Active Learning in Medical Education: Application to the Training of Surgeons

Implementation and Impact of an Adapted Digital Perioperative Competency-Building Tool to Enhance Teaching, Learning And Feedback in Postgraduate Competency-Based Medical Education

OBJECTIVES

The purpose of this educational intervention was to introduce, iteratively adapt, and implement a digital formative assessment tool in a surgical speciality. The study also evaluated the intervention's impact on perioperative teaching, learning, feedback, and surgical competency.

DESIGN

A participatory action research model with a mixed methods approach.

SETTING

This study was performed over 10 months in an institutional hospital in South Africa with a general surgery department.

PARTICIPANTS

Twelve supervising surgical trainers/faculty and 12 surgical trainees/residents consented to participate in the intervention.

RESULTS

The first 4 months of the intervention focused on relationship building, a multi-stakeholder contextual needs assessment and training sessions to support a shared mindset and shift in the teaching and learning culture. The final adapted perioperative competency-building tool comprised a 23-item assessment with four open-text answers (Table 1). Over the following 6-month period, 48 workplace-based competency-building perioperative evaluations were completed. Most trainees took less than 5 minutes to self-assess (67%) before most trainers (67%) took less than 5 minutes to give oral feedback to the trainee after the perioperative supervised learning encounter. On average, the digital tool took 6 minutes to complete during the bidirectional perioperative teaching and learning encounter with no negative impact on the operational flow. All trainers and trainees reported the training and implementation of the digital tool to be beneficial to teaching, learning, feedback, and the development of surgical competency. Analysis of the completed tools revealed several trainees showing evidence of progression in surgical competency for index procedures within the speciality. The focus groups and interviews also showed a change in the teaching and learning culture: more positively framed, frequent, structured, and specific feedback, improved accountability, and trainee-trainer perioperative readiness for teaching. Highlighted changes included the usefulness of trainee self-assessment before perioperative trainer feedback and the tool's value in improving competency to Kirkpatrick Level 4.

CONCLUSION

Implementing an adapted digital Workplace-Based Assessment (WBA) tool using a participatory action research model has proven successful in enhancing the effectiveness of supervised perioperative teaching and learning encounters. This approach has improved teaching and feedback practices, facilitated the development of surgical competency, and ultimately impacted the overall culture to Kirkpatrick level 4. Importantly, it has positively influenced the trainee-trainer relationship dynamic. Based on these positive outcomes, we recommend using this effective method and our relationship-centred framework for implementing formative competency-building tools in future studies. By doing so, larger-scale and successful implementation of Competency-Based Medical Education (CBME) could be achieved in various contexts. This approach can potentially enhance teaching and learning encounters, promote competency development, and improve the overall educational experience for surgical trainees and trainers.

Art-based assignment in head and neck anatomical course, a dynamic experience

In recent years, alternative uses of art within medical education have been explored and extended. We report here a method of art-based assignments in anatomy and histology, which we have incorporated into the head and neck course as a means of enlivening didactic lectures. One hundred and two first-year medical students at the Alborz University of Medical Sciences participated in a 15-week educational intervention, in which an art-based assignment method was employed. The learning module focuses on the human anatomy and histology of head and neck. In each session, after the teacher's lecture and practical work, students were given an assignment based on the topics of that session and based on the drawing. The learning outcome was evaluated twice, 1 week and 4 weeks after the course. Student's feedbacks were collected via an anonymous questionnaire at the end of the module. The data were analyzed by using the SPSS 20 software by paired and independent t-tests and the normality of data was evaluated by the Kolmogorov-Smirnov test. Most of students (90%) had rated the new format as very informative. Exam scores were significantly higher at 4 weeks tests (P ≤ 0.05) and data showed significant difference in long-term retention of knowledge. The use of this module by medical students during their head and neck course improves their confidence through drawing. Teacher's feedback provides a step-wise approach that simplifies the learning of anatomy and histology. The strategy has appeal for visual, auditory, read/write, and kinesthetic learners.

Clinical Judgment Development and Assessment in Clinical Nursing Education

BACKGROUND

There is a gap in evidence for effective clinical teaching strategies to promote nursing students' development of clinical judgment (CJ).

PURPOSE

This study examined the effect of active learning strategies (ALSs) during clinical postconference sessions on the CJ of undergraduate nursing students.

METHODS

This quasi-experimental study of ALSs or standard postconferences used the Lasater Clinical Judgment Rubric (LCJR) to rate CJ at 3 time points. All faculty members and students were trained on use of the LCJR. Ratings were done by both faculty and students.

RESULTS

All ratings of CJ improved over time ( P < .001). Ratings of CJ varied between the control and intervention groups.

CONCLUSIONS

The findings of this study contribute to knowledge regarding the effectiveness of clinical teaching strategies for CJ and preparation for entry to nursing practice.

