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Mullikin DR, Flanagan RP, Merkebu J, Durning SJ, Soh M. Physiologic measurements of cognitive load in clinical reasoning. Diagnosis (Berl) 2024; 11:125-131. [PMID: 38282337 DOI: 10.1515/dx-2023-0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Cognitive load is postulated to be a significant factor in clinical reasoning performance. Monitoring physiologic measures, such as heart rate variability (HRV) may serve as a way to monitor changes in cognitive load. The pathophysiology of why HRV has a relationship to cognitive load is unclear, but it may be related to blood pressure changes that occur in a response to mental stress. METHODS Fourteen residents and ten attendings from Internal Medicine wore Holter monitors and watched a video depicting a medical encounter before completing a post encounter form used to evaluate their clinical reasoning and standard psychometric measures of cognitive load. Blood pressure was obtained before and after the encounter. Correlation analysis was used to investigate the relationship between HRV, blood pressure, self-reported cognitive load measures, clinical reasoning performance scores, and experience level. RESULTS Strong positive correlations were found between increasing HRV and increasing mean arterial pressure (MAP) (p=0.01, Cohen's d=1.41). There was a strong positive correlation with increasing MAP and increasing cognitive load (Pearson correlation 0.763; 95 % CI [; 95 % CI [-0.364, 0.983]). Clinical reasoning performance was negatively correlated with increasing MAP (Pearson correlation -0.446; 95 % CI [-0.720, -0.052]). Subjects with increased HRV, MAP and cognitive load were more likely to be a resident (Pearson correlation -0.845; 95 % CI [-0.990, 0.147]). CONCLUSIONS Evaluating HRV and MAP can help us to understand cognitive load and its implications on trainee and physician clinical reasoning performance, with the intent to utilize this information to improve patient care.
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Affiliation(s)
- Dolores R Mullikin
- Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, USA
| | - Ryan P Flanagan
- Department of Pediatric Cardiology, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Jerusalem Merkebu
- Department of Medicine, Center for Health Professions Education, Uniformed Services University of Health Sciences, USA
| | - Steven J Durning
- Department of Medicine, Center for Health Professions Education, Uniformed Services University of Health Sciences, USA
| | - Michael Soh
- Department of Medicine, Center for Health Professions Education, Uniformed Services University of Health Sciences, USA
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Montreuil J, Lacasse M, Audétat MC, Boileau É, Laferrière MC, Lafleur A, Lee S, Nendaz M, Steinert Y. Interventions for undergraduate and postgraduate medical learners with academic difficulties: A BEME systematic review update: BEME Guide No. 85. MEDICAL TEACHER 2024:1-19. [PMID: 38589011 DOI: 10.1080/0142159x.2024.2331041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Clinical teachers often struggle to record trainee underperformance due to lacking evidence-based remediation options. OBJECTIVES To provide updated evidence-based recommendations for addressing academic difficulties among undergraduate and postgraduate medical learners. METHODS A systematic review searched databases including MEDLINE, CINAHL, EMBASE, ERIC, Education Source, and PsycINFO (2016-2021), replicating the original Best Evidence Medical Education 56 review strategy. Original research/innovation reports describing intervention(s) for medical learners with academic difficulties were included. Data extraction used Michie's Behaviour Change Techniques (BCT) Taxonomy and program evaluation models from Stufflebeam and Kirkpatrick. Quality appraised used the Mixed Methods Appraisal Tool (MMAT). Authors synthesized extracted evidence by adapting GRADE approach to formulate recommendations. RESULTS Eighteen articles met the inclusion criteria, primarily addressing knowledge (66.7%), skills (66.7%), attitudinal problems (50%) and learner's personal challenges (27.8%). Feedback and monitoring was the most frequently employed BCT. Study quality varied (MMAT 0-100%). We identified nineteen interventions (UG: n = 9, PG: n = 12), introducing twelve new thematic content. Newly thematic content addressed contemporary learning challenges such as academic procrastination, and use of technology-enhanced learning resources. Combined with previous interventions, the review offers a total dataset of 121 interventions. CONCLUSION This review offers additional evidence-based interventions for learners with academic difficulties, supporting teaching, learning, faculty development, and research efforts.
