Moving from Novice to Expertise and Its Implications for Instruction

Clinical negligence and physiotherapy: UK survey of physiotherapists' experiences of litigation

AIM

To investigate the extent and impact of litigation on the UK physiotherapy profession.

DESIGN

An online cross-sectional questionnaire survey design was used. The survey was open to all qualified physiotherapists who have practiced in the UK, from any speciality, of any grade and from any setting including NHS, non-NHS, and private practice.

RESULTS

688 respondents completed the survey (96% CI). All UK nations were represented. 73% were female, 44% were qualified >20 Years. Most worked in the NHS (74%) and worked in a neuromusculoskeletal setting (62%). 10% of respondents had been involved in litigation. 128 claims were reported with some respondents being involved in more than 1 case. Litigation was a highly stressful experience for those who experienced it and was a source of concern for many others. The personal impact was stress (76%) and worry and anxiety (67%). The most common professional impact was defensive practice (68%). Most respondents incorrectly identified who should provide their legal support. 46% were not satisfied with the support received. Most (77%) reported that litigation training should be included in pre-registration, as well as postgraduate (68%) programs.

CONCLUSION

This is the first UK survey that has investigated the experiences of litigation on the UK physiotherapy profession. Ten percent of physiotherapists in our survey had been involved in litigation. Litigation impacted physiotherapists' physical and mental wellbeing and their clinical practice. Improved support, both emotional and legal is required. Clinical negligence training should be included in pre-registration and postgraduate programs. CONTRIBUTION OF THE PAPER.

Identifying and Exploring the Cognitive Nature of Threshold Concepts in Pharmacology to Improve Medical Students' Learning

Phenomenon: Pharmacology is a fundamental healthcare discipline, but it can be difficult and counterintuitive for learners to learn. Navigation toward understanding pharmacology can be troublesome, but once the threshold to comprehension is crossed, learners can experience a transformative shift in their ways of thinking and practicing. We conducted an in-depth examination of threshold concepts within pharmacology, aiming to identify and prioritize their learning to improve the medical curriculum and enhance medical treatment and patient safety. Approach: We carried out a consensus generation process using the Nominal Group Technique (NGT) to identify potential threshold concepts in pharmacology. Participant groups of pharmacology experts and medical students considered, identified, reviewed, and ranked potential pharmacology threshold concepts within their own group. Then, using a logical, step-by-step approach, we combined the final ranked data from these multiple NGT sessions. We further analyzed these data using an abductive analysis approach; data were coded, categorized, reorganized, and conceptually mapped after critical evaluation. Conceptual themes were established corresponding to different phases of cognitive schema development. Findings: Six comprehensive conceptual themes were identified: Drug Mechanism of Action; Pharmacotherapeutics; Pharmacokinetics; Drug Receptor Interactions; Drug Terminology and Nomenclature; and Signaling Pathways. These concepts align with many of the key attributes of threshold concepts (e.g., troublesome, integrative and transformative). The cognitive schematic themes generated were (i) acquisition-troublesome; (ii) acquisition-transformative; (iii) automation-troublesome; (iv) automation-transformative. Insights: Transformative learning involves different stages of cognitive schema evolution, including acquisition, elaboration, and automation, and is influenced by both the inherent challenges of the concepts and limitations of human cognition. The high interactivity of these troublesome concepts challenge schema acquisition and automation. Troublesome concepts underpinning procedures or skills, while not easily explained by cognitive rules, can lead to slow, awkward, error-prone performance, creating additional barriers for practice. Integrating concepts into a coherent structure leads to the irreversible assimilation of knowledge and the transferability of both knowledge and skills, influencing learners' epistemological transitions and ontological transformations at theoretical and professional levels. Further work on designing instructional models around assisting and automating schemas around identified troublesome knowledge, while addressing the impact of cognitive load, has the potential to promote transformational learning.

European Training Requirements in Neonatology 2021: The ESPR, EAP, and UEMS Accredited European Syllabus for Neonatal Training

INTRODUCTION

The European Union stipulates transnational recognition of professional qualifications for several sectoral professions, including medical doctors. The Union of European Medical Specialists (UEMS), in its "Charter on Training of Medical Specialists," defines the principles for high-level medical training. These principles are manifested in the framework for European Training Requirements (ETR), ensuring medical training reflects modern medical practice and current scientific findings. In 1998, the European Society for Paediatric Research developed the first ETR for Neonatology. We present the ETR Neonatology in its third iteration (ETR III), ratified by the European Academy of Paediatrics (EAP), and approved by UEMS in 2021.

METHODS

In generating the ETR III, existing European policy documents on training requirements, including national syllabi and the European Standards of Care for Newborn Health were considered. To ensure the ETR III meets a pan-European standard of expertise in Neonatology, input from representatives from 27 European national paediatric/neonatal societies, and a European parent organisation, was sought.

RESULTS

The ETR III summarises the requirements of contemporary training programs in Neonatology and offers a system for accrediting trainers and training centres. We describe the content of the ETR III training syllabus and means of gaining and assessing competency as a medical care provider in Neonatology.

CONCLUSION

Graduates of courses following the ETR III Neonatology will obtain a certificate of satisfactory training completion which should be accepted by all European member states as a baseline qualification to practice as a specialist in neonatal medicine, enabling mutual recognition of status throughout Europe.

Development, implementation, and evaluation of an undergraduate family medicine program in the United Arab Emirates

BACKGROUND

Healthcare systems rely on well-trained family medicine physicians who can offer continuous quality services to their communities and beyond. The American Academy of Family Physicians and the World Organization of Family Doctors recommend that medical curricula should have adequately supervised education and training of the learners in family medicine during their preclinical and clinical placements. However, some medical schools don't have a comprehensive family medicine program to prepare graduates who can meet the community needs. This work aims to report the essential steps for the development, implementation, and evaluation of the family medicine program at the College of Medicine at the University of Sharjah in United Arab Emirates.

METHODS

We used the Kern's 6-step model to describe the development, implementation, and evaluation of the family medicine program. This includes problem identification, needs assessment, goals setting, educational strategies, implementation, and evaluation. During 2014-2022, we longitudinally collected essential information about the family medicine program from different stakeholders including the feedback of clinical coordinators, adjunct clinical faculty, and medical students at the end-of-clerkship. All responses were analysed to determine the effective implementation and evaluation of the family medicine program.

RESULTS

Over the course of 8 academic years, 804 medical students, 49 adjunct clinical faculty and three College of Medicine faculty participated in the evaluation of the family medicine program. The majority of respondents were satisfied with various aspects of the family medicine program, including the skills gained, the organisation of program, and the variety of clinical encounters. The medical students and adjunct clinical faculty suggested the inclusion of e-clinics, faculty development program, and the expansion of more clinical sites for the effectiveness of the family medicine program.

CONCLUSIONS

We report a successful development, implementation, and evaluation of the family medicine program in United Arab Emirates with a positive and impactful learning experience. More attention should be paid towards a suitable representation of family medicine program in the medical curriculum with focused and targeted educational plans for medical students.

Technical Skills Curriculum in Neonatology: A Modified European Delphi Study

INTRODUCTION

Simulation-based training (SBT) aids healthcare providers in acquiring the technical skills necessary to improve patient outcomes and safety. However, since SBT may require significant resources, training all skills to a comparable extent is impractical. Hence, a strategic prioritization of technical skills is necessary. While the European Training Requirements in Neonatology provide guidance on necessary skills, they lack prioritization. We aimed to identify and prioritize technical skills for a SBT curriculum in neonatology.

METHODS

A three-round modified Delphi process of expert neonatologists and neonatal trainees was performed. In round one, the participants listed all the technical skills newly trained neonatologists should master. The content analysis excluded duplicates and non-technical skills. In round two, the Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula (CAMES-NAF) was used to preliminarily prioritize the technical skills according to frequency, importance of competency, SBT impact on patient safety, and feasibility for SBT. In round three, the participants further refined and reprioritized the technical skills. Items achieving consensus (agreement of ≥75%) were included.

