grace M Ng
- New York Simulation Center for the Health Sciences, A Partnership of the City University of New York and New York University Grossman School of Medicine, New York, New York, USA
| | - Thomas S Riles
- Departments of Surgery and Medical Education and Technology, New York University Grossman School of Medicine, New York, New York, USA
| | - Adina L Kalet
- Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education at Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
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Ai Li E, Wilson CA, Davidson J, Kwong A, Kirpalani A, Wang PZT. Exploring Perceptions of Competency-Based Medical Education in Undergraduate Medical Students and Faculty: A Program Evaluation. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:381-389. [PMID: 37101694 PMCID: PMC10124618 DOI: 10.2147/amep.s399851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/10/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND There is limited work exploring competency-based medical education (CBME) in undergraduate medical education. We aimed to assess medical students' and faculty's perception of CBME in the undergraduate medicine setting after its implementation at our institution through a Content, Input, Process, Product (CIPP) program evaluation model. METHODS We explored the rationale for the transition to a CBME curriculum (Content), the changes to the curriculum and the teams involved in the transition (Input), medical students' and faculty's perception of the current CBME curriculum (Process), and benefits and challenges of implementing undergraduate CBME (Product). A cross-sectional online survey was delivered over 8-weeks in October 2021 to medical students and faculty as part of the Process and Product evaluation. RESULTS Medical students displayed greater optimism towards CBME, compared to faculty, in terms of its role in medical education (p<0.05). Faculty were less certain about how CBME was currently implemented (p<0.05), as well as how feedback to students should be delivered (p<0.05). Students and faculty agreed on perceived benefits to CBME implementation. Faculty time commitment to teaching and logistical concerns were reported as perceived challenges. CONCLUSION Education leaders must prioritize faculty engagement and continued professional development of faculty to facilitate the transition. This program evaluation identified strategies to aid the transition to CBME in the undergraduate setting.
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Affiliation(s)
- Erica Ai Li
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Claire A Wilson
- Division of Pediatric Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Jacob Davidson
- Division of Pediatric Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Aaron Kwong
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Amrit Kirpalani
- Division of Pediatric Nephrology, London Health Sciences Centre, London, Ontario, Canada
| | - Peter Zhan Tao Wang
- Division of Pediatric Surgery, London Health Sciences Centre, London, Ontario, Canada
- Division of Urology, London Health Sciences Center, London, Ontario, Canada
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AAIM Recommendations for Undergraduate Medical Education to Graduate Medical Education Transition Curricula in Internal Medicine. Am J Med 2023; 136:489-495. [PMID: 36775049 DOI: 10.1016/j.amjmed.2023.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/05/2023] [Indexed: 02/12/2023]
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Abbasi Abianeh N, Yazdani S, Heydari M, Farmad SA. Global perspectives on trends in health higher education. J Family Med Prim Care 2022; 11:4991-5003. [PMID: 36505656 PMCID: PMC9731060 DOI: 10.4103/jfmpc.jfmpc_2461_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/26/2021] [Accepted: 02/16/2022] [Indexed: 12/15/2022] Open
Abstract
Today, changes in political and economic conditions, epidemiological and sociological developments, and the advancement of science and technology have necessitated the health and medical education systems to change. Therefore, we conducted a study entitled "Global perspectives on trends in higher education in healthcare," to improve the quality of healthcare so that it can be used as a model for predicting future events related to medical education. This futures study applied the social, technological, economical, ecological, political, values (STEEPV) model to identify and analyze the trends that affect medical education at different levels. To collect and analyze the data, a scoping review of the articles published from the year 2000 was conducted on the World Health Organization (WHO), Web of Science, Scopus, PubMed/MEDLINE, EMBASE, Science Direct, Google Scholar, EBSCO, and Cochrane databases. The review process was performed in five stages: 1- Determining the research question, 2- Identifying relevant studies, 3- Selecting the studies, 4- Charting the data, and 5- Analyzing data. The preferred reporting item for systematic review and meta-analysis (PRISMA) statement was used in the selection and screening of articles. A total of 213 articles were included in the study for qualitative synthesis. A total of 154 trends were identified using the STEEPV model at seven levels of health behaviors and patients, diseases and health problems, healthcare system, medical education system, medical education institutions, medical curricula, and teaching and learning. Considering the results of this study, it is possible to formulate proper and efficient future scenarios for the higher health education system. Also, it will be helpful for medical education policymaking.
