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Belhomme N, Lescoat A, Dion L, Pottier P, Triby E, Pelaccia T. The culture of doubt: Do medical students really experience clinical uncertainty when they should? Med Teach 2024:1-3. [PMID: 38460188 DOI: 10.1080/0142159x.2024.2323181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 03/11/2024]
Abstract
Uncertainty is a fundamental aspect of medical practice, necessitating incorporation into undergraduate medical training. The integrative model of uncertainty tolerance (UT) developed by Hillen and Han serves as a comprehensive framework for exploring clinical uncertainty. While studies have extensively examined UT dimensions, including sources, responses, and moderators, the factors influencing the perception of uncertainty stimuli remain underexplored. However, students' ability to perceive uncertainty and their approach to uncertain stimuli play a crucial role in enabling them to develop adaptive responses to uncertainty, necessary for their comfort in these situations. Defining uncertainty as a metacognitive state suggests significant variability in its perception among individuals and within an individual over time. Moreover, several studies have demonstrated the substantial influence of various individual and contextual factors on how individuals perceive and respond to uncertainty. In this paper, the authors present multiple hypotheses to address the question of whether students genuinely perceive uncertainty stimuli when they should. The authors argue that students' personal relationship with their knowledge is essential in their ability to identify clinical uncertainty, particularly concerning the limits of medical knowledge. Therefore, they propose that an academic culture fostering doubt, through exposing students to a variety of perspectives, would enhance their ability to identify uncertainty zones in a clinical situation at an early stage. Drawing on Dewey's situational theory, the authors emphasize the importance of better understanding, in a work setting, the influence of contextual and situational characteristics on individual perceptions of uncertainty. In line with this idea, ethnographic studies would offer valuable insights into identifying the relationship between the students, their work environment, and their perception of clinical uncertainty.
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Affiliation(s)
- N Belhomme
- Service de Médecine Interne et Immunologie Clinique, CHU Rennes, Rennes, France
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
- Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication, LISEC_UR2310, Université de Strasbourg, Strasbourg, France
| | - A Lescoat
- Service de Médecine Interne et Immunologie Clinique, CHU Rennes, Rennes, France
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
| | - L Dion
- Service de Gynécologie, CHU Rennes Hôpital Sud, Rennes, France
- Irset - Inserm UMR_S 1085, Rennes, France
| | - P Pottier
- Service de Médecine Interne et Immunologie Clinique, CHU Nantes, Nantes, France
- Faculté de Médecine-Pôle Santé, Nantes Université, Nantes, France
| | - E Triby
- Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication, LISEC_UR2310, Université de Strasbourg, Strasbourg, France
| | - T Pelaccia
- Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication, LISEC_UR2310, Université de Strasbourg, Strasbourg, France
- Service d'Urgences (SAMU 67), CHU Strasbourg, Strasbourg, France
- Centre de Formation et de Recherche en Pédagogie des Sciences de la Santé, faculté de Médecine, Université de Strasbourg, Strasbourg, France
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Abbiati M, Severac F, Bajwa N, Sibilia J, Pelaccia T. Validity Evidence of A Screening Tool for Early Detection of Clinical Crisis-Related Anxiety Amongst Medical Students. Teach Learn Med 2023:1-10. [PMID: 37394942 DOI: 10.1080/10401334.2023.2230180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Construct: Psychological distress among students is a growing concern in medical education, even more so with the advent of COVID-19 pandemic. Anxiety is among students' mental health issues. High and persistent anxiety has many negative impacts on students' academic and personal life. Early detection is essential for timely intervention. Background: Currently, medical student anxiety is assessed using tools primarily designed for psychiatric purposes. Despite their excellent validity evidence, these tools contain sensitive items and do not explore stressors related to clinical activities. There is a need for contextualized tools to better identify anxiety-provoking factors specific to the medical education environment. Approach: We previously developed the Crisis Experience Rating Scale (CERS-7), a short screening tool to identify early on anxious students participating in clinical activities during the first wave of the COVID-19 pandemic. The present study sought to produce further validity evidence for the CERS-7. Medical students in their clinical years at two Swiss and one French medical school, all involved in COVID-19 clinical activity during the second wave of the pandemic, completed the CERS-7 and the State Anxiety Inventory (STAI-A), the best known and widely used tool to measure for general anxiety. We evaluated internal structure using confirmatory factor analysis (CFA) and relation to other variables using linear regression (LR) and receiver operating characteristic (ROC) curves with thresholds defined using the Youden index. Findings: There were 372 participants. CFA confirmed the two-factor structure of the CERS-7 scale from first-wave dataset. The CERS-7 total scale and subscales demonstrated validity evidence in relationship to the STAI-A scores and categories. A CERS-7 total scale score < 27.5 identified 93% of severely anxious students. Conclusion: The CERS-7 produces reliable scores to use for monitoring anxiety status when assigning students to clinical settings as well as for improving training conditions during clinical crisis.