RESULTS

We included 168 participants from 10 European countries. The response rates in rounds two and three were 80% (135/168) and 87% (117/135), respectively. In round one, the participants suggested 1964 different items. Content analysis revealed 81 unique technical skills prioritized in round two. In round three, 39 technical skills achieved consensus and were included.

CONCLUSION

We reached a European consensus on a prioritized list of 39 technical skills to be included in a SBT curriculum in neonatology.

A blended approach to developing psychomotor skills in novice learners in a doctor of physical therapy curriculum

PURPOSE

Psychomotor skill performance is central to effective clinical practice across health professions. These complex skills are challenging to teach, particularly in the novice learner. As many health professions programs have increased blended course offerings, educators must establish best practices for teaching psychomotor skills in this evolving learning environment. The purpose of this paper is to describe the innovative application of an evidence-based framework to teaching psychomotor skills to novice learners in a blended learning environment.

MATERIALS AND METHODS

Using a modified 9-step framework, two novice clinical skills courses in a Doctor of Physical Therapy Program were redesigned to teach psychomotor skills in a blended format, using online and in-person class sessions. Online coursework consisted of synchronous and asynchronous learning activities that preceded an immersive lab experience. Formative and summative assessments occurred during lab immersion.

RESULTS AND CONCLUSIONS

The learning framework provided a central evidence-based pillar for novel course design, guiding development of learning activities for teaching psychomotor skills to novice learners in a blended learning environment. Initial student outcomes appear favorable when compared with previous traditional course structures and satisfaction was high. These preliminary findings align with prior research using similar frameworks for learning complex skills and provide an archetype curricular model for a blended learning environment.

Development of the EVIBEC Learning Outcomes Framework to support the delivery of evidence-based practice curricula in health care professional programmes: a codesign approach

BACKGROUND

All healthcare professional education programmes must adopt a systematic approach towards ensuring graduates achieve the competencies required to be an evidence-based practitioner. While a list of competencies for evidence-based practice exist, health care educators continue to struggle with effectively integrating the necessary competencies into existing curricula. The purpose of this project was to develop an open access cross-discipline, learning outcomes framework to support educators in integrating the teaching, learning and assessment required to ensure all graduates of health care professional programmes can achieve the necessary evidence-based practice competencies.

METHODS

An interdisciplinary team of health care professional educators and a librarian completed a review of the health professions literature on the teaching and assessment of evidence-based practice. The literature, coupled with the teams' collective experiences in evidence-based education and research, were used to identify relevant teaching, learning and evidence-based competency frameworks to inform the project design. The guide and toolkit for experience-based co-design developed by the National Health Service Institute for Innovation and Improvement was adopted for this study ( Institute for Innovation and Improvement: Experience Based Design: Guide & Tools In. Leeds: NHS; 2009.). A four-step approach involving three online participatory co-design workshops and a national validation workshop was designed. Students (n = 33), faculty (n = 12), and clinical educators (n = 15) participated in formulating and mapping learning outcomes to evidence-based competencies.

RESULTS

Through a rigorous, systematic co-design process the Evidenced-based Education Collaborative (EVIBEC) Learning Outcomes Framework was developed. This framework consists of a series of student-centred learning outcomes, aligned to evidence-based practice competencies, classified according to the 5 As of EBP and mapped to the cognitive levels of Bloom's taxonomy. Associated learning activities for each step of EBP are suggested.

CONCLUSIONS

A consensus-based, student-centred learning outcomes framework aligned to a contemporary set of EBP core competencies has been developed. The freely accessible EVIBEC framework may support entry level health care professional EBP education, by informing EBP curriculum development and offering the potential for interdisciplinary approaches to and sharing of valuable teaching and learning resources. Co-design proved an effective method in creating and refining this framework.

Long-Term Retention of Advanced Cardiovascular Life Support Knowledge and Confidence in Doctor of Pharmacy Students

OBJECTIVE

This study aimed to evaluate the impact of American Heart Association (AHA) advanced cardiovascular life support (ACLS) education and training on long-term retention of ACLS knowledge and confidence in Doctor of Pharmacy (PharmD) students.

METHODS

This multicenter study included PharmD students who received ACLS training through different means: 1-hour didactic lecture (didactic), 1-hour didactic lecture with 2-hour skills practice (didactic + skills), and comprehensive AHA ACLS certification through an elective course (elective-certification). Students completed a survey before training, immediately after training, and at least 6-12 months after training to assess demographics and ACLS confidence and knowledge. The primary outcome was a passing score, defined as ≥ 84% on the long-term knowledge assessment. Secondary outcomes included overall knowledge score and perceived confidence, assessed using the Dreyfus model.

RESULTS

The long-term assessment was completed by 160 students in the didactic group, 66 in the didactic + skills group, and 62 in the elective-certification group. Six (4%), 8 (12%), and 14 (23%) received a passing score on the long-term knowledge assessment in the didactic, didactic + skills, and elective-certification groups, respectively. The median (IQR) scores on the long-term knowledge assessment were 50% (40-60), 60% (50-70), and 65% (40-80) in the 3 groups. On the long-term assessment, confidence was higher in the elective-certification group, demonstrated by more self-ratings of competent, proficient, and expert, and fewer self-ratings of novice and advanced beginner.

CONCLUSION

Long-term retention of ACLS knowledge was low in all groups, but was higher in students who received AHA ACLS certification through an ACLS elective course.

The development of pre-registration occupational therapy student perceptions of research and evidence-based practice: A Q-methodology study

BACKGROUND

Pedagogically sound curricula are needed for occupational therapy (OT) students to adopt evidence-based practice (EBP) principles and internalise EBP within their professional identities. Exploring students' perceptions of this knowledge area can contribute to effective curriculum design.

AIMS/OBJECTIVES

To explore the evolution of pre-registration OT student perceptions of research and EBP over the course of their engagement with undergraduate teaching and learning.

MATERIALS AND METHODS

The Q-sort approach synthesises different viewpoints regarding a sample of statements, using by-person factor analysis (respondents = variables; statements = sample). Final year pre-registration OT students completed the same Q-sort at three timepoints (pre-dissertation [n = 18]; post-dissertation submission [n = 12]; post-student research conference [n = 6]). Q-sort responses were intercorrelated and factor-analysed; extraction of factors with an eigenvalue of ¬>0.9 and varimax rotation identified majority viewpoints.

RESULTS

Significant factors were revealed at each timepoint: 1a: 'Evidence-inseparable from OT practice', 1b: 'Research for research's sake-inseparable from the occupational therapy identity', 2: 'Who am I to question the gurus?', 3: 'I can do it with confidence…but so what?'

CONCLUSIONS

Opportunities for completing 'authentic' student research projects, with 'ownership' of results, may enhance research and EBP confidence and professional identity.

SIGNIFICANCE

Findings expand current knowledge regarding effective use of pre-registration educational opportunities to support future research and EBP.

What Faculty and Students Value When Evaluating Human Digital Anatomy Platforms: A Mixed-Methods Study

OBJECTIVES

There is an increasing availability of digital technologies for teaching and learning of human anatomy. Studies have shown that such applications allow for better spatial awareness than traditional methods. These digital human anatomy platforms offer users myriad features, such as the ability to manipulate 3D models, conduct prosection, investigate anatomical regions through virtual reality, or perform knowledge tests on themselves. This study examined what faculty members' value when using digital human anatomy platforms for teaching and what students value when using these platforms for learning.

METHODS

Six anatomy faculty members and 21 students were selected to participate in this study. After using the three digital anatomy platforms for at least 1 week, a survey was conducted to record their feedback in 4 categories: usability, interactive features, level of detail, and learning support. Respondents' Qualitative feedback within each category was also analyzed to strengthen the study's findings.

RESULTS

The study's findings showed that faculty members and students have different priorities when evaluating digital anatomy platforms. Faculty members valued platforms that provided better accuracy and detailed anatomical structures, while students prioritized usability above the rest of the features.