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Affiliation(s)
- Nooshin Abbasi Abianeh
- PhD Candidate of Medical Education, Department of Medical Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Faculty Member of Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Shahram Yazdani
- Professor of Orthopedics, Department of Medical Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Address for correspondence: Prof. Shahram Yazdani, Professor of Orthopedics, Department of Medical Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, India. E-mail:
| | - Majid Heydari
- PhD in Health Policy, National Agency for Strategic Reassert in Medical Education, Tehran, Iran
| | - Somaieh Akbari Farmad
- Phd in Medical Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Chang YC, Nkambule NS, Chen SY, Hsieh MJ, Chaou CH. Exploring the Impact of Pre-course High-Fidelity Simulation on Professional Socialization of Medical Students in Emergency Medicine Internship Rotation—A Qualitative Approach. Front Med (Lausanne) 2022; 9:933212. [PMID: 35847773 PMCID: PMC9280693 DOI: 10.3389/fmed.2022.933212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Medical students in block clerkships constantly adapt to new environments and learn to interact with new people as they rotate between specialties. This frequent change potentially limited interns' opportunities for participation in real clinical practice. The aims of this study were to explore interns' conceptualization of their learning opportunities and experiences in the workplace during an emergency medicine (EM) block internship. In addition, the study also explored how participating in the pre-rotation high-fidelity simulation (HFS) orientation influenced interns' perception of their transition, participation and learning experiences in the real EM setting. Methods We implemented a newly developed pre-EM rotation orientation curriculum for interns. This orientation took place on the first day of the 2-week EM internship rotation. Two focus group discussions were held after each simulation training, one immediately after simulation to understand the students' perception and the educational impact of this activity, the other at the end of EM rotation to explore and compare their roles and perception in both simulation activity and the real clinical practice. A total of 151 seventh-year medical students enrolled in the pre-course HFS and post-hoc focus group discussions between 2017 and 2019. We applied thematic analysis to systemically identify, examine, and construct themes. Results Four major themes were constructed from the data; 1. Challenges in finding authentic learning experiences within the context of emergency medicine; 2. Effectiveness of the pre-course HFS 3. Limitations of EM internship rotation curriculum and pre-course simulation. 4. Suggestions for EM block-internship curriculum reforms. Our study's key findings indicate that pre-rotation orientation HFS activity, which offered a psychologically safe space for students to explore facets of EM and gain a contextualized understanding of the emergency work culture and environment, was essential for enhancing students' ability to identify and maximize practice affordances in real workplace. Conclusion Simulation, facilitates interns' negotiation of legitimate peripheral participation opportunities as they transition into the EM community of practice during their block internship rotation; putting students at the center of the learning process.