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Affiliation(s)
- Milena Abbiati
- Institute of Legal Psychiatry, Lausanne University Hospitals, Lausanne, Switzerland
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - François Severac
- Public Health Service, GMRC, Strasbourg University Hospital, Strasbourg, France
| | - Nadia Bajwa
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean Sibilia
- Dean's Office, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Thierry Pelaccia
- Centre for Training and Research in Health Sciences Education (CFRPS), Faculty of Medicine, University of Strasbourg, Strasbourg, France
- Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France
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Dumas F, Charpentier S, Bouzid D, Cerfon CHH, Joly LM, Pelaccia T, Philippon A, Truchot J. Premier séminaire pédagogique du collège des universitaires de médecine d’urgence ou comment la médecine d’urgence s’empare de la réforme du 2 e cycle des études médicales (R2C). Ann Fr Med Urgence 2023. [DOI: 10.3166/afmu-2022-0477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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Abbiati M, Pelaccia T. When I say … Self. Med Educ 2022; 56:23-24. [PMID: 34693545 DOI: 10.1111/medu.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Milena Abbiati
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Psychiatry Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Thierry Pelaccia
- Center for Training and Research in Health Sciences Education (CFRPS), Faculty of Medicine, University of Strasbourg, Strasbourg, France
- Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France
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Pelaccia T, Sibilia J, Fels É, Gauer L, Musanda A, Severac F, Abbiati M. And if we had to do it all over again, would we send medical students to the emergency departments during a pandemic? Lessons learned from the COVID-19 outbreak. Intern Emerg Med 2021; 16:1967-1974. [PMID: 33453012 PMCID: PMC7811345 DOI: 10.1007/s11739-020-02629-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022]
Abstract
The COVID-19 pandemic has led to increased staffing needs in emergency departments. The question quickly arose as to whether it was appropriate to offer medical students the opportunity to assist this staff. The dilemma stems in part from the potential impact on their psychological well-being as well as their academic and clinical performances. We sought to determine the level of anxiety of medical students during the COVID-19 outbreak, and whether it was higher among the students who chose to return to the clinical setting, especially in first-line units (i.e., emergency departments and resuscitation units). In May 2020, 1180/1502 (78.5%) undergraduate medical students at Strasbourg Medical School (France) completed a questionnaire assessing their anxiety and clinical experience. A 2018 cohort of undergraduate medical students served as the baseline. The 2020 COVID cohort had higher rates of anxiety than the 2018 cohort. This difference was specifically observed in the students who chose not to return to the clinical setting during the crisis (N = 684, 59%). At linear regression, the main factors associated with anxiety were gender (p < 0.005) and perceived clinical activity personal conditions (p < 0.001). Employment site, including COVID first-line units, was not correlated with anxiety. Working in the clinical setting during the COVID-19 outbreak is not a risk factor for anxiety in medical students. Instead, it is an active coping strategy, suggesting that there are no barriers to allowing students to return to clinical settings during a pandemic, including first-line units, in terms of their psychological well-being.
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Affiliation(s)
- Thierry Pelaccia
- Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France.