CONCLUSION

Given that faculty and students have different preferences when selecting digital anatomy platforms, this article proposed that educators maximize the specific affordances offered by the technology by having a clear pedagogy and strategy on how the technology will be incorporated into the curriculum to help students achieve the desired learning outcomes.

Students' experience and perceptions of undergraduate endodontic education in New Zealand

This study investigated the clinical experience and perceptions of New Zealand graduating dental students (2019 and 2020) towards endodontic teaching and their clinical learning outcomes using an online survey and clinical scenarios. Quantitative data were analysed using SPSS software, and qualitative data were analysed thematically. Responses were similar for both cohorts (response rates 74%, 2019; 73%, 2020). Endodontic teaching was valuable and interesting but difficult compared with other disciplines. Molar endodontics, finding canals and managing posture were challenging. Students felt more confident and less anxious when supervised by clinicians experienced in endodontics. Time management was the most anxiety-inducing factor and significantly related to clinical experience (p < 0.001). Overall, students appropriately applied knowledge in most areas of endodontics while holistic problem-solving in complex scenarios was variable. Maximising clinical experience and supervision from teachers experienced in endodontics are important for learning, improving confidence and reducing anxiety.

A Comparison of Study Behaviors and Metacognitive Evaluation Used by Biology Students

Student-study behaviors and metacognition are predictors of student-academic success. However, student metacognitive evaluation of their own study habit behavior use has been largely unexplored. To address this gap, we gave students enrolled in three different Biology courses (n = 1140) a survey that asked them to identify the study behaviors used to prepare for their first and third exams and to appraise the effectiveness of each behavior. We observed that, across all courses, students used different counts of active- and passive-study behaviors. However, there were no differences in performance across courses, and the use of effective (i.e., active) study behaviors resulted in improved exam performance for all students, regardless of course, while the use of ineffective (i.e., passive) study behaviors had no significant impact on exam performance. Finally, our qualitative analysis revealed that students across all courses demonstrated similar ability in identifying effective-study behaviors, but students could not explain why those behaviors were effective. Taken together, our study demonstrates that students use various study behaviors to prepare for exams without understanding their effectiveness. We encourage instructors to structure their courses to promote the development of metacognitive evaluation and effective-study behaviors.

Differences in Effort, Reward, Grit, Burnout, and Continuous Exercise Intention: Assessing the Effort-Reward Imbalance among Korean Athletes

Although studies have shown that an imbalance between effort and reward in the workplace negatively affects an individual's physiological and mental health, few have looked at how this imbalance may affect the mental state of athletes. Therefore, this study aimed to evaluate the importance of the effort-reward imbalance (ERI) in athletes by examining whether psychological variables would differ depending on the ERI. To accomplish this, 795 registered collegiate athletes were recruited. Of them, 227 and 230 responses with the ERI in the bottom and in the top 30% of the ERI scale were selected to compare groups with a high and a low ERI. Athletes completed a self-reported 64-item questionnaire (general characteristics: 5; effort: 14; rewards: 14; grit: 12; burnout: 15; and continuous exercise intention: 4 items). Data analysis included reliability and validity using the Jamovi and SPSS/AMOS software. The results showed no significant differences in effort, reward, grit, burnout, and intention to continue to exercise based on gender, weekly training frequency, and hours of training per day. There were differences in effort, reward, grit, burnout, and intention to continue exercising based on the presence of a professional league. Additionally, differences were found in effort, reward, grit, burnout, and intention to continue exercising between the low and high ERI groups. There was a clear difference between the mental state of those who were satisfied with their effort and reward, and those who were not. However, given that the two groups spent approximately the same amount of time exercising each week, the difference may have been more a function of the psychology of athletes than an actual difference in effort and reward. As our findings confirmed that the level of the ERI in athletes is related to their mental state, further research is necessary to identify and control factors that affect the ERI in athletes.

Student Perceptions of Learning Clinical Masking in Audiology: An Exploratory Survey Study

PURPOSE

The audiology literature is rich with work in the area of clinical masking, yet there is a perception that learning how to mask is difficult. The purpose of this study was to explore the experiences of audiology doctoral students and recent graduates in learning clinical masking.

METHOD

This exploratory study used a cross-sectional survey design, sampling doctor of audiology (AuD) students and recent graduates to probe the perceived effort required and challenges experienced in learning clinical masking. A total of 424 survey responses were included in the analysis.

RESULTS

A large majority of respondents rated learning clinical masking as being challenging and effortful. Responses suggested that it took more than 6 months for confidence to develop. Qualitative analysis of the open-ended question uncovered four themes: "negative experience in the classroom"; "lack of consensus or variation in teaching"; "focus on content/rules"; and "positives, internal and external."

CONCLUSIONS

Survey responses shed light on the perception that clinical masking is difficult to learn and highlight teaching and learning strategies that affect the development of this skill. Students reported a negative experience when significant emphasis was placed on formulas and theories and when encountering multiple masking methods in the clinic. On the other hand, students found clinic, simulations, lab-based classes, and some classroom instruction beneficial to learning. Students reported that their learning process included use of cheat sheets, practicing independently, and conceptualizing the process of masking to support their learning.

Investigating the network structure of domain-specific knowledge using the semantic fluency task

Cognitive scientists have a long-standing interest in quantifying the structure of semantic memory. Here, we investigate whether a commonly used paradigm to study the structure of semantic memory, the semantic fluency task, as well as computational methods from network science could be leveraged to explore the underlying knowledge structures of academic disciplines such as psychology or biology. To compare the knowledge representations of individuals with relatively different levels of expertise in academic subjects, undergraduate students (i.e., experts) and preuniversity high school students (i.e., novices) completed a semantic fluency task with cue words corresponding to general semantic categories (i.e., animals, fruits) and specific academic domains (e.g., psychology, biology). Network analyses of their fluency networks found that both domain-general and domain-specific semantic networks of undergraduates were more efficiently connected and less modular than the semantic networks of high school students. Our results provide an initial proof-of-concept that the semantic fluency task could be used by educators and cognitive scientists to study the representation of more specific domains of knowledge, potentially providing new ways of quantifying the nature of expert cognitive representations.

Clinical reasoning pattern used in oral health problem solving - A case study in Indonesian undergraduate dental students

BACKGROUND

Health professionals are known to use various combinations of knowledge and skills, such as critical thinking, clinical reasoning, clinical judgment, problem-solving, and decision-making, in conducting clinical practice. Clinical reasoning development is influenced by knowledge and experience, the more knowledge and experience, the more sophisticated clinical reasoning will be. However, clinical reasoning research in dentistry shows varying results .

AIMS

This study aims to observe the clinical reasoning pattern of undergraduate dental students when solving oral health problems, and their accordance with their knowledge acquisition.

MATERIAL AND METHODS

This qualitative study employed the think-aloud method and the result was assessed through verbal protocol analyses. Five respondents from final year dental undergraduate students were agreed to participate. A unique hypothetical clinical scenario was used as a trigger. The audio data were transcribed, interpreted, and categorized as a clinical reasoning pattern; and the concept maps created were assessed by a Structure of Learning Outcomes (SOLO) taxonomy as knowledge acquisition.

RESULTS

Observations on clinical reasoning patterns and the level of knowledge acquisition in five undergraduate dental students showed varying results. They applied clinical reasoning patterns according to their knowledge acquisition during didactical phase. Learners with inadequate knowledge relied on guessing, meanwhile learners with adequate knowledge applied more sophisticated reasoning pattern when solving problems.

CONCLUSIONS

Various problem-solving strategies were encountered in this study, which corresponded to the level of knowledge acquisition. Dental institutions must set minimum standards regarding the acquisition of conceptual knowledge accompanied by improvement of clinical reasoning skills, as well as refinement of knowledge and procedural skills.