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Affiliation(s)
- Yu-Che Chang
- Chang Gung Medical Education Research Centre, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Nothando Sithulile Nkambule
- International Graduate Program of Education and Human Development, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ju Hsieh
- Chang Gung Medical Education Research Centre, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Hsien Chaou
- Chang Gung Medical Education Research Centre, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Chung-Hsien Chaou
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Cangiarella J, Eliasz K, Kalet A, Cohen E, Abramson S, Gillespie C. A Preliminary Evaluation of Students' Learning and Performance Outcomes in an Accelerated 3-Year MD Pathway Program. J Grad Med Educ 2022; 14:99-107. [PMID: 35222827 PMCID: PMC8848877 DOI: 10.4300/jgme-d-21-00284.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/27/2021] [Accepted: 10/21/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Little outcome data exist on 3-year MD (3YMD) programs to guide residency program directors (PDs) in deciding whether to select these graduates for their programs. OBJECTIVE To compare performance outcomes of 3YMD and 4-year MD (4YMD) students at New York University Grossman School of Medicine. METHODS In 2020, using the Kirkpatrick 4-level evaluation model, outcomes from 3 graduating cohorts of 3YMD students (2016-2018) were compared with the 4YMD counterparts. RESULTS Descriptive statistics compared outcomes among consented student cohorts: 92% (49 of 53) 3YMD, 87% (399 of 459) 4YMD-G, and 84% (367 of 437) 4YMD-S. Student survey response rates were 93% (14 of 15), 74% (14 of 19), and 89% (17 of 19) from 2016 to 2018. PDs' response rates were 58% (31 of 53, 3YMD) and 51% (225 of 441, 4YMD). Besides age, 3YMD and 4YMD cohorts did not differ significantly in admissions variables. Other than small statistically significant differences in the medicine shelf examination (3YMD mean 74.67, SD 7.81 vs 4YMD-G mean 78.18, SD 7.60; t test=3.02; P=.003) and USMLE Step 1 (3YMD mean 235.13, SD 17.61 vs 4YMD-S mean 241.70, SD 15.92; t test=2.644; P=.009 and vs 4YMD-G mean 242.39, SD 15.65; t test=2.97; P=.003) and Step 2 CK scores (3YMD mean 242.57, SD 15.58 vs 4YMD-S mean 248.55, SD 15.33; t test=2.55; P=.01 and vs 4YMD-G mean 247.83, SD 15.38; t test=2.97; P=.03), other metrics and overall intern ratings did not differ by pathway. CONCLUSIONS Exploratory findings from a single institution suggest that 3YMD students performed similarly to 4YMD students in medical school and the first year of residency.
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Affiliation(s)
- Joan Cangiarella
- Joan Cangiarella, MD, is Associate Dean of Education and Faculty, Associate Professor of Pathology, and Director, Accelerated 3-Year MD Pathway, New York University Grossman School of Medicine
| | - Kinga Eliasz
- Kinga Eliasz, PhD, is a Postdoctoral Research Scientist, New York University Grossman School of Medicine
| | - Adina Kalet
- Adina Kalet, MD, MPH, is Director, Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin
| | - Elisabeth Cohen
- Elisabeth Cohen, MD, is Professor of Ophthalmology and Accelerated 3-Year MD Pathway Advisor, New York University Grossman School of Medicine
| | - Steven Abramson
- Steven Abramson, MD, is Vice Dean for Education, Faculty and Academic Affairs, New York University Grossman School of Medicine
| | - Colleen Gillespie
- Colleen Gillespie, PhD, is Director, Division of Education Quality, and Associate Professor of Medicine, New York University Grossman School of Medicine
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Ten Cate O, Schultz K, Frank JR, Hennus MP, Ross S, Schumacher DJ, Snell LS, Whelan AJ, Young JQ. Questioning medical competence: Should the Covid-19 crisis affect the goals of medical education? MEDICAL TEACHER 2021; 43:817-823. [PMID: 34043931 DOI: 10.1080/0142159x.2021.1928619] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has disrupted many societal institutions, including health care and education. Although the pandemic's impact was initially assumed to be temporary, there is growing conviction that medical education might change more permanently. The International Competency-based Medical Education (ICBME) collaborators, scholars devoted to improving physician training, deliberated how the pandemic raises questions about medical competence. We formulated 12 broad-reaching issues for discussion, grouped into micro-, meso-, and macro-level questions. At the individual micro level, we ask questions about adaptability, coping with uncertainty, and the value and limitations of clinical courage. At the institutional meso level, we question whether curricula could include more than core entrustable professional activities (EPAs) and focus on individualized, dynamic, and adaptable portfolios of EPAs that, at any moment, reflect current competence and preparedness for disasters. At the regulatory and societal macro level, should conditions for licensing be reconsidered? Should rules of liability be adapted to match the need for rapid redeployment? We do not propose a blueprint for the future of medical training but rather aim to provoke discussions needed to build a workforce that is competent to cope with future health care crises.