- Centre for Training and Research in Health Sciences Education (CFRPS), Faculty of Medicine, University of Strasbourg, Strasbourg, France.
| | - Jean Sibilia
- Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Élodie Fels
- Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Lucas Gauer
- Strasbourg University Hospital, 1 place de l'Hôpital, Strasbourg, France
| | - Audrey Musanda
- Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - François Severac
- Public Health Service, GMRC, Strasbourg University Hospital, Strasbourg, France
| | - Milena Abbiati
- Institute of Legal Psychiatry, Lausanne University Hospitals, Lausanne, Switzerland
- Unit of Development and Research (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Abensur Vuillaume L, Laudren G, Bosio A, Thévenot P, Pelaccia T, Chauvin A. A Didactic Escape Game for Emergency Medicine Aimed at Learning to Work as a Team and Making Diagnoses: Methodology for Game Development. JMIR Serious Games 2021; 9:e27291. [PMID: 34463628 PMCID: PMC8441606 DOI: 10.2196/27291] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/30/2021] [Accepted: 06/28/2021] [Indexed: 01/23/2023] Open
Abstract
Background In the health care environment, teamwork is paramount, especially when referring to patient safety. We are interested in recent and innovative solutions such as escape games, which is a type of adventure game that may be highly useful as an educational tool, potentially combining good communication skills with successful gamification. They involve teams of 5 to 10 individuals who are “locked” in the same room and must collaborate to solve puzzles while under pressure from a timer. Objective The purpose of this paper was to describe the steps involved in creating and implementing an educational escape game. This tool can then be put into service or further developed by trainers who wish to use it for learning interprofessional collaboration. Therefore, we started with an experience of creating an educational escape game for emergency medicine teams. Methods We chose to develop an educational escape game by using 6 successive steps. First, we built a team. Second, we chose the pedagogical objectives. Third, we gamified (switched from objectives to scenario). Next, we found the human and material resources needed. Thereafter, we designed briefing and debriefing. Lastly, we tested the game. Results By following these 6 steps, we created the first ambulant educational escape game that teaches people, or nurses, doctors, and paramedics, working in emergency medicine to work as a team. Conclusions From a pedagogic point of view, this game may be a good tool for helping people in multidisciplinary fields (medical and paramedical teams) to learn how to work collaboratively and to communicate as a group. Above all, it seems to be an innovative tool that complements medical simulation–based learning and thus consolidates traditional education.
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Affiliation(s)
| | - Garry Laudren
- Intensive Care and Anesthesiology, Pediatric Necker Hospital, Paris, France
| | - Alexandre Bosio
- Emergency Department, Hospital Center of Verdun, Verdun, France
| | | | - Thierry Pelaccia
- University of Strasbourg Medical School, Strasbourg, France.,Prehospital Emergency Care Service (SAMU 67), Center for Training and Research in Health Sciences Education, Strasbourg University Hospital, Strasbourg, France
| | - Anthony Chauvin
- Emergency Department, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Affiliation(s)
- Thierry Pelaccia
- Centre for Training and Research in Health Sciences Education (CFRPS), Faculty of Medicine, University of Strasbourg, Strasbourg, France.
- Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France.
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Guillou P, Pelaccia T, Bacqué MF, Lorenzo M. Does burnout affect clinical reasoning? An observational study among residents in general practice. BMC Med Educ 2021; 21:35. [PMID: 33413369 PMCID: PMC7792007 DOI: 10.1186/s12909-020-02457-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Burnout results from excessive demands at work. Caregivers suffering from burnout show a state of emotional exhaustion, leading them to distance themselves from their patients and to become less efficient in their work. While some studies have shown a negative impact of burnout on physicians' clinical reasoning, others have failed to demonstrate any such impacts. To better understand the link between clinical reasoning and burnout, we carried out a study looking for an association between burnout and clinical reasoning in a population of general practice residents. METHODS We conducted a cross-sectional observational study among residents in general practice in 2017 and 2019. Clinical reasoning performance was assessed using a script concordance test (SCT). The Maslach Burnout Inventory for Human Services Survey (MBI-HSS) was used to determine burnout status in both original standards of Maslach's burnout inventory manual (conventional approach) and when individuals reported high emotional exhaustion in combination with high depersonalization or low personal accomplishment compared to a norm group ("emotional exhaustion +1" approach). RESULTS One hundred ninety-nine residents were included. The participants' mean SCT score was 76.44% (95% CI: 75.77-77.10). In the conventional approach, 126 residents (63.31%) had no burnout, 37 (18.59%) had mild burnout, 23 (11.56%) had moderate burnout, and 13 (6.53%) had severe burnout. In the "exhaustion + 1" approach, 38 residents had a burnout status (19.10%). We found no significant correlation between burnout status and SCT scores either for conventional or "exhaustion + 1" approaches. CONCLUSIONS Our data seem to indicate that burnout status has no significant impact on clinical reasoning. However, one speculation is that SCT mostly examines the clinical reasoning process's analytical dimension, whereas emotions are conventionally associated with the intuitive dimension. We think future research might aim to explore the impact of burnout on intuitive clinical reasoning processes.