Rethinking clinical decision-making to improve clinical reasoning

Improving clinical reasoning techniques is the right way to facilitate decision-making from prognostic, diagnostic, and therapeutic points of view. However, the process to do that is to fill knowledge gaps by studying and growing experience and knowing some cognitive aspects to raise the awareness of thinking mechanisms to avoid cognitive errors through correct educational training. This article examines clinical approaches and educational gaps in training medical students and young doctors. The authors explore the core elements of clinical reasoning, including metacognition, reasoning errors and cognitive biases, reasoning strategies, and ways to improve decision-making. The article addresses the dual-process theory of thought and the new Default Mode Network (DMN) theory. The reader may consider the article a first-level guide to deepen how to think and not what to think, knowing that this synthesis results from years of study and reasoning in clinical practice and educational settings.

Development and preliminary validation of a public health emergency competency model for medical staffs of national health emergency teams in China

Background

In the present study, we attempted to develop and validate a participatory competency model for medical workers and then evaluate the current status of competency characteristics of Chinese medical workers.

Methods

The competency model was constructed in a multistage process, including literature review, expert consultation, critical incident and focus group interview. A pilot study was conducted to refine the initial model among 90 participators and the viability and reliability were evaluated by a questionnaire survey among 121 medical workers. Then, the current status of competency characteristics was measured based on the final version of competency model.

Results

In the pilot study, ten questionnaires were dropped for the poor quality and thus the eligible rate was 92% (138/150). KMO value was 0.785 and Bartlett test showed that the χ² = 6464.546 (df = 903) and p value < 0.001. Then, 10 items with double loading and factor loading < 0.4 were deleted. Finally, 33 items were retained with the lowest factor loading value of 0.465. The validity and reliability of competency model were determined with Cronbach’s α coefficient of 0.975 and ICC value of 0.933. Finally, a revised competency model with 5 dimensions and 31 items was obtained. The overall competencies of current medical workers were in a high level, except for emergency knowledge related competencies. Age was an independent factor affecting the competencies.

Conclusions

Our competency model was a reliable and validated tool for assessing the competences of medical staffs against public health emergencies, and the overall competencies of current medical workers in China were in a high level, except for emergency knowledge related competencies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08361-z.

Performance Gains in an Open Skill Video-Game Task: The Role of Neural Efficiency and Neural Proficiency

We examined whether practice in an open skill video-game task would lead to changes in performance, attention, motivation, perceived effort, and theta, alpha, and beta waves. Specifically, we were interested on whether potential performance gains from practice would be primarily explained by the neural efficiency (i.e., cortical idling) or the neural proficiency hypothesis (i.e., mix of heightened and reduced activation across the cortex). To this end, we asked 16 novice participants (8 males and 8 females; Mage = 23.13 years) to play a Nintendo Wii video-game shooting task, namely Link's Crossbow Training. Pre-test scores, which were followed by an acquisition phase, were compared to post-test scores. Performance and subjective data were recorded for each trial and EEG data was continuously recorded using the portable EEGO System. Our findings revealed that performance increased while attention decreased at post-test, thereby confirming that practice leads to performance gains and reduces attentional overload. No changes in motivation or perceived effort were observed, perhaps because effort is a gestalt multidimension construct and video-gaming is an inherently motivating activity. EEG frequency analysis revealed that, for the most part, performance gains were accompanied by increased cortical activity across frequencies bands, thus lending primary support to the neural proficiency hypothesis. Accordingly, neurofeedback interventions to aid motor learning should teach performers not only how to silence their brains (i.e., quiescence state linked to automaticity and "flow") but also how to amplify task-relevant brain networks.

Reflections on Reflection: Clarifying and Promoting Use in Experienced Coaches

Background

We draw on the work of established scholars in the field of reflective practice who highlight its importance as a key cognitive skill for professionals to hold. While the substantive effect of engaging in reflective practice is emphasised in the literature, apparently coaches only spend a limited time learning about and engaging with it.

Objectives

This study was conducted in two parts: Part 1 examined coaches' knowledge of reflective practice and ascertained their perceived lack of value and use of reflective practice within their coaching. In response to the unexpected findings in Part 1, in Part 2, we instituted an educational intervention to further these participant coaches' knowledge of Reflective Practice (RP) and facilitate its integration into their coaching practice.

Design

The present study utilised a mixed method design with semi-structured interviews being conducted in Part 1. A coach development reflective programme inspired by Stimulated Recall approach was implemented in Part 2.

Participants

Twelve high level coaches were interviewed about their reflective practices in Part 1. In Part 2, the same coaches agreed to participate in the educational intervention for the duration of the project.

Results

Findings from Part 1 revealed an interesting paradox: coaches demonstrated a lack of appreciation for reflective practice yet recounted the positive influence that specific events and individuals had on their practice. In Part 2, to fully develop RP with the present cohort, an educational intervention was conducted. While watching videos of their own practice, coaches initially required lots of prompts from the lead interviewer to facilitate a deep and meaningful discussion of their practice. During the latter stages of the intervention, however, participants were less dependent on questions and prompts.

Conclusion

In part 1, the coaches in this study did employ reflection, although they did not label it as such. The qualitative evidence we have gathered enables us to suggest that it is the combination of how to reflect, and against what criteria that makes RP a powerful tool to develop expertise which it has the potential to be. Importantly, however, additional coach education input is necessary for these benefits to be fully realised.

Anesthesia workforce capacity in Thailand: A multicenter study

Background

Workforce management in anesthesia services is crucial for service quality. However, the data associated with this are lacking. Therefore, this study was done to analyze workforce and workload and to compare differences among hospital clusters in Thailand.

Materials and Methods

We conducted a cross-sectional study in multilevel hospitals that were classified by location, the population cared for, and the categorization of physicians. Stratified randomization from all health service regions across Thailand was done. The profile of hospitals, number of anesthesia staffs, their capabilities, and ratio of anesthesia personnel to the service provided during the 5 workdays and 1 weekend period were analyzed.

Results

A total of 18 hospitals, ranging from secondary to super-tertiary referral centers, were included in the study. The mean number of personnel ranged from 2.0 ± 1.2 to 12.0 ± 0 for anesthesiologists and 7.5 ± 2.9 to 42.3 ± 19.3 for nurse anesthetists from each hospital cluster, which vary in terms of capabilities and the number of staff. The average number of anesthesia service units was 9.1 ± 4.2 to 31.9 ± 16.4, while the number of operating theaters was 6.9 ± 2.2 to 22.7 ± 8.3. However, the ratio of anesthesia personnel to one anesthesia service unit and the ratio of these personnel to an operating theater were not significantly different among the participating hospitals, with a mean of 0.94 ± 0.45 and 1.34 ± 0.38, respectively.

Conclusion

The overall number of anesthesia service units was above the designated operating theater capacity, while the ratio of anesthesiologists was 0.8-1.3 and nurse anesthetists was 2.4-6.5 per 100,000 people on an average, with a disproportionate responsibility ratio of anesthesia personnel to anesthesia service units during that time.

The Relationship of Technical Skills and Cognitive Workload to Errors During Robotic Surgical Exercises

Purpose We attempt to understand the relationship between surgeon technical skills, cognitive workload and errors during a simulated robotic dissection task. Materials and Methods Participant surgeons performed a robotic surgery dissection exercise. Participants were grouped based on surgical experience. Technical skills were evaluated utilizing the validated Global Evaluative Assessment of Robotic Skills (GEARS) assessment tool. The dissection task was evaluated for errors during active dissection or passive retraction maneuvers. We quantified cognitive workload of surgeon participants as an Index of Cognitive Activity (ICA), derived from Task-Evoked-Pupillary-Response metrics; ICA ranged 0-1, with 1 representing maximum ICA. Generalized Estimating Equation (GEE) was used for all modellings to establish relationships between surgeon technical skills, cognitive workload and errors. Results We found a strong association between technical skills as measured by multiple GEARS domains (depth perception, force sensitivity and robotic control) and passive errors, with higher GEARS scores associated with a lower relative risk of errors (all p < 0.01). For novice surgeons, as average GEARS scores increased, the average estimated ICA decreased. In contrast, as average GEARS increased for expert surgeons, the average estimated ICA increased. When exhibiting optimal technical skill (maximal GEARS scores) novices and experts reached a similar range of ICA scores (ICA 0.47 and 0.42, respectively). Conclusions This study found that there is an optimal cognitive workload level for surgeons of all experience levels during our robotic surgical exercise. Select technical skill domains were strong predictors of errors. Future research will explore whether an ideal cognitive workload range truly optimizes surgical training and reduce surgical errors.