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Affiliation(s)
- Olle Ten Cate
- Center for Research Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karen Schultz
- Department of Family Medicine, Queen's University, Queen's University, Kingston, Canada
| | - Jason R Frank
- Royal College of Physicians and Surgeons of Canada and Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | | | - Shelley Ross
- CBAS Program in the Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Daniel J Schumacher
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Linda S Snell
- Royal College of Physicians and Surgeons of Canada, McGill University, Montreal, Canada
| | - Alison J Whelan
- Association of American Medical Colleges, Washington DC, USA
| | - John Q Young
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Zucker Hillside Hospital at Northwell Health, Glen Oaks, NY, USA
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Chen T, Stapleton S, Babcock M, Kelley MN, Frallicciardi A. Handoffs and Nurse Calls: Overnight Call Simulation for Fourth-Year Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11138. [PMID: 33816798 PMCID: PMC8015711 DOI: 10.15766/mep_2374-8265.11138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Interns must be able to give and receive handoffs and use handoff information to respond to calls from nursing staff regarding patient concerns. Medical students may not receive adequate instruction in these tasks and often feel unprepared in this aspect of transitioning to residency. This program simulated an overnight call experience for fourth-year medical students emphasizing handoffs, nurse calls, and medical emergency response. METHODS The program utilized a combination of traditional didactics and simulated handoffs, nurse calls, and patient scenarios to allow groups of fourth-year medical students to independently manage a simulated overnight call. The program was designed for students as part of a larger Transition to Residency capstone course. RESULTS We ran four sessions over 3 years, with a total of 105 medical student participants. All students reported increased confidence or comfort in their ability to manage handoffs and respond to nurse calls. Students reported that the sessions were helpful and realistic. DISCUSSION This program provided fourth-year medical students with a realistic and useful opportunity to simulate handoffs and response to nurse calls, which increased their confidence and comfort. Minor changes were made between iterations of the course with continued positive feedback from medical students. The course is generalizable and can be adapted to the needs and resources of different institutions.
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Affiliation(s)
- Tina Chen
- Assistant Professor, Division of Emergency Medicine, Saint Louis University School of Medicine
| | - Stephanie Stapleton
- Assistant Professor, Department of Emergency Medicine, Boston University School of Medicine
| | - Matthew Babcock
- Assistant Professor, Department of Emergency Medicine, University of Connecticut School of Medicine
| | - Mariann Nocera Kelley
- Assistant Professor, Departments of Pediatrics and Emergency Medicine/Traumatology, Division of Pediatric Emergency Medicine, University of Connecticut School of Medicine and Connecticut Children's Medical Center; Director of Simulation Education, University of Connecticut School of Medicine
| | - Alise Frallicciardi
- Associate Professor, Department of Emergency Medicine, University of Connecticut School of Medicine; Emergency Department Medical Director, University of Connecticut John Dempsey Hospital
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Burm S, Chahine S, Goldszmidt M. "Doing it Right" Overnight: a Multi-perspective Qualitative Study Exploring Senior Medical Resident Overnight Call. J Gen Intern Med 2021; 36:881-887. [PMID: 33078297 PMCID: PMC8041983 DOI: 10.1007/s11606-020-06284-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 10/05/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Competency-based medical education (CBME) requires the development of workplace-based assessment tools that are grounded in authentic clinical work. Developing such tools, however, requires a deep understanding of the underlying facets of the competencies being assessed. Gaining this understanding remains challenging in contexts where performance is not readily visible to supervisors such as the senior medical resident (SMR) on-call role in internal medicine. OBJECTIVE This study draws on the perspectives of healthcare professionals with whom the SMR interacts with overnight to generate insights into the different components of on-call SMR practice and the range of ways SMRs effectively and less effectively enact these. APPROACH We used a constructivist grounded theory (CGT) approach to examine variation in how on-call SMRs carry out their role overnight. PARTICIPANTS Six medical students, five junior residents, five internal medicine attending physicians, five emergency physicians, and three emergency nurses conducted observations of their on-call interactions with SMRs. Participants were then interviewed and asked to elaborate on their observations as well as provide comparative reflections on the practices of past SMRs they worked with. KEY RESULTS Strong collaboration and organizational skills were identified as critical components to effectively being the on-call SMR. Perceived weaker SMRs, while potentially also having issues with clinical skills, stood out more when they could not effectively manage the realities of collaboration in a busy workplace. CONCLUSION What consistently differentiated a perceived effective SMR from a less effective SMR was someone who was equipped to manage the realities of interprofessional collaboration in a busy workplace. Our study invites medical educators to consider what residents, particularly those in more complex roles, need to receive feedback on to support their development as physicians. It is our intention that the findings be used to inform the ways programs approach teaching, assessment, and the provision of feedback.