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Affiliation(s)
- Julie Montreuil
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Miriam Lacasse
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Marie-Claude Audétat
- University Institute for primary care (IuMFE), University of Geneva, Geneva, Switzerland
- Unit of Development and Research (UDREM), University of Geneva, Geneva, Switzerland
| | - Élisabeth Boileau
- Department of Family and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Shirley Lee
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Mathieu Nendaz
- Unit of Development and Research (UDREM), University of Geneva, Geneva, Switzerland
- Department of Medicine, University Hospitals, Geneva, Switzerland
| | - Yvonne Steinert
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Canada
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Cushing R. Clinical Preceptor Development and the Benefit of Structured Teaching Techniques: A Scoping Review. J Physician Assist Educ 2024; 35:52-61. [PMID: 37791780 DOI: 10.1097/jpa.0000000000000525] [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: 10/05/2023]
Abstract
INTRODUCTION Physician assistant (PA) education in the clinical year is dependent on clinical preceptors. Recruitment of preceptors has been identified as a significant barrier for programs. As a result of the preceptor shortage, evaluation of the barriers to recruitment and retention has been considered. The lack of development and training was identified as a barrier to recruitment and retention of preceptors.The aim of this scoping review article was to identify structured teaching strategies to reduce the development and training barrier and improve preceptor efficacy and efficiency. Structured teaching techniques, such as the One-Minute Preceptor and Summarize, Analyze, Narrow, Probe, Plan, and Select (SNAPPS), are proven to be effective and efficient ways to train learners. METHODS Online databases were used to identify articles published from 2014 to 2022 using the following terms: "physician assistant" or "nurse practitioner," "preceptor development," "preceptorship," "teaching methods," "pedagogy," "clinical teaching," and "medical education." Seventeen articles formed the basis of the scoping review of the literature. A singular author reviewed the articles. RESULTS Training resources help ease student instruction burden that preceptors experience. Many preceptors rely on clinical experience to guide their teaching methods. Introducing formal, structured teaching strategies can improve preceptors' effectiveness. By implementing preceptor training using structured teaching strategies, PA programs can decrease barriers for preceptors and potentially increase preceptor effectiveness and efficiency. CONCLUSIONS Training preceptors on using structured teaching strategies through workshops, asynchronous learning modules, and podcasts could provide preceptors with the support needed to educate clinical phase PA students. Physician assistant programs must explore best practices in clinical teaching and the associated education and operational outcomes.
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Affiliation(s)
- Rachel Cushing
- Rachel Cushing, DMSc, MPAS, PA-C, Creighton University, School of Medicine, Physician Assistant Program, Omaha, Nebraska
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Shrivastava S, Manivasakan S, Shrivastava PS, Somu L. Perception of Faculty toward Challenges in Teaching and the Role of Medical Education Workshops in Addressing Them: A Mixed-Methods Study. Avicenna J Med 2022; 12:21-30. [PMID: 35586390 PMCID: PMC9110101 DOI: 10.1055/s-0042-1744434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background
A medical teacher has a very complex job profile, wherein they are expected to train a cohort of newly joined medical aspirants to competent health care professionals. The current study was conducted to identify the challenges faced by the faculty members in medical teaching and to assess the perception of teachers on the role of medical education workshops in addressing these challenges.
Methods
It was a Mixed Methods study conducted over a period of 9 months from January to September 2021 in a tertiary teaching medical college and hospital of Chengalpet District of Tamil Nadu amongst the faculty members of the teaching medical college and hospital. In the first phase, universal sampling method was employed, wherein all faculty members were asked to fill the online semi-structured questionnaire. In the second phase, purposive sampling was employed, wherein all teachers who have a minimum teaching experience of 3 years and have attended any medical education workshop were included and interviewed using a focus group discussion guide. The quantitative date was analyzed using descriptive statistics, while the qualitative data was analyzed using manual content analysis.
Results
In the quantitative phase, 149 faculty members filled the online questionnaire, of which majority were females (52.3%) and were from the clinical departments (63.1%). The manual thematic content analysis of the FGD resulted in the identification of two themes (challenges and utility of workshops). The challenges theme consisted of three categories of Faculty, Students, and Administration, while Utility of workshops theme included two categories of refinement of skills, and suggestions for future
Conclusion
In conclusion, lack of teamwork in the department, multiple responsibilities assigned to a single person, and shortage of clinical material during COVID-19 were identified as the main challenges in teaching–learning. The medical education workshops play a significant role in improving the knowledge of various domains of teaching and assessment, introduction of innovations, and ensure better performance of the faculty members.
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Affiliation(s)
- Saurabh Shrivastava
- Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth—Deemed to be University, Chengalpet, Tamil Nadu, India
| | - Shivasakthy Manivasakan
- Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth—Deemed to be University, Chengalpet, Tamil Nadu, India
| | - Prateek Saurabh Shrivastava
- Department of Prosthodontics, Indira Gandhi Institute of Dental Sciences, Centre for Health Professions Education, Sri Balaji Vidyapeeth (SBV)—Deemed to be University, Pillayarkuppam, Puducherry, India
| | - Lavakumar Somu
- Department of Pharmacology, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth—Deemed to be University, Chengalpet, Tamil Nadu, India
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Gagnon N, Bernier C, Houde S. How best can faculty development support teachers in clinical settings? Br J Hosp Med (Lond) 2022; 83:1-8. [DOI: 10.12968/hmed.2021.0671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Faculty development is key to ensuring quality clinical teaching, but standardising teaching practices in multiple settings is a challenge. This article presents an example of a 3-year faculty development programme for teaching clinical reasoning skills, implemented by the Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada for its faculty members at multiple teaching sites. A follow-up study 1–5 months after the final workshop, using a self-assessment questionnaire, indicates that almost half of the participants transferred some of their newly acquired knowledge into their teaching practices. This article discusses factors to consider when developing a faculty development culture, at both a programme and faculty level, to support quality teaching and learning.
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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
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Shrivastava S, Shrivastava P. Challenges encountered by teachers in medical education. JOURNAL OF THE SCIENTIFIC SOCIETY 2022. [DOI: 10.4103/jss.jss_153_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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