Transitioning to practice: a qualitative investigation of Australian graduate naturopath's experiences of being in practice

BACKGROUND

The transition from student to practitioner can be challenging, resulting in stress, burnout and attrition. While there has been ample research examining graduate medical and allied health practitioner experiences of transitioning to practice, there is a paucity of research exploring such experiences in newly qualified naturopathic medicine practitioners. In light of this knowledge gap, the objective of this study was to ascertain the experiences of practicing as a naturopath in Australia within the first 5 years post-graduation.

METHODS

Using a qualitative descriptive approach, recent graduates of an Australian Bachelor of Naturopathy (or equivalent) program were invited to participate in a semi-structured telephone interview to address the study objective. Data were analysed utilising a framework approach.

RESULTS

A total of 19 new graduates (94.7% female; 57.9% aged 40-59 years) undertook an interview. Five inter-related themes emerged from the data: practitioner, practice, proprietorship, professions, and perceptions. Connected with these themes were contrasting feelings, multiplicity of duties, small business challenges, professional collaboration, and professional identity, respectively.

CONCLUSIONS

Participants were generally content with their decision to become a naturopath. However, most were confronted by a range of challenges as they transitioned from graduate to practitioner, for which many felt ill-prepared. In light of the complexity of the issue, and the potential impact on the sustainability of the profession, it is evident that a multi-pronged, multi-stakeholder approach would be needed to better support graduate naturopath transition to practice.

Validation of a clinical competence evaluation tool for community service nurses in North West province, South Africa

Background

Little has been done to evaluate clinical competence of community service nurses (CSNs) during the 12-month compulsory community service in South Africa. Evaluating clinical competence of CSNs would be of benefit as it might improve quality patient care and promote patient satisfaction. It therefore became of paramount importance for the researcher to establish some method of evaluating the CSNs’ clinical competence during their compulsory service in the North West province (NWP), South Africa.

Aim

To evaluate the clinical competence evaluation tool (CCET) for CSNs for reliability and validity.

Setting

A selected regional level 2 hospital.

Methods

Ten experts participated in the validation process. The tool was tested at one of the public hospitals in the NWP and 11 out of 13 CSNs participated in this process. Statistical Package for the Social Sciences version 25 was employed and the reliability of the tool was measured using Cronbach’s alpha.

Results

This tool’s content validity index has exceeded 0.80 and is indicated at 0.98, which reflects excellent content validity. The higher the content validity ratio score the greater the agreement amongst the experts. The Cronbach’s alpha coefficients in the six competencies are all greater than 0.7 implying that the tool developed in this study is reliable. All the experts indicated that the tool is clear, simple, general, accessible and important.

Conclusion

From the above-mentioned results, a CCET for CSNs was proven to be valid and reliable.

Contribution

This was the first tool to be developed in NWP of South Africa.

Validity Evidence for Vascular Skills Assessment: The Feasibility of Fundamentals of Vascular Surgery in General Surgery Residency

OBJECTIVE

As the Fundamentals of Laparoscopic Surgery (FLS) and Fundamentals of Endoscopic Surgery (FES) have been used for general surgery assessment, the Fundamentals of Vascular Surgery (FVS) has recently been developed to evaluate core operative skills for vascular trainees. This study examines the 3 year implementation of FVS for general surgery residents and it gathers validity evidence using Messick's framework. We hypothesized that the curriculum and assessment tool enhance general surgery resident training and assessment.

DESIGN

This is a retrospective review of FVS assessments of residents using descriptive and multivariate analyses.

SETTING

This study was conducted at an academic institution, where simulation-based teaching sessions occur in coordination between the general surgery and the integrated vascular surgery residency programs.

PARTICIPANTS

Seventeen general surgery residents were assessed in FVS skills by an expert rater from 2018 to 2020.

RESULTS

Overall, 86 assessments were completed.

CONTENT

Assessment focuses on 3 open vascular skills (End-to-Side Anastomosis, Patch Angioplasty and Clockface Suturing). Response Process: 7 items comprise a graded rating for a skills score. Additionally, a global summary score is designated. Internal Structure: The assessment tool has a Cronbach's alpha of 0.87, demonstrating good internal consistency. Addition of the second rater correlated with Cohen's kappa -0.69 (p < 0.001), indicating poor interrater reliability. Relationships to other variables: The most significant improvement occurred in total scores between PGY2s (17.4 ± 2.37) and PGY4s (23.2 ± 3.00), p < 0.001, indicating adequate level discernment.

CONCLUSIONS

The validity evidence of FVS assessment in this study supports its use in general surgery residency at a time when opportunities for open vascular skills assessment may be decreasing due to case availability and shifting paradigms. Further study into quality rater training is needed to optimize national implementation of FVS and ensure consistency in grading.

Developing a Robotic General Surgery Training Curriculum: Identifying Key Elements Through a Delphi Process

OBJECTIVE

A national robotic surgery curriculum is still developing for general surgery residents as robotic surgery becomes increasingly accessible. One general surgery residency program utilized a Delphi process to optimize a robotic surgery curriculum and to determine key factors that might affect robotic proficiency and intraoperative independence.

DESIGN

Delphi methodology was used to gain consensus amongst robotic surgery faculty and trainees. Consensus was defined as agreement of 66.7% or above in factors that would allow a resident to independently operate in a robotic case. A panel of diverse representatives proposed factors that might affect resident robotic learning and operative experience. In a subsequent round, questions were sent through an anonymous online survey for respondents to identify factors that affect resident robotic independence. Respondents were also given the ability to write in pertinent factors.

SETTING

This study was conducted from July 2020 to September 2020 via anonymous web-based questionnaires for education researchers, faculty members, and residents of a university-affiliated independent general surgery residency program.

PARTICIPANTS

The initial panel consisted of a robotic surgeon, a 2020 graduate, a 2019 graduate and/or robotic fellow, a research resident, and a current resident. The subsequent survey was completed by 8 faculty members, 6 recent graduates, and 15 current residents within the general surgery residency program.

RESULTS

Proposed items fell into 3 categories: institutional resources, individual qualities, and curricular elements. Consensus within groups was achieved in the following items: dual robotic console models, robotic-focused faculty, resident interest, PGY level, and resident time spent on a simulator.

CONCLUSIONS

This Delphi exercise has informed this general surgery residency program in the development of a robotic surgery curriculum, through contribution from multiple stakeholders. While curricular elements for baseline robotic knowledge are necessary, institutional resources, deliberate practice, resident entrustment and faculty teaching proficiency warrant further study.

Twelve tips for introducing the concept of validity argument in assessment to novice medical teachers in a workshop

This article was migrated. The article was marked as recommended. Background: Misconceptions have been observed in the application of validity by faculty and in the reporting of validity in a significant amount of published work in the field of students' assessment. As a result, actions concerning the dissemination of information about the concept of validity in relation to assessments, especially among novice medical teachers, is needed. Aim: This work aims to guide how the concept of validity argument in assessments is delivered to novice medical teachers in a workshop. Methods: Critical reflection and a careful review of relevant literature were used to develop these tips. Results and Conclusion: Twelve tips were introduced to support instructors conducting workshops on introducing the concept of validity, especially to novice medical teachers.

Isolating steps instead of learners: Use of deliberate practice and validity evidence in coronavirus disease (COVID)-era procedural assessment

Background

In surgical training, assessment tools based on strong validity evidence allow for standardized evaluation despite changing external circumstances. At a large academic institution, surgical interns undergo a multimodal curriculum for central line placement that uses a 31-item binary assessment at the start of each academic year. This study evaluated this practice within increased in-person learning restrictions. We hypothesized that external constraints would not affect resident performance nor assessment due to a robust curriculum and assessment checklist.