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Affiliation(s)
- Philippe Guillou
- Departement of General Practice, Medicine Campus, University of Strasbourg, 4, rue Kirschleger, 67085, Strasbourg Cedex, France
| | - Thierry Pelaccia
- Center for Training and Research in Health Sciences Education, Medicine Campus, University of Strasbourg, 4, rue Kirschleger, 67085, Strasbourg Cedex, France
- Prehospital Emergency Care Service, Strasbourg University Hospital, University of Strasbourg, 1, place de l'hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Marie-Frédérique Bacqué
- EA3071, Psychology Faculty, University of Strasbourg, 12, rue Goethe, 67000, Strasbourg, France
| | - Mathieu Lorenzo
- Departement of General Practice, Medicine Campus, University of Strasbourg, 4, rue Kirschleger, 67085, Strasbourg Cedex, France.
- Center for Training and Research in Health Sciences Education, Medicine Campus, University of Strasbourg, 4, rue Kirschleger, 67085, Strasbourg Cedex, France.
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Pelaccia T, Messman AM, Kline JA. Misdiagnosis and failure to diagnose in emergency care: Causes and empathy as a solution. Patient Educ Couns 2020; 103:1650-1656. [PMID: 32169322 DOI: 10.1016/j.pec.2020.02.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/03/2019] [Revised: 02/06/2020] [Accepted: 02/27/2020] [Indexed: 06/10/2023]
Abstract
Diagnostic error is the most frequent cause of allegations of negligence in emergency care in the United States and is estimated to contribute to the death of hundreds of thousands of patients worldwide each year. In this special contribution, we elucidate the cognitive mechanisms that emergency physicians use to make decisions and identify how these mechanisms can become sources of diagnostic error. The discussion centers on the appraisal of proposed methods to reduce the risk of diagnostic error, including debiasing strategies and a brief discussion of the theoretical basis for interventions to improve clinician empathy.
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Affiliation(s)
- Thierry Pelaccia
- Center for Training and Research in Health Sciences Education (CFRPS), University of Strasbourg, 67085 Strasbourg, France; Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, France.
| | - Anne M Messman
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
| | - Jeffrey A Kline
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Tambone V, Boudreau D, Ciccozzi M, Sanders K, Campanozzi LL, Wathuta J, Violante L, Cauda R, Petrini C, Abbate A, Alloni R, Argemi J, Argemí Renom J, De Benedictis A, Galerneau F, García-Sánchez E, Ghilardi G, Hafler JP, Linden M, Marcos A, Onetti Muda A, Pandolfi M, Pelaccia T, Picozzi M, Revello RO, Ricci G, Rohrbaugh R, Rossi P, Sirignano A, Spagnolo AG, Stammers T, Velázquez L, Agazzi E, Mercurio M. Ethical Criteria for the Admission and Management of Patients in the ICU Under Conditions of Limited Medical Resources: A Shared International Proposal in View of the COVID-19 Pandemic. Front Public Health 2020; 8:284. [PMID: 32612972 PMCID: PMC7308475 DOI: 10.3389/fpubh.2020.00284] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/01/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vittoradolfo Tambone
- Institute of Philosophy of Scientific and Technological Practice (FAST), Campus Bio-Medico University of Rome, Rome, Italy
| | - Donald Boudreau
- Department of Medicine, Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
| | - Massimo Ciccozzi
- Research Unit of Medical Statistic and Molecular Epidemiology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Karen Sanders
- Department of Business, Law and Society, St Mary's University, London, United Kingdom
| | - Laura Leondina Campanozzi
- Institute of Philosophy of Scientific and Technological Practice (FAST), Campus Bio-Medico University of Rome, Rome, Italy
| | - Jane Wathuta
- Institute for Family Studies & Ethics, Strathmore University, Nairobi, Kenya
| | | | - Roberto Cauda
- Section of Infection Diseases, Department of Healthcare Surveillance and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Carlo Petrini
- Bioethics Unit, Italian National Institute of Health, Rome, Italy
| | - Antonio Abbate
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Rossana Alloni
- Hospital Clinical Direction, Campus Bio-Medico University of Rome, Rome, Italy