Inclusion of cross-sectional and radiological images for better understanding of musculoskeletal anatomy and decreasing the risk of adverse events during dry needling in undergraduate physiotherapy students

Since there is an increasing rate of physiotherapists using invasive procedures during the clinical practice, understanding the cross-sectional anatomy and radiological images is essential for ensuring patients' safety during these interventions. Therefore, the aim of this study was to analyze the students' opinion of including cross-sectional and radiological images to traditional methodologies, to evaluate whether these additional resources improve their ability to identify musculoskeletal structures in radiological images and their understanding of neurovascular and visceral structures related with specific muscles to be avoided during invasive procedures. First-year undergraduate physiotherapy students were enrolled in the study. A brief online survey asking about their opinion about the use of cross-sectional and radiological images as complementary resources was built. In addition, two open-answer tests (before and after the inclusion of these resources) were conducted to evaluate their ability to identify correctly musculoskeletal structures in magnetic resonance and ultrasound images and to evaluate their awareness of high-risk structures related with specific muscles. One-hundred-thirty-two students returned the online survey and one-hundred-forty-eight completed all the tests. In general, students opined cross-sectional images to be of utility for learning anatomy (81.8%) and radiological images (93.9%) and felt they benefited from cross-sectional and ultrasound images (78.0%). All tests showed significant improvements after the inclusion of these complementary resources (all, p < 0.001) except for trunk structures in MRI (p = 0.777). The implementation of anatomical cross-sectional and radiological images resulted in better understanding of radiological images and better cognition of possible risk during invasive procedures.

An Online, Modular Curriculum Enhances Surgical Education and Improves Learning Outcomes in East, Central, and Southern Africa: A Mixed-Methods Study

Objective

We aimed to determine the impact of a standardized curriculum on learning outcomes for surgical trainees in East, Central, and Southern Africa (ECSA).

Background

As surgical education expands throughout ECSA, there is a recognized need for a standardized curriculum. We previously described the design of a novel, large-scale, flipped-classroom, surgical curriculum for trainees in ECSA.

Methods

In January 2020, the first year of curricular content for trainees of the College of Surgeons of ECSA was released, containing 11 monthly thematic topics, each with 2 to 5 weekly modular subtopics. We aimed to evaluate 3 outcomes utilizing data sources incorporated into the curriculum structure. Learner engagement was assessed by the number of trainees completing curriculum topics. User experience was evaluated using quantitative and qualitative feedback responses to embedded surveys for each content week. Curriculum impact on trainee examination performance was assessed by comparing certification examination scores stratified by the number of curricular topics each trainee completed.

Results

Two hundred seventy-one trainees (96%) in 17 countries accessed at least 1 weekly module. Trainees completed a median of 9 topics (interquartile range: 6-10). The feedback survey response rate was 92% (5742/6233). Quantitative and qualitative responses were positive in overall module value (93.7% + 2.6%), amount of learning experienced (97.9% + 1.4%), confidence in achieving learning objectives (97.1% + 2.4%), and ease of use of the module (77.6% + 5.98%). Topic-related certification examination performance improved significantly with increased completion of thematic topics.

Conclusions

A standardized surgical curriculum in ECSA demonstrated excellent trainee usage, positive feedback, and improved examination scores.

Twelve tips for surgeons to maximise medical student learning in the operating theatre

Theatre-based learning is an essential component of undergraduate surgical education and offers a wide range of learning opportunities. However, studies have demonstrated that medical students have not always benefited from this holistic learning environment due to many reasons, including intimidation, hierarchies within the surgical environment and fear of making mistakes. The lead surgical educator's approach is an important influence on the experience and learning of their medical students. These twelve tips are aimed at surgical educators with undergraduate teaching responsibilities. This guidance is based upon evidence from literature and established theories of teaching and learning, supplemented by qualitative interviews with surgeons and medical students. The resulting tips were checked and refined by surgical teaching fellows. These learner-centred tips provide guidance on thorough induction, managing mutual expectations and approaches that optimise teaching and learning in the operating theatre. They are designed to support surgical educators in improving their students' engagement and learning experiences in this setting.

Design of a Novel Online, Modular, Flipped-classroom Surgical Curriculum for East, Central, and Southern Africa

Objective

We describe a structured approach to developing a standardized curriculum for surgical trainees in East, Central, and Southern Africa (ECSA).

Summary Background Data

Surgical education is essential to closing the surgical access gap in ECSA. Given its importance for surgical education, the development of a standardized curriculum was deemed necessary.

Methods

We utilized Kern's 6-step approach to curriculum development to design an online, modular, flipped-classroom surgical curriculum. Steps included global and targeted needs assessments, determination of goals and objectives, the establishment of educational strategies, implementation, and evaluation.