Methods

From 2018 to 2020, 81 residents completed central line training and assessment. In 2020, this curriculum was modified to conform to in-person restrictions and social distancing guidelines. Resident score reports were analyzed using multivariate analyses to compare performance, objective scoring parameters, and subjective assessments among “precoronavirus disease” years (2018 and 2019) and 2020.

Results

There were no significant differences in average scores or objective pass rates over 3 years. Significant differences between 2020 and precoronavirus disease years occurred in subjective pass rates and in first-time success for 4 checklist items: patient positioning, draping, sterile ultrasound probe cover placement, and needle positioning before venipuncture.

Conclusion

Modifications to procedural training within current restrictions did not adversely affect residents’ overall performance. However, our data suggest that in 2020, expert trainers may not have ensured learner acquisition of automated procedural steps. Additionally, although 2020 raters could have been influenced by logistical barriers leading to more lenient grading, the assessment tool ensured training and assessment integrity.

Challenges Faced by New Psychiatric-Mental Health Nurse Practitioner Prescribers

One of the main challenges that psychiatric-mental health nurse practitioner (PMNHP) students experience is preparing to prescribe medications by demonstrating psychopharmacological competency. To examine the challenges as they relate to this issue, self-reflective journaling narratives were evaluated from two cohorts of Post-Master's PMHNP program graduates, across each of two semesters of pediatric and adult clinical experience. The most prominent challenges reported by students were in regard to medication treatment adherence, decision making, and monitoring symptom-related outcomes. The narratives also demonstrate that reflection, combined with faculty- and preceptor-supported clinical education, assists PMHNP students in developing psychopharmacological competency. All PMHNP students described in this article were nurse practitioners before they began the program. By seeking to augment their competencies and through continued self-reflective learning and practice, they will improve access to mental health care for the populations they serve. [Journal of Psychosocial Nursing and Mental Health Services, 58(10), 7-11.].

Quantitative Comparison of Human and Software Reliability in the Categorization of Sit-to-Stand Motion Pattern

The Sit-to-Stand (STS) test is used in clinical practice as an indicator of lower-limb functionality decline, especially for older adults. Due to its high variability, there is no standard approach for categorising the STS movement and recognising its motion pattern. This paper presents a comparative analysis between visual assessments and an automated-software for the categorisation of STS, relying on registrations from a force plate. 5 participants (30 ± 6 years) took part in 2 different sessions of visual inspections on 200 STS movements under self-paced and controlled speed conditions. Assessors were asked to identify three specific STS events from the Ground Reaction Force, simultaneously with the software analysis: the start of the trunk movement (Initiation), the beginning of the stable upright stance (Standing) and the sitting movement (Sitting). The absolute agreement between the repeated raters' assessments as well as between the raters' and software's assessment in the first trial, were considered as indexes of human and software performance, respectively. No statistical differences between methods were found for the identification of the Initiation and the Sitting events at self-paced speed and for only the Sitting event at controlled speed. The estimated significant values of maximum discrepancy between visual and automated assessments were 0.200 [0.039; 0.361] s in unconstrained conditions and 0.340 [0.014; 0.666] s for standardised movements. The software assessments displayed an overall good agreement against visual evaluations of the Ground Reaction Force, relying, at the same time, on objective measures.

How Can We Raise Awareness of Physician's Needs in Order to Increase Adherence to Management and Leadership Training?

Due to the increasing complexity of medical education and practice, the training of healthcare professionals for leadership and management roles and responsibilities has become increasingly important. But gaps in physician leadership and management skills have been identified across a broad range of organizational and geographic settings. Many clinicians are inadequately prepared to meet their day-to-day clinical leadership responsibilities. Simultaneously, physicians' leadership and management skills play a central role and yield superior outcomes for patients and health care delivery organizations. Currently, there is a tremendous variability in the amount of time, structure and resources dedicated to leadership/management training for physicians. Physicians who have completed such trainings seem to be pleased with the outcome. However, only a limited number of physicians enroll in these types of trainings. Several reasons can explain this fact, but it seems crucial to investigate what could increase the involvement of medical leaders and managers in these training programs. This paper offers a framework for addressing the barriers to training commitment and for designing initial training interventions for physicians. This framework is rooted in two well-known theoretical models used in social sciences. It aims to promote self-assessed knowledge and expertise amongst physicians about to embrace leader/manager careers. By developing the ability to explore and be curious about one's own experience and actions, physicians may suddenly open up the possibilities of purposeful learning. The process we describe in this paper may be an essential step in fostering the involvement of physicians in leadership and management training processes. And this is essential to contribute to the advancement of medical discipline.

K12 Practitioners' Perceptions of Learning from Failure, Creativity, and Systems Thinking: a Collective Case Study

This article presents the results of a collective case study exploring how K12 practitioners perceive the interaction of systems thinking, creativity, and learning from failure within their professional practice. In order to identify K12 practitioners who were well-versed in systems thinking, we targeted students within an instructional design and technology graduate program that included a course on human performance improvement (HPI). At the conclusion of the semester, all students in the course were invited to participate in an individual, semi-structured interview where they discussed the relationship among these three concepts within their professional practice. Participants described how learning from failure and creativity manifest within their practice and through systems thinking. Additionally, they identified that learning from failure and creativity are crucial components of problem solving. Further insights for how these three concepts can impact professional practice are addressed.

High-definition videolaryngoscopy is superior to fiberoptic laryngoscopy: a 111 multi-observer study

Purpose

This study aims to analyse differences in fiberoptic laryngoscopy (FOL) versus high definition laryngoscopy (HDL) by examining videolaryngoscopy images by a large group of observers with different levels of clinical expertise in ear, nose and throat (ENT) medicine.

Methods

This study is a 111 observer paired analysis of laryngoscopy videos during an interactive presentation. During a National Meeting of the Dutch Society of ENT/Head and Neck Surgery, observers assessed both FOL and HDL videos of nine cases with additional clinical information. Observers included 41 ENT consultants (36.9%), 34 ENT residents (30.6%), 22 researchers with Head and Neck interest (19.8%) and 14 with unspecified clinical expertise (12.6%). For both laryngoscopic techniques, sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were determined for identifying a normal glottis, hyperkeratosis, radiotherapy adverse effects and squamous cell carcinoma. The sensitivities for FOL and HDL were analysed with regard to the different levels of clinical expertise.

Results

The overall sensitivity for correctly identifying the specific histological entity was higher in HDL (FOL 61% vs HDL 66.3%, p < 0.05). HDL was superior to FOL in identifying a normal glottis (FOL 68.1% vs HDL 91.6%, p < 0.01) and squamous cell carcinoma (FOL 70.86% vs HDL 79.41%, p = 0.02). Residents and researchers with Head and Neck interest diagnosed laryngeal lesions more correctly with HDL (p < 0.05).

Conclusions

In a large population of observers with different levels of clinical expertise, HDL is superior to FOL in identifying laryngeal lesions.

Applying Eye Movement Modeling Examples to Guide Novices' Attention in the Comprehension of Process Models

Process models are crucial artifacts in many domains, and hence, their proper comprehension is of importance. Process models mediate a plethora of aspects that are needed to be comprehended correctly. Novices especially face difficulties in the comprehension of process models, since the correct comprehension of such models requires process modeling expertise and visual observation capabilities to interpret these models correctly. Research from other domains demonstrated that the visual observation capabilities of experts can be conveyed to novices. In order to evaluate the latter in the context of process model comprehension, this paper presents the results from ongoing research, in which gaze data from experts are used as Eye Movement Modeling Examples (EMMEs) to convey visual observation capabilities to novices. Compared to prior results, the application of EMMEs improves process model comprehension significantly for novices. Novices achieved in some cases similar performances in process model comprehension to experts. The study’s insights highlight the positive effect of EMMEs on fostering the comprehension of process models.

Changes in physiotherapists' perceptions of evidence-based practice after a year in the workforce: A mixed-methods study

BACKGROUND

Few studies have explored evidence-based practice (EBP) knowledge, attitudes and behaviours of health professional graduates transitioning into the workforce. This study evaluated changes in these EBP domains in physiotherapists after one year of working.