| | - Josepmaria Argemi
- Division of Medicine, Gastroenterology and Hepatology Department, University of Pittsburgh, Pittsburgh, PA, United States
| | - Josep Argemí Renom
- Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anna De Benedictis
- Hospital Clinical Direction, Campus Bio-Medico University of Rome, Rome, Italy
| | - France Galerneau
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Emilio García-Sánchez
- Department of Political Sciences, Ethics and Sociology, University CEU Cardenal Herrera, Valencia, Spain
| | - Giampaolo Ghilardi
- Institute of Philosophy of Scientific and Technological Practice (FAST), Campus Bio-Medico University of Rome, Rome, Italy
| | - Janet Palmer Hafler
- Teaching and Learning Center, Yale University School of Medicine, New Haven, CT, United States
| | - Magdalena Linden
- Department of Medicine, Solna, Karolinska Institutet, Center for Molecular Medicine, Stockholm, Sweden
| | - Alfredo Marcos
- Department of Philosophy, Universidad de Valladolid, Valladolid, Spain
| | - Andrea Onetti Muda
- Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Pandolfi
- Fondazione Leonardo, Civiltà delle Macchine, Rome, Italy
| | - Thierry Pelaccia
- Prehospital Emergency Medical Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France
| | - Mario Picozzi
- Center for Clinical Ethics, Insubria University, Varese, Italy
| | - Ruben Oscar Revello
- Instituto de Bioética de la Facultad de Ciencias Médica, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | | | - Robert Rohrbaugh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Patrizio Rossi
- Central Medical Department, National Institute for Insurance against Accidents at Work (INAIL), Rome, Italy
| | | | | | - Trevor Stammers
- Centre for Bioethics and Emerging Technologies, Institute of Theology, St Mary's University, London, United Kingdom
| | - Lourdes Velázquez
- Interdisciplinary Bioethics Center, Universidad Panamericana, Mexico City, Mexico
| | - Evandro Agazzi
- Interdisciplinary Bioethics Center, Universidad Panamericana, Mexico City, Mexico
| | - Mark Mercurio
- Program for Biomedical Ethics, Yale University School of Medicine, New Haven, CT, United States
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Chaptal M, Tendron L, Claret PG, Muller L, Markarian T, Mattatia L, Roger C, de la Coussaye JE, Pelaccia T, Bobbia X. Focused Cardiac Ultrasound: A Prospective Randomized Study of Simulator-Based Training. J Am Soc Echocardiogr 2020; 33:404-406. [DOI: 10.1016/j.echo.2019.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/19/2019] [Accepted: 10/15/2019] [Indexed: 12/29/2022]
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Pelaccia T, Forestier G, Wemmert C. Une intelligence artificielle raisonne-t-elle de la même façon que les cliniciens pour poser des diagnostics ? Rev Med Interne 2020; 41:192-195. [DOI: 10.1016/j.revmed.2019.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
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Affiliation(s)
- Thierry Pelaccia
- Centre for Training and Research in Health Sciences Education (Pelaccia), Faculty of Medicine, University of Strasbourg; Hôpitaux universitaires de Strasbourg (Pelaccia), Strasbourg, France; Institute of Research in Computer Science, Mathematics, Automation and Signal (Forestier), Université de Haute-Alsace, Mulhouse, France; Computer Science and Imaging Research Institute (Wemmert), The Engineering Science, Computer Science and Imaging Laboratory, University of Strasbourg, Illkirch, France
| | - Germain Forestier
- Centre for Training and Research in Health Sciences Education (Pelaccia), Faculty of Medicine, University of Strasbourg; Hôpitaux universitaires de Strasbourg (Pelaccia), Strasbourg, France; Institute of Research in Computer Science, Mathematics, Automation and Signal (Forestier), Université de Haute-Alsace, Mulhouse, France; Computer Science and Imaging Research Institute (Wemmert), The Engineering Science, Computer Science and Imaging Laboratory, University of Strasbourg, Illkirch, France
| | - Cédric Wemmert
- Centre for Training and Research in Health Sciences Education (Pelaccia), Faculty of Medicine, University of Strasbourg; Hôpitaux universitaires de Strasbourg (Pelaccia), Strasbourg, France; Institute of Research in Computer Science, Mathematics, Automation and Signal (Forestier), Université de Haute-Alsace, Mulhouse, France; Computer Science and Imaging Research Institute (Wemmert), The Engineering Science, Computer Science and Imaging Laboratory, University of Strasbourg, Illkirch, France