Results

Global needs assessment identified the development of a standardized curriculum as an essential next step in the growth of surgical education programs in ECSA. Targeted needs assessment of stakeholders found medical knowledge challenges, regulatory requirements, language variance, content gaps, expense and availability of resources, faculty numbers, and content delivery method to be factors to inform curriculum design. Goals emerged to increase uniformity and consistency in training, create contextually relevant material, incorporate best educational practices, reduce faculty burden, and ease content delivery and updates. Educational strategies centered on developing an online, flipped-classroom, modular curriculum emphasizing textual simplicity, multimedia components, and incorporation of active learning strategies. The implementation process involved establishing thematic topics and subtopics, the content of which was authored by regional surgeon educators and edited by content experts. Evaluation was performed by recording participation, soliciting user feedback, and evaluating scores on a certification examination.

Conclusions

We present the systematic design of a large-scale, context-relevant, data-driven surgical curriculum for the ECSA region.

Multi-Institutional Evaluation of a Debate-Style Journal Club for Cardiothoracic Surgery Trainees

BACKGROUND

Traditional journal clubs address individual articles and are limited in terms of breadth and depth of content covered. The present study describes the outcomes of a novel debate-style journal club in a multi-institutional setting.

METHODS

Participating institutions were recruited through the Thoracic Education Cooperative Group (TECoG). The distributed curriculum included instructions, debate scenarios, suggested article lists, moderator slides, debate scoresheets, exams, and feedback surveys.

RESULTS

Six institutions participated in the study (2015-2019), consisting of a total of 10 years' worth of cumulative debates. Cardiothoracic surgery trainees participated in 10 monthly debates over each academic year. Trainee performance on the written examination in the realm of evidence-based medicine and critical appraisal improved over the course of the academic year (beginning 55.2% vs end 76.3%, p=0.040). Importantly, written examination after debates revealed a significant improvement in scores on questions relating to topics that were debated as compared to those that were not (+27.1% vs +2.5%, p=0.006), emphasizing the importance of the debates as compared to other sources of knowledge gain. Surveys completed by trainees and faculty overall favored the debate-style journal club as compared to the traditional journal club in gaining familiarity with seminal literature in the field, improving upon oral presentation skills, and applying published literature to questions encountered clinically.

CONCLUSIONS

In this multi-institutional prospective study, we demonstrate that the novel debate-style cardiothoracic surgery journal club is an effective educational intervention for cardiothoracic surgical trainees to acquire, retain, and gain practice in applying literature-based evidence to case-based scenarios.

Advancing trauma care through social media

Social media has become an integral part of everyday life. Because of this, medical representation has become increasingly popular across social media. Medical professionals have begun to recognize the value of social media in areas such as research promotion, mentorship program expansion and collaboration with peers. To date, these online medical communities are being underused in the field of trauma. Trauma centers may benefit by creating a more prominent online presence to allow for the dissemination of critical research, expansion of injury prevention programs and participation in national annual meetings. When used properly, social media can serve as a platform for the advancement of trauma care in a cost-effective manner.

Analysis of Surgical Resident Operative Volumes on China's Resident Training

Doctors entering surgical residency with different educational degrees and from different specialties is a unique feature of the Chinese medical system. The effect of this on the experience of surgical residents is not known. We retrospectively investigated whether residents' operative volumes were based on highest educational degree or postgraduate specialty. Using our operating data management system, a retrospective analysis of surgical resident operative experience at Shanghai General Hospital from 2012 to 2017 was conducted. The overall monthly average operative volume for surgical residents was 17.7 (12.6-26.5), but this decreased with each advanced degree of education from 26.0 (19.2-34.5) for those with a bachelor's degree only, to 19.5 (16.0-28.1) for a master's degree, to 15.9 (12.2-22.9) for those with a doctorate. Regarding specialty, residents in plastic surgery had the highest operative volume, and those in cardiothoracic surgery and neurosurgery had the lowest. At Shanghai General Hospital, the operative volumes of surgical residents differed according to their highest educational degree and postgraduate specialty. This analysis should be useful for the future planning of surgical residency programs in China.

Tracking Active Learning in the Medical School Curriculum: A Learning-Centered Approach

BACKGROUND

Medical education is moving toward active learning during large group lecture sessions. This study investigated the saturation and breadth of active learning techniques implemented in first year medical school large group sessions.

METHODS

Data collection involved retrospective curriculum review and semistructured interviews with 20 faculty. The authors piloted a taxonomy of active learning techniques and mapped learning techniques to attributes of learning-centered instruction.

RESULTS

Faculty implemented 25 different active learning techniques over the course of 9 first year courses. Of 646 hours of large group instruction, 476 (74%) involved at least 1 active learning component.

CONCLUSIONS

The frequency and variety of active learning components integrated throughout the year 1 curriculum reflect faculty familiarity with active learning methods and their support of an active learning culture. This project has sparked reflection on teaching practices and facilitated an evolution from teacher-centered to learning-centered instruction.