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Affiliation(s)
- Sarah Burm
- Continuing Professional Development/Division of Medical Education, Faculty of Medicine, Dalhousie University, , Room 2L-23 Sir Charles Tupper Medical Building, 5850 College Street, Halifax, Nova Scotia, Canada.
| | - Saad Chahine
- Faculty of Education, Queen's University, , Kingston, Ontario, Canada
| | - Mark Goldszmidt
- Division of General Internal Medicine, Department of Medicine, Centre for Education Research and Innovation, Western University, , London, Ontario, Canada
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Hawkins N, Younan HC, Fyfe M, Parekh R, McKeown A. Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on-call simulation. BMC MEDICAL EDUCATION 2021; 21:165. [PMID: 33731104 PMCID: PMC7972243 DOI: 10.1186/s12909-021-02605-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/05/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND Current research shows that many UK medical graduates continue to feel underprepared to work as a junior doctor. Most research in this field has focused on new graduates and employed the use of retrospective self-rating questionnaires. There remains a lack of detailed understanding of the challenges encountered in preparing for clinical practice, specifically those faced by medical students, where relevant educational interventions could have a significant impact. Through use of a novel on-call simulation, we set out to determine factors affecting perceived preparation for practice in final year medical students and identify ways in which we may better support them throughout their undergraduate training. METHODS 30 final year medical students from Imperial College London participated in a 90-minute simulation on hospital wards, developed to recreate a realistic on-call experience of a newly qualified doctor. Students partook in pairs, each observed by a qualified doctor taking field notes on their decisions and actions. A 60-minute semi-structured debrief between observer and student pair was audio-recorded for analysis. Field notes and students' clinical documentation were used to explore any challenges encountered. Debrief transcripts were thematically analysed through a general inductive approach. Cognitive Load Theory (CLT) was used as a lens through which to finalise the evolving themes. RESULTS Six key themes emerged from the on-call simulation debriefs: information overload, the reality gap, making use of existing knowledge, negative feelings and emotions, unfamiliar surroundings, and learning 'on the job'. CONCLUSIONS The combination of high fidelity on-call simulation, close observation and personalised debrief offers a novel insight into the difficulties faced by undergraduates in their preparation for work as a junior doctor. In using CLT to conceptualise the data, we can begin to understand how cognitive load may be optimised within this context and, in doing so, we highlight ways in which undergraduate curricula may be adapted to better support students in their preparation for clinical practice. Recommendations are centred around enhancing the expertise of the learner through 'whole task' training approaches and integrated learning, as well as navigating negative emotions and supporting lifelong 'learning while working'.
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Affiliation(s)
- Nichola Hawkins
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK.