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Pelaccia T. Réformes des études médicales : les enjeux pour les enseignants et la spécialité de médecine d’urgence. Ann Fr Med Urgence 2019. [DOI: 10.3166/afmu-2019-0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Roubaud JC, Pelaccia T, Bartier JC, Schmitt J, Forato M. Pourquoi les médecins urgentistes ne respectent-ils pas les recommandations internationales relatives à l’administration d’adrénaline dans l’arrêt cardiaque ? Ann Fr Med Urgence 2019. [DOI: 10.3166/afmu-2019-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : La prise en charge de l’arrêt cardiaque repose sur des recommandations internationales définissant notamment un schéma précis d’administration d’adrénaline. Chez les médecins exerçant la médecine d’urgence préhospitalière, il existe pourtant d’importantes variabilités interindividuelles concernant l’usage de l’adrénaline. L’objectif de cette étude était d’identifier les facteurs à l’origine du nonrespect des recommandations.
Matériel et méthodes : Nous avons mené une étude qualitative prospective et multicentrique fondée sur des entretiens individuels semi-structurés auprès de médecins urgentistes. Après retranscription, ils ont fait l’objet d’une analyse thématique par le premier auteur.
Résultats : Treize entretiens ont été menés. Ils ont permis de conclure qu’un non-respect des recommandations concernant l’administration de l’adrénaline était retrouvé chez sept médecins. Les interviewés expliquaient essentiellement ces écarts par une volonté de majorer les chances de succès de la réanimation (ce qui les conduisait à augmenter la posologie), ou bien en fin de réanimation, à vider la seringue d’adrénaline afin d’administrer un bolus final considéré comme la « dernière chance » pour le patient. Le poids du patient, les comorbidités et l’âge pouvaient également conduire à ajuster la posologie, tout comme le souhait de mettre en oeuvre une « réanimation d’attente », le niveau de connaissance des dernières recommandations par les praticiens ou leurs habitudes personnelles.
Conclusion : Il existe, chez les médecins urgentistes, une importante variabilité dans l’usage de l’adrénaline lors de la prise en charge préhospitalière de l’arrêt cardiaque. Ces écarts de pratique imposent la mise en oeuvre de mesures destinées à favoriser le respect des recommandations scientifiques.
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Abbiati M, Severac F, Baroffio A, Pelaccia T. Construct and predictive validity of the Strength of Motivation for Medical School-Revised (SMMS-R) questionnaire: a French validation study. Can Med Educ J 2019; 10:e39-e48. [PMID: 31388375 PMCID: PMC6681925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Motivation is a major indicator of students' learning behaviors. Therefore, researchers require consistent and valid instruments to assess students' motivation. Consequently, motivation has been an important topic in medical education research for the last decade. The present study evaluated the construct and predictive validities of the French version of the Strength of Motivation for Medical School-Revised questionnaire (SMMS-R-FR). Our sample comprised 372 students at three French-speaking medical schools, who filled in the SMMS-R-FR and the Revised two-factor Study Process Questionnaire (R2-SPQ). Results confirmed the three-factor structure of the original SMMS-R questionnaire. Reliabilities were good for the Total Strength of Motivation scale, moderate for the Willingness to Sacrifice and Readiness to Start subscales, and poor (but still acceptable) for the Persistence subscale. Both Total Strength of Motivation and Readiness to Start positively predicted a deep learning approach and negatively predicted a surface learning approach, while Willingness to Sacrifice positively predicted a deep learning approach and Persistence negatively predicted a surface learning approach. Our results both support the SMMS-R- FR's suitability as a tool for measuring motivation in medical students, and suggest that it could be used to guide the development of educational interventions to strengthen motivation.