METHOD

A mixed methods design was used. Participants completed two psychometrically-tested EBP questionnaires at two timepoints. The Evidence-Based Practice Profile questionnaire collected self-report EBP data (Terminology, Relevance, Confidence, Practice, Sympathy) and the Knowledge of Research Evidence Competencies collected objective data (Actual Knowledge). Changes were calculated using descriptive statistics (paired t-tests, 95% CI, effect sizes). Qualitative interview data collected at one timepoint were analysed using a descriptive approach and thematic analysis, to examine the lived experience of participants in the context of their first employment. The aim of the mixed methods approach was a broader and deeper understanding of participants' first year of employment and using EBP.

RESULTS

Data were analysed from 50 participants who completed both questionnaires at the two timepoints. After one year in the workforce, there was a significant decrease in participants' perceptions of Relevance (p<0.001) and Confidence with EBP (p<0.001) and non-significant decreases in the other domains. Effect sizes showed medium decreases for Relevance (0.69) and Confidence (0.57), small decreases in Terminology (0.28) and Practice (0.23), and very small decreases in Sympathy (0.08) and Actual Knowledge (0.11). Seven themes described participants experience of using EBP in their first working year.

CONCLUSIONS

After a year in the workplace, confidence and perceptions of relevance of EBP were significantly reduced. A subtle interplay of features related to workplace culture, competing demands to develop clinical skills, internal and external motivators to use EBP and patient expectations, together with availability of resources and time, may impact early graduates' perceptions of EBP. Workplace role models who immersed themselves in evidence discussion and experience were inspiring to early graduates.

How Experts Adapt Their Gaze Behavior When Modeling a Task to Novices

Domain experts regularly teach novice students how to perform a task. This often requires them to adjust their behavior to the less knowledgeable audience and, hence, to behave in a more didactic manner. Eye movement modeling examples (EMMEs) are a contemporary educational tool for displaying experts’ (natural or didactic) problem‐solving behavior as well as their eye movements to learners. While research on expert‐novice communication mainly focused on experts’ changes in explicit, verbal communication behavior, it is as yet unclear whether and how exactly experts adjust their nonverbal behavior. This study first investigated whether and how experts change their eye movements and mouse clicks (that are displayed in EMMEs) when they perform a task naturally versus teach a task didactically. Programming experts and novices initially debugged short computer codes in a natural manner. We first characterized experts’ natural problem‐solving behavior by contrasting it with that of novices. Then, we explored the changes in experts’ behavior when being subsequently instructed to model their task solution didactically. Experts became more similar to novices on measures associated with experts’ automatized processes (i.e., shorter fixation durations, fewer transitions between code and output per click on the run button when behaving didactically). This adaptation might make it easier for novices to follow or imitate the expert behavior. In contrast, experts became less similar to novices for measures associated with more strategic behavior (i.e., code reading linearity, clicks on run button) when behaving didactically.

Adaptive tutorials versus web-based resources in radiology: a mixed methods analysis in junior doctors of efficacy and engagement

BACKGROUND

Radiology education is limited in undergraduate Medicine programs. Junior doctors might not have the necessary background to effectively order and interpret diagnostic imaging investigations. Furthermore, junior doctors are often time-poor, balancing clinical commitments with ongoing learning, leadership and teaching responsibilities. Previous studies have demonstrated the efficacy of radiology-themed online adaptive tutorials for senior medical students. Such adaptive tutorials might therefore be an efficient and effective form of radiology education for junior doctors.

METHODS

A randomised controlled crossover trial was performed to evaluate the impact of adaptive tutorials on learning the indications for, and interpretation of, basic imaging studies, compared with peer-reviewed web-based resources. Ninety-one volunteer junior doctors, comprising 53 postgraduate year 1 (PGY 1) and 38 postgraduate year 2 (PGY 2), were randomly allocated into two groups. In the first phase of the trial, focusing on head CT, one group accessed adaptive tutorials while the other received web-based resources. In the second phase of the trial, focusing on chest CT, the groups crossed over. Following each phase of the trial, participants completed exam-style online assessments. At the conclusion of the study, participants also completed an online questionnaire regarding perceived engagement and efficacy of each type of educational resource.

RESULTS

Junior doctors completed the adaptive tutorials significantly faster than the relevant web-based resources for both head CT and chest CT (p = 0.03 and < 0.01 respectively). Mean quiz scores were higher in the groups receiving adaptive tutorials on head CT and chest CT (86.4% vs 83.5 and 77.7% vs 75% respectively). However, in contrast to previous studies in senior medical students, these differences were not statistically significant. Participants reported higher engagement and perceived value of adaptive tutorials, compared with web-based resources.

CONCLUSIONS

Adaptive tutorials are more time-efficient than existing web-based resources for learning radiology by junior doctors, while both types of resources were equally effective for learning in this cohort. Junior doctors found the adaptive tutorials more engaging and were more likely to recommend these resources to their colleagues.

A Student-Led Elective Provides Quality Improvement Feedback for a Required Compounding Course

Objective. To implement an advanced elective compounding course where pharmacy students conduct investigations to improve compounding-related issues that were subsequently evaluated in a required compounding course. Methods. The elective compounding course required students to engage in self-directed learning, critical thinking, creation and evaluation of laboratory data, and self- and group reflection. Students researched and developed "solutions" to compounded preparation problems, and their solutions were tested in the next iteration of a required compounding course. For example, students in the elective course identified sources of potency variability in a ketoprofen Pluronic organogel (PLO) emulsion preparation. The students identified six variables and executed an investigative action plan. They considered all data collected and proposed a method to reduce potency variation. The recommended solution was implemented in the next offering of a required compounding course and the potency variability results were compared to the previous required course's results. Results. The mean ketoprofen PLO emulsion potency achieved in the required course prior to implementing the elective course recommendation was 129% (SD 21%), n=158. After the recommended change from elective course was implemented, the mean potency was 118% (SD 21%), n=131. Conclusion. The teaching methods and activities conducted in the elective course provided students with a deeper level of learning and understanding of compounding science, while providing practical experience in scientific research methodology. The course also provided a cyclic quality improvement feedback mechanism for the required course.

Alignment of CanMEDS-based Undergraduate and Postgraduate Pharmacy Curricula in The Netherlands

In this article the design of three master programs (MSc in Pharmacy) and two postgraduate specialization programs for community or hospital pharmacist is described. After a preceding BSc in Pharmacy, these programs cover the full pharmacy education capacity for pharmacists in primary and secondary health care in the Netherlands. All programs use the CanMEDS framework, adapted to pharmacy education and specialization, which facilitates the horizontal integration of pharmacists’ professional development with other health care professions in the country. Moreover, it is illustrated that crossing the boundary from formal (university) education to experiential (workplace) education is eased by a gradual change in time spent in these two educational environments and by the use of comparable monitoring, feedback, and authentic assessment instruments. A reflection on the curricula, based on the principles of the Integrative Pedagogy Model and the Self-determination Theory, suggests that the alignment of these educational programs facilitates the development of professional expertise and professional identity of Dutch pharmacists.

Teaching research skills to student pharmacists: A multi-campus, multi-semester applied critical care research elective

BACKGROUND AND PURPOSE

Research electives are commonly offered in doctor of pharmacy programs but are typically limited to one faculty member mentoring individual students at a single site for a semester long self-study experience. The purpose of this paper is to describe pharmacy student experiences and perceptions of the research process after completing a multi-campus, multi-investigator critical care research elective.

EDUCATIONAL ACTIVITY AND SETTING

The Research in Critical Care Pharmacotherapy elective was launched in spring 2019 and implemented a novel approach to the pharmacy research elective that promoted collaborative research across four campuses that may be continued for up to four semesters of credit.

