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Rasmussen MB, Tolsgaard MG, Dieckmann P, Østergaard D, White J, Plenge P, Ringsted CV. Social ties influence teamwork when managing clinical emergencies. BMC Med Educ 2020; 20:63. [PMID: 32131807 PMCID: PMC7057460 DOI: 10.1186/s12909-020-1953-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Our current understanding of medical team competence is traditionally influenced by an individualistic perspective focusing on individual team members' knowledge, skills as well as on effective communication within the team. However, team dynamics may influence team performance more than previously anticipated. In particular, recent studies in other academic disciplines suggest that social ties between team members may impact team dynamics but this has not been explored for medical teams. We aimed to explore intensive care staff's perceptions about teamwork and performance in clinical emergencies focusing particularly on the teams' social ties. METHODS Semi-structured interviews were conducted with a purposive sample of intensive care staff. We used a thematic analysis approach to data interpretation. RESULTS Thematic saturation was achieved after three group interviews and eight individual interviews. Findings demonstrated that social ties influenced teamwork by affecting the teams' ability to co-construct knowledge, coordinate tasks, the need for hierarchy, the degree to which they relied on explicit or implicit communication, as well as their ability to promote adaptive behavior. CONCLUSIONS Social ties may be an important factor to consider and acknowledge in the design of future team training, as well as for work planning and scheduling of team activities during clinical practice. More research is needed into the causal effect of social ties on team performance and outcome.
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Affiliation(s)
- Maria B. Rasmussen
- Department of Obstetrics and Gynecology, University hospital Sealand, Roskilde Hospital. Sygehusvej 10, 4000 Roskilde, Denmark
| | - Martin G. Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark Centre for Human Resource, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark Centre for Human Resource, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark Centre for Human Resource, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark
| | - Jonathan White
- Intensive Care Unit 4131, University Hospital Rigshospitalet, Blegdamsvej 9. 2100, Købenahvn Ø, Denmark
| | - Pernille Plenge
- Intensive Care Unit 4131, University Hospital Rigshospitalet, Blegdamsvej 9. 2100, Købenahvn Ø, Denmark
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Tolsgaard MG, Jepsen RMHG, Rasmussen MB, Kayser L, Fors U, Laursen LC, Svendsen JH, Ringsted C. The effect of constructing versus solving virtual patient cases on transfer of learning: a randomized trial. Perspect Med Educ 2016; 5:33-38. [PMID: 26754313 PMCID: PMC4754215 DOI: 10.1007/s40037-015-0242-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to explore the effect of actively constructing virtual patient (VP) cases compared with solving VP cases on knowledge gains, skills transfer and time spent on cases. Forty-five fourth-year medical students were randomized to constructing (VP-construction, n = 23) or solving (VP-solving, n = 22) four cardiopulmonary VP cases. Whereas the VP-solving group solved the cases, the VP-construction group only received the final diagnosis and had to complete the history, physical findings, and lab results. After a week, participants completed a transfer test involving two standardized patients representing cardiopulmonary cases. Performances on the transfer test were video-recorded and assessed by two blinded raters using the Reporter, Interpreter, Manager, Educator (RIME) framework. Thirty-nine participants completed the transfer test. The VP-construction group spent significantly more time on the VP cases compared with the VP-solving group, p = 0.002. There were no significant differences in RIME scores between the VP-construction group and VP-solving group, p = 0.54.In conclusion, engaging novice students in active VP case construction may be more time consuming than solving VP cases, without resulting in superior skills transfer.
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Affiliation(s)
- Martin G Tolsgaard
- Centre for Clinical Education, Capital Region of Denmark and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Obstetrics and Gynaecology, Nordsjælland University Hospital, Hillerød, Denmark.
| | - Rikke M H G Jepsen
- Centre for Clinical Education, Capital Region of Denmark and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Danish Institute for Medical Simulation, Herlev University Hospital, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Maria B Rasmussen
- Centre for Clinical Education, Capital Region of Denmark and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Kayser
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Uno Fors
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Lars C Laursen
- Department of Pulmonary Medicine, Herlev University Hospital, Herlev, Denmark
| | - Jesper H Svendsen
- Department of Cardiology, Department of Clinical Medicine, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen and Danish Arrhythmia Research Centre, University of Copenhagen, Copenhagen, Denmark
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Abstract
Training in pairs (dyad practice) has been shown to improve efficiency of clinical skills training compared with single practice but little is known about students' perception of dyad practice. The aim of this study was to explore the reactions and attitudes of medical students who were instructed to work in pairs during clinical skills training. A follow-up pilot survey consisting of four open-ended questions was administered to 24 fourth-year medical students, who completed four hours of dyad practice in managing patient encounters. The responses were analyzed using thematic analysis. The students felt dyad practice improved their self-efficacy through social interaction with peers, provided useful insight through observation, and contributed with shared memory of what to do, when they forgot essential steps of the physical examination of the patient. However, some students were concerned about decreased hands-on practice and many students preferred to continue practising alone after completing the initial training. Dyad practice is well received by students during initial skills training and is associated with several benefits to learning through peer observation, feedback and cognitive support. Whether dyad training is suited for more advanced learners is a subject for future research.