| | - Helen-Cara Younan
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK
| | - Molly Fyfe
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK
| | - Ravi Parekh
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK
| | - Andrew McKeown
- University of Buckingham Medical School, Hunter Street, MK18 1EG, Buckingham, UK
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Ten Cate O, Carraccio C, Damodaran A, Gofton W, Hamstra SJ, Hart DE, Richardson D, Ross S, Schultz K, Warm EJ, Whelan AJ, Schumacher DJ. Entrustment Decision Making: Extending Miller's Pyramid. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:199-204. [PMID: 33060399 DOI: 10.1097/acm.0000000000003800] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The iconic Miller's pyramid, proposed in 1989, characterizes 4 levels of assessment in medical education ("knows," "knows how," "shows how," "does"). The frame work has created a worldwide awareness of the need to have different assessment approaches for different expected outcomes of education and training. At the time, Miller stressed the innovative use of simulation techniques, geared at the third level ("shows how"); however, the "does" level, assessment in the workplace, remained a largely uncharted area. In the 30 years since Miller's conference address and seminal paper, much attention has been devoted to procedures and instrument development for workplace-based assessment. With the rise of competency-based medical education (CBME), the need for approaches to determine the competence of learners in the clinical workplace has intensified. The proposal to use entrustable professional activities as a framework of assessment and the related entrustment decision making for clinical responsibilities at designated levels of supervision of learners (e.g., direct, indirect, and no supervision) has become a recent critical innovation of CBME at the "does" level. Analysis of the entrustment concept reveals that trust in a learner to work without assistance or supervision encompasses more than the observation of "doing" in practice (the "does" level). It implies the readiness of educators to accept the inherent risks involved in health care tasks and the judgment that the learner has enough experience to act appropriately when facing unexpected challenges. Earning this qualification requires qualities beyond observed proficiency, which led the authors to propose adding the level "trusted" to the apex of Miller's pyramid.
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Affiliation(s)
- Olle Ten Cate
- O. ten Cate is professor of medical education and senior scientist, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780
| | - Carol Carraccio
- C. Carraccio was vice president of competency-based assessment, American Board of Pediatrics, Chapel Hill, North Carolina, at the time of writing; ORCID: https://orcid.org/0000-0001-5473-8914
| | - Arvin Damodaran
- A. Damodaran is rheumatologist and director of medical education, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; ORCID: https://orcid.org/0000-0002-5067-9483
| | - Wade Gofton
- W. Gofton is professor of surgery, University of Ottawa, Ottawa, Ontario, Canada; ORCID: https://orcid.org/0000-0003-0438-1659
| | - Stanley J Hamstra
- S.J. Hamstra is research consultant, milestone research and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois, professor, Department of Surgery, University of Toronto, Toronto, Ontario, Canada, and adjunct professor, Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-0680-366X
| | - Danielle E Hart
- D.E. Hart is program director, Emergency Medicine, and director of simulation, Interdisciplinary Simulation and Education Center, Hennepin Healthcare, Minneapolis, Minnesota
| | - Denyse Richardson
- D. Richardson is associate professor, Department of Medicine, Division of Physiatry, and a faculty member, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-6113-158X
| | - Shelley Ross
- S. Ross is associate professor, Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada; ORCID: https://orcid.org/0000-0001-9581-3191
| | - Karen Schultz
- K. Schultz is professor and assessment director, Department of Family Medicine, Queens University, Kingston, Ontario, Canada, and chair, Certification Process and Assessment Committee, College of Family Physicians of Canada, Mississauga, Ontario, Canada; ORCID: https://orcid.org/0000-0001-7041-1700
| | - Eric J Warm
- E.J. Warm is Richard W. Vilter Professor of Medicine, director, Internal Medicine Residency Program, and medical director, Resident Ambulatory Practice, University of Cincinnati, College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6088-2434
| | - Alison J Whelan
- A.J. Whelan is chief medical education officer, Association of American Medical Colleges, Washington, DC; ORCID: https://orcid.org/0000-0001-7661-148X
| | - Daniel J Schumacher
- D.J. Schumacher is associate professor of pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-3747-2410
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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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Nicholson J, Kalet A, van der Vleuten C, de Bruin A. Understanding medical student evidence-based medicine information seeking in an authentic clinical simulation. J Med Libr Assoc 2020; 108:219-228. [PMID: 32256233 PMCID: PMC7069825 DOI: 10.5195/jmla.2020.875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/01/2019] [Indexed: 11/21/2022] Open
Abstract
Objective Evidence-based medicine practices of medical students in clinical scenarios are not well understood. Optimal foraging theory (OFT) is one framework that could be useful in breaking apart information-seeking patterns to determine effectiveness and efficiency of different methods of information seeking. The aims of this study were to use OFT to determine the number and type of resources used in information seeking when medical students answer a clinical question, to describe common information-seeking patterns, and identify patterns associated with higher quality answers to a clinical question. Methods Medical students were observed via screen recordings while they sought evidence related to a clinical question and provided a written response for what they would do for that patient based on the evidence that they found. Results Half (51%) of study participants used only 1 source before answering the clinical question. While the participants were able to successfully and efficiently navigate point-of-care tools and search engines, searching PubMed was not favored, with only half (48%) of PubMed searches being successful. There were no associations between information-seeking patterns and the quality of answers to the clinical question. Conclusion Clinically experienced medical students most frequently relied on point-of-care tools alone or in combination with PubMed to answer a clinical question. OFT can be used as a framework to understand the information-seeking practices of medical students in clinical scenarios. This has implications for both teaching and assessment of evidence-based medicine in medical students.