FINDINGS

Six second- and third-year doctor of pharmacy students enrolled in the course during the first offering. Three students were located on the main campus with one student on each of the extended campuses. Students completed a median of five unique research activities with at least one student participating in 15 of the 19 activities evaluated. Students were asked to complete a pre- and post-course survey assessing perceived research abilities using the Dreyfus model. There was a significant decrease in the number of novice responses in the post-course survey (pre- 10 vs. post- 2, p = 0.043).

SUMMARY

A multi-campus, multi-investigator critical care research elective provided broad research experiences and increased student confidence related to numerous research skills.

Rethinking Competence: A Nexus of Educational Models in the Context of Lifelong Learning

Competency-based education (CBE) “derives a curriculum from an analysis of a prospective or actual role in modern society and attempts to certify students’ progress on the basis of demonstrated performance in some or all aspects of that role”. This paper summarizes pertinent aspects of existing CBE models in health professions education; pharmacy education presented as an example. It presents a synthesis of these models to propose a new diagrammatic representation. A conceptual model for competency-based health professions education with a focus on learning and assessment is discussed. It is argued that various elements of CBE converge to holistically portray competency-based learning and assessment as essential in initial education and relevant to practitioners’ continuing professional development, especially in the context and importance of pursing lifelong learning practices.

Critical Thinking in Health Sciences and How It Pertains to Sonography Education: A Review of the Literature

Objective:

Critical thinking is an important skill that sonographers must develop beginning in educational programs and into professional practice. Critical thinking requires students to reflect on information, use judgment skills, and engage in higher levels of thinking, including analysis, interpretation, inference, evaluation, and explanation, to formulate reliable decisions.

Methods:

Current research related to critical thinking has focused on medicine, nursing, physical therapy, pharmacy, and dental programs, but there has been no description of assessing sonography students. The Dreyfus model has been used as a framework to describe acquired skills that reflects students’ progress from novice to expert clinicians. This model illustrates specific cognitive abilities that students develop as they advance in education.

Results:

This review of the literature describes critical thinking skills coupled with a framework to understand different levels of cognitive thinking, as well as how it can be assessed.

Conclusion:

To understand differences between undergraduate sonography students and experts, the Dreyfus model is an excellent model to recognize progression. It can be used with the Health Sciences Reasoning Test, which is a nationally recognized critical thinking examination that can ascertain different levels of health sciences students’ critical thinking skills.

Experience as a Determinant of Declarative and Procedural Knowledge in School Football

The study of declarative and procedural knowledge makes it possible to ascertain what cognitive processes are like during motor learning. This study aimed to compare, according to the methodology, gender and experience (football practise), and the levels of declarative and procedural knowledge after the implementation of two intervention programmes on school football including one based on the tactics learning and the other on the technique learning. A total of 41 students in the 5th year of primary education from a state school from Spain, distributed in two class groups, participated in the study. Each class group participated in a different intervention programme. The sample of subjects was equal (tactical programme (n = 20) and technical programme (n = 21)). A panel of 13 experts validated both programmes. Levels of knowledge were measured using the Tactical Knowledge Assessment test in football. A descriptive analysis was performed to characterise the sample. Moreover, a t-test for independent samples, a t-test for related samples, and a 2 × 2 ANOVA (analysis of variance) were performed to compare the levels of knowledge between the pre-test and the post-test, according to the methodology, gender, and experience of the students. Results indicate that both intervention programmes induced higher levels of declarative and procedural knowledge in the post-test. Similarly, there were no significant differences with regard to the applied methodology. This fact is due to the heterogeneous character of the class groups with gender and experience showing effects on the levels of knowledge. The boys possessed greater experience and a higher level of knowledge compared to the girls.

Community pharmacists' and residents' decision making and unmet information needs when completing comprehensive medication reviews

OBJECTIVE

To (1) characterize community pharmacists' and community pharmacy residents' decision making and unmet information needs when conducting comprehensive medication reviews (CMRs) as part of medication therapy management and (2) explore any differences between community pharmacists and community pharmacy residents in CMR decision making and unmet information needs.

DESIGN

Thirty-to 60-minute semistructured interviews framed using a clinical decision-making model (CDMM) were conducted with community pharmacists and residents.

SETTING AND PARTICIPANTS

Participants were recruited from practice-based research networks and researchers' professional networks. Eligible participants had completed or supported the completion of at least 2 CMRs in the last 30 days.

OUTCOME MEASURES

Two researchers independently coded transcripts using a combination of inductive and deductive methods to identify themes pertaining to community pharmacists' and residents' decision making and unmet information needs in the provision of CMRs. Discrepancies among researchers' initial coding decisions were resolved through discussion.

RESULTS

Sixteen participants (8 pharmacists and 8 residents) were interviewed. Themes were mapped to 5 CDMM steps. Participants primarily used subjective information during "case familiarization"; objective information was secondary. Information used for "generating initial hypotheses" varied by medication therapy problem (MTP) type. During "case assessment," if information was not readily available, participants sought information from patients. Thus, patients' levels of self-management and health literacy influenced participants' ability to identify and resolve MTPs, as described under "identifying final hypotheses." Finally, participants described "decision-making barriers," including communication with prescribers to resolve MTPs. Although pharmacist and resident participants varied in the types of MTPs identified, both groups cited the use and need of similar information.

CONCLUSION

Community pharmacists and residents often rely primarily on patient-provided information for decision making during CMRs because of unmet information needs, specifically, objective information. Moreover, confidence in MTP identification and resolution is reduced by communication challenges with prescribers and limitations in patients' ability to convey accurate and necessary information.

Implementation and evaluation of problem-based video podcasts in an introductory pharmacokinetics course

INTRODUCTION

The use of problem-based video podcasts in health sciences education is limited. Principles of Pharmacokinetics is an introductory course that establishes a foundation for understanding pharmacokinetic concepts. The primary objective was to determine the impact of problem-based video podcasts in an introductory pharmacokinetics course on student learning.

METHODS

Problem-based video podcasts were implemented in an introductory pharmacokinetics course in spring 2015. Student pharmacists in the first professional year enrolled in the course during spring 2015, 2016, and 2017 were included in the study with students enrolled in the course in spring 2014 serving as the control group. The primary outcome was the impact of problem-based video podcasts on student learning as assessed by student performance on the final exam. Other outcomes included student utilization of the video podcasts, overall course grades, and student perceptions of learning using video podcasts.

RESULTS

A total of 633 students in four academic years were included for analysis. Final exam scores were significantly higher in spring 2015 and 2016 compared to 2014. The 2017 final exam scores were similar to the final exam scores in 2014. Students perceived the problem-based video podcasts enhanced their ability to apply concepts to a patient case, reinforced concepts from lectures, and improved their understanding of clinical pharmacokinetics.

CONCLUSION

The use of problem-based video podcasts is an innovative method to augment learning outside of the traditional class time and may enhance learning without replacing direct instructor-student contact. Students reported the video podcasts improved their understanding of clinical pharmacokinetics.

Pharmacy Student Performance in a Capstone Course Utilizing the Pharmacists' Patient Care Process

Objective. To develop, implement, and assess student performance and confidence in a pharmacy capstone course that used case-based instruction and the Pharmacist's Patient Care Process (PPCP) to develop patient work-up skills in third-year Doctor of Pharmacy (PharmD) students. Methods. A skills-based capstone course was developed by a team of faculty members and instructional designers that focused on patient evaluation skills and applying the steps of the PPCP to complex patient cases housed in a simulated electronic health record (SEHR). The acuity of the cases increased over the course of the semester. For each patient case, students were expected to identify drug-related problems and develop an assessment and plan based on the information provided in the SEHR. Results. Students (n=134) were assessed through weekly quizzes and two practical examinations. The average score for all quizzes was 81%. A significant correlation was found between average quiz scores and performance on the end-of-course practical examination. Student scores significantly improved from the first to the second practical examination (10.4 vs 12.9, respectively), and student confidence with regard to all course objectives significantly improved from the beginning to the end of the semester. Conclusion. A capstone course that applied the PPCP framework successfully taught third-year PharmD students the patient care skills they would need in advanced pharmacy practice experiences.