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Affiliation(s)
- Martin G Tolsgaard
- The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100-O, Copenhagen, Denmark.
- Centre for Clinical Education, Capital Region of Denmark and Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100-O, Copenhagen, Denmark.
| | - Maria B Rasmussen
- Centre for Clinical Education, Capital Region of Denmark and Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100-O, Copenhagen, Denmark
| | - Sebastian Bjørck
- Department of Orthopaedic Surgery, University Hospital Slagelse, Slagelse, Denmark
| | - Amandus Gustafsson
- Department of Orthopaedic Surgery, University Hospital Hvidovre, Hvidovre, Denmark
| | - Charlotte V Ringsted
- The Wilson Centre and Department of Anesthesia, University of Toronto and University Health Network, Toronto, Canada
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Rasmussen MB, Tolsgaard MG, Dieckmann P, Issenberg SB, Ostergaard D, Søreide E, Rosenberg J, Ringsted CV. Factors relating to the perceived management of emergency situations: a survey of former Advanced Life Support course participants' clinical experiences. Resuscitation 2014; 85:1726-31. [PMID: 25151548 DOI: 10.1016/j.resuscitation.2014.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 07/06/2014] [Accepted: 08/05/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study explored individual, team, and setting factors associated with the quality of management of in-hospital emergency situations experienced by former Advanced Life Support (ALS) course participants. METHODS This study was a survey of former ALS course participants' long-term experience of management of in-hospital, emergency situations. The survey was carried out in 2012 in Denmark and Norway. RESULTS A questionnaire was send to 526 potential responders and (281/479 × 100) 58.7% responded. The results demonstrated that 75% of the emergency situations were perceived as "managed well". In general, the responders' confidence in being ALS providers was high, mean 4.3 (SD 0.8), scale 1-5. Significant differences between the perceived "well" and "not well" managed situations were found for all questions, p<0.001. The largest differences related to perception of co-workers' ability to apply ALS principles, the team atmosphere and communication. Responders' ratings of quality of management of emergency situations increased with intensity of setting. However, the 'clinical setting' was rated significantly lower as attributor to ability to apply ALS principles compared to 'co-workers familiarity with ALS principles', 'own confidence as ALS-provider' and 'own social/inter-personal skills'. CONCLUSION The results of this survey emphasise that ALS providers' perceived ability to apply ALS skills were substantially affected by teamwork skills and co-workers' skills. Team related factors associated with successful outcome were related to clear role distribution, clear inter-personal communication and attentive listening, as well as respectful behaviour and positive team atmosphere. Although intensity of setting was attributed to ability to apply ALS principles, this did not affect management of emergency situations to the same extent as individual and team factors.