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Affiliation(s)
- Milena Abbiati
- Unit of Development and Research in Medical Education (EDREM), University of Geneva, Faculty of Medicine, Switzerland
| | | | - Anne Baroffio
- Unit of Development and Research in Medical Education (EDREM), University of Geneva, Faculty of Medicine, Switzerland
| | - Thierry Pelaccia
- Strasbourg University Hospital, France
- Center for Training and Research in Health Sciences Education (CFRPS), University of Strasbourg, Faculty of Medicine, France
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Douillet D, Ammirati C, Amsallem C, Hausfater P, Fonsegrive J, Annweiler C, Roy PM, Pelaccia T. Quelle est la motivation des internes de la première promotion du DES de médecine d’urgence ? Ann Fr Med Urgence 2019. [DOI: 10.3166/afmu-2019-0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : La motivation en formation étant positivement corrélée à l’implication, à la persévérance et aux performances des apprenants, nous avons souhaité identifier le profil motivationnel des étudiants de la première promotion du diplôme d’études spécialisées (DES) en médecine d’urgence (MU), afin d’identifier des leviers motivationnels et d’actions pour les enseignants permettant d’améliorer la qualité de la formation.
Matériel et méthodes : Nous avons mené une étude observationnelle descriptive multicentrique auprès des internes de première année de DES. Un questionnaire autoadministré en ligne a été envoyé à tous les internes. Cinq composantes de la motivation étaient explorées : la motivation intrinsèque (MI), la motivation extrinsèque (ME), la perception de valeur à la tâche (PVT), la perception de contrôlabilité (PCO) et le sentiment d’efficacité personnel (SEP).
Résultats : Trois cent soixante-quinze internes de la promotion 2017–2018 ont répondu, soit un taux de participation de 81,5 %. La MI était nettement supérieure à laME (5,7 versus 3,8). Parmi les autres composantes de la motivation, la PVT était la plus élevée (5,9) devant la PCO (5,2) et le SEP (5,2). Il n’y avait pas de corrélation entre les différentes composantes de la motivation et le rang de classement à l’ECN (épreuves classantes nationales) ni selon le fait que la MU était ou non leur premier choix.
Conclusion : La première promotion d’internes de MU obtient globalement des scores élevés de motivation. Deux leviers, sur lesquels les enseignants peuvent essayer d’agir prioritairement, ont été identifiés afin d’améliorer la motivation des internes.
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Pelaccia T, Roy PM, Douillet D, Bilbault P, Abbiati M. Qu’est-ce qui motive [ou non] les étudiants en médecine à choisir comme spécialité la médecine d’urgence ? Ann Fr Med Urgence 2019. [DOI: 10.3166/afmu-2019-0166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : Le diplôme d’études spécialisées de médecine d’urgence a été créé en France à la rentrée universitaire 2017. En 2018, 21 postes ont été laissés vacants aux épreuves classantes nationales (ECN). Cette étude avait pour but d’identifier les raisons pour lesquelles les étudiants souhaitent ou non choisir la médecine d’urgence, ainsi que leur motivation pour cette spécialité.
Matériel et méthodes : Nous avons mené une étude observationnelle prospective et monocentrique. Tous les étudiants du premier et du deuxième cycle de la faculté de médecine de Strasbourg ont été sollicités entre 2017 et en 2018. Des questionnaires ont été autoadministrés en présentiel ou en ligne afin de recueillir le type de spécialisation envisagé, le degré de motivation des répondants pour devenir médecin urgentiste et l’influence de différents facteurs motivationnels sur leur volonté ou non de choisir la médecine d’urgence aux ECN.
Résultats : Sept pour cent