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Affiliation(s)
- Joey Nicholson
- Vice Chair for Education; Head, Education and Curriculum Support; Associate Curator; and Coordinator, Systematic Review Services, NYU Health Sciences Library, New York University School of Medicine, New York, NY, , http://orcid.org/0000-0001-8658-5879
| | - Adina Kalet
- Director of the Kern Institute, Medical College of Wisconsin, Milwaukee, WI, , https://orcid.org/0000-0003-4855-0223
| | - Cees van der Vleuten
- Professor of Education, School of Health Professions Education, Maastricht University, Maastricht, Netherlands, , https://orcid.org/0000-0001-6802-3119
| | - Anique de Bruin
- Professor of Self-Regulation in Higher Education, School of Health Professions Education, Maastricht University, Maastricht, Netherlands, , https://orcid.org/0000-0001-5178-0287
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Hanley K, Gillespie C, Zabar S, Adams J, Kalet A. Monitoring communication skills progress of medical students: Establishing a baseline has value, predicting the future is difficult. PATIENT EDUCATION AND COUNSELING 2019; 102:309-315. [PMID: 30318384 DOI: 10.1016/j.pec.2018.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 07/26/2018] [Accepted: 09/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To provide evidence for the validity of an Introductory Clinical Experience (ICE) that was implemented as a baseline assessment of medical students' clinical communication skills to support progression of skills over time. METHODS In this longitudinal study of communication skills, medical students completed the ICE, then a Practice of Medicine (POM) Objective Structured Clinical Exam 8 months later, and the Comprehensive Clinical Skills Exam (CCSE) 25 months later. At each experience, trained Standardized Patients assessed students, using the same behaviorally anchored checklist in 3 domains: Information Gathering, Relationship Development, and Patient Education and Counseling (PEC) with good internal reliability (.70-.87). Skills development patterns were described. ICE as a predictor of later performance was explored. Students' perspectives were elicited. RESULTS 140 (80%) medical students consented to include their data in this study. Overall communication scores increased over time (eta2 = .17, medium effect) mostly attributable to increase in PEC skills (eta2 = .48, large effect), in 4 patterns. ICE and POM scores predicted future communication skills. Most students recognized the educational value of ICE. CONCLUSION Entering medical students' clinical communication skills increase over time on average and may predict future performance. PRACTICE IMPLICATIONS Implementing an ICE is likely a valid strategy for monitoring progress and facilitating communication skills development.
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Affiliation(s)
- Kathleen Hanley
- Department of Medicine, New York University School of Medicine, New York, USA
| | - Colleen Gillespie
- Department of Medicine, New York University School of Medicine, New York, USA; Institute for Innovations in Medical Education, New York University School of Medicine, New York, USA
| | - Sondra Zabar
- Department of Medicine, New York University School of Medicine, New York, USA
| | - Jennifer Adams
- Department of Medicine, New York University School of Medicine, New York, USA
| | - Adina Kalet
- Department of Medicine, New York University School of Medicine, New York, USA.
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