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Affiliation(s)
- Maria B Rasmussen
- Centre for Clinical Education (CEKU), Centre for Human Resources and Rigshospitalet, Capital Region of Denmark and University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Martin G Tolsgaard
- Centre for Clinical Education (CEKU), Centre for Human Resources and Rigshospitalet, Capital Region of Denmark and University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; Juliane Marie Centre, Rigshospitalet, Capital Region of Denmark, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Peter Dieckmann
- Danish Institute for Medical Simulation (DIMS) and Herlev Hospital, Capital Region of Denmark, and University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - S Barry Issenberg
- Gordon Centre for Research in Medical Education, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Miami, FL 33136, USA
| | - Doris Ostergaard
- Danish Institute for Medical Simulation (DIMS) and Herlev Hospital, Capital Region of Denmark, and University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Eldar Søreide
- Stavanger Acute Medicine Foundation for Education and Research (Safer), Stavanger University Hospital, 4068 Stavanger, Norway
| | - Jens Rosenberg
- Department of Internal Medicine, Capital Region of Denmark, Glostrup University Hospital, Nordre Ringvej 57, 2600 Glostrup, Denmark
| | - Charlotte V Ringsted
- Department of Anesthesia and The Wilson Centre, University of Toronto and University Health Network, Toronto, ON, Canada
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Tolsgaard MG, Rasmussen MB, Tappert C, Sundler M, Sorensen JL, Ottesen B, Ringsted C, Tabor A. Which factors are associated with trainees' confidence in performing obstetric and gynecological ultrasound examinations? Ultrasound Obstet Gynecol 2014; 43:444-51. [PMID: 24105723 DOI: 10.1002/uog.13211] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/28/2013] [Accepted: 09/04/2013] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To explore the association between clinical training characteristics and trainees' level of confidence in performing ultrasound scans independently. METHODS A cross-sectional e-survey was distributed to members of the national societies of junior obstetricians/gynecologists in Denmark, Sweden and Norway (n = 973). Multiple linear regression models were used to explore the effect that amount of time spent in specialized ultrasound units and clinical experience had on trainees' confidence in performing ultrasonography independently. Exploratory factor analysis was used to identify factors that contributed to trainees' confidence in performing ultrasonography. Trainees' ultrasound confidence was finally compared with their expected levels of performance. RESULTS Of the 682 respondents (response rate 70.1%), 621 met the inclusion criteria. Clinical experience and time spent in specialized ultrasound units were predictors of trainees' confidence in performing ultrasonography independently (P < 0.001). Trainees required more than 24 months of clinical experience and 12-24 days of training in specialized ultrasound units in order to feel confident about performing transvaginal and transabdominal ultrasound scans independently. Three factors were related to ultrasound confidence: technical aspects, image perception and integration of scan into patient care. There were significant differences between trainees' level of confidence and their expected levels of performance (P < 0.001). CONCLUSIONS Clinical experience and time spent in specialized ultrasound units were predictors of trainees' confidence in performing ultrasonography independently. Discrepancies between trainees' confidence and their expected levels of performance raised concerns about the adequacy of current ultrasound training programs.
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Affiliation(s)
- M G Tolsgaard
- Department of Obstetrics, Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Abstract
BACKGROUND The rising number of medical students and the impact this has on students' learning of clinical skills is a matter of concern. Cooperative learning in pairs, called dyad training, might help address this situation. OBJECTIVE The aim of this study was to evaluate the effect of dyad training on students' patient encounter skills. DESIGN Experimental, randomized, observer-blinded trial. PARTICIPANTS Forty-nine pre-clerkship medical students without prior clinical experience. INTERVENTION All students underwent a 4-h course on how to manage patient encounters. Subsequently, the students were randomized into a dyad practice group (n = 24) or a single practice group (n = 25). Both groups practiced for 4 h on four different case scenarios, using simulated patients. Students in the dyad group practiced together and took turns as the active participant, whereas students in the single group practiced alone. MAIN MEASURE Performance tests of patient encounter skills were conducted 2 weeks after the training by two blinded raters. Students had no clinical training during those weeks. A questionnaire-based evaluation surveyed students' confidence in their patient management skills. KEY RESULTS The dyad group scored significantly higher on the performance test, mean 40.7 % (SD 6.6), than the single group, mean 36.9 % (SD 5.8), P = 0.04, effect size 0.61. Inter-rater reliability was 0.69. The dyad group expressed significantly higher confidence in managing future clinical patient encounters than the single group, mean 7.6 (SD 0.9) vs. mean 6.5 (SD 1.1), respectively, P < 0.001, effect size 1.16. CONCLUSION Dyad training of pre-clerkship medical students' patient encounter skills is effective, efficient, and prompts higher confidence in managing future patient encounters compared to training alone. This training format may help maintain high-quality medical training in the face of an increasing number of students in medical schools.
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Affiliation(s)
- Martin G Tolsgaard
- Centre for Clinical Education, University of Copenhagen, Department 5404, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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Ringsted C, Lippert F, Hesselfeldt R, Rasmussen MB, Mogensen SS, Frost T, Jensen ML, Jensen MK, Van der Vleuten C. Assessment of Advanced Life Support competence when combining different test methods—Reliability and validity. Resuscitation 2007; 75:153-60. [PMID: 17467869 DOI: 10.1016/j.resuscitation.2007.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 03/06/2007] [Accepted: 03/07/2007] [Indexed: 11/21/2022]
Abstract
UNLABELLED Robust assessment of Advanced Life Support (ALS) competence is paramount to the credibility of ALS-provider certification and for estimating the learning outcome and retention of ALS competence following the courses. The European Resuscitation Council (ERC) provides two sets of MCQs and four Cardiac Arrest Simulation Test (CASTest) scenarios for the assessments according to guidelines 2005. AIMS To analyse the reliability and validity of the individual sub-tests provided by ERC and to find a combination of MCQ and CASTest that provides a reliable and valid single effect measure of ALS competence. METHODS Two groups of participants were included in this randomised, controlled experimental study: a group of newly graduated doctors, who had not taken the ALS course (N=17) and a group of students, who had passed the ALS course 9 months before the study (N=16). Reliability in terms of inter-rater agreement and generalisability across skills scenarios were estimated. Validity was studied in terms of equality of test difficulty and ability to discriminate performance between the groups. RESULTS Inter-rater agreement on checklist scores were generally high, Intraclass Correlation Coefficients between 0.766 and 0.977. Inter-rater agreements on pass/fail decisions were not perfect. The one MCQ test was significantly more difficult than the other. There were no significant differences between CASTests. Generalisability theory was use to identify a composite of MCQ and CASTest scenarios that possessed high reliability, equality of test sets, and ability to discriminate between the two groups of supposedly different ALS competence. CONCLUSIONS ERC sub-tests of ALS competence possess sufficient reliability and validity. A combined ALS score with equal weighting of one MCQ and one CASTest can be used as a single measurement of ALS competence.
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Affiliation(s)
- C Ringsted
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Tolsgaard MG, Gustafsson A, Rasmussen MB, Høiby P, Müller CG, Ringsted C. Student teachers can be as good as associate professors in teaching clinical skills. Med Teach 2007; 29:553-7. [PMID: 17978968 DOI: 10.1080/01421590701682550] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
AIM The aim of this study is to compare student teachers and clinical associate professors regarding the quality of procedural skills teaching in terms of participants' technical skills, knowledge and satisfaction with the teaching. METHODS This is an experimental, randomized, controlled study comparing the teaching of student teachers and associate professors regarding participants' learning outcome and satisfaction with the teaching. Two skills are chosen for the experiment, i.v.-access and bladder catheterization. Learning outcome is assessed by a pre- and post testing of the participants' knowledge and skills. Participants evaluate satisfaction with teaching on nine statements immediately after the teaching. RESULTS In total 59 first year medical students are included as participants in the experiment. The students taught by student teachers perform just as well as the students taught by associate professors and in one skill--catheterization--they perform even better, mean post- minus pre-test scores 65.5 (SD 12.9) vs. 35.0 (SD 23.3), One-way ANOVA, p < 0.0001, effect size 1.62. Student teachers receive significantly more positive evaluations than associate professors on several statements. CONCLUSION Trained student teachers can be as good as associate professors in teaching clinical skills.
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Affiliation(s)
- Martin G Tolsgaard
- Centre for Clinical Education, Copenhagen University Hospital, Rigshospitalet, Denmark.
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Rasmussen MB, Holsteen V. [Dopa-responsive dystonia of childhood]. Ugeskr Laeger 1999; 161:1273-4. [PMID: 10083825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
A case story of dopa-responsive childhood dystonia is presented. The symptoms, diagnostics, pitfalls and treatment are discussed.
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Rasmussen MB, Andersen C, Andersen P, Frandsen F. [Cost-benefit analysis of electric stimulation of the spinal cord in the treatment of angina pectoris]. Ugeskr Laeger 1992; 154:1180-4. [PMID: 1604746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Since August 1988, in Odense Hospital, electric spinal cord stimulation (SCS) has been employed for the treatment of pain in patients with confirmed ischaemic heart disease who suffer from incapacitating angina pectoris despite maximal medical/surgical treatment. The object of the present investigation was to assess not only the social economic consequences of SCS treatment (cost-utility analysis) but also altered quality of life in SCS patients (perception of pain, mobility, function in daily life and physical activity). Sixteen consecutive SCS patients all of whom were resident in the County of Funen and who were submitted to implantation of an SCS system during the period August 1988 to December 1989, participated in this investigation. The results are based on data from the year prior to SCS implantation compared with the subsequent time with SCS treatment. Saving was found at hospital level (reduction in number of admissions) og 40,200 Danish crowns/annum/patient (approximately IJ 3,000) (1989 prices), and for non-hospital related expenses a corresponding saving of 16,289 Danish crowns/annum/patient (approximately IJ 1,600) was found mainly on account of reduction in the amount of home nursing required. The total saving was found to constitute 56,489 Danish crowns/annum/patient (approximately IJ 5,600). In addition, improvements were registered in all respects which constituted assessment of the quality of life of the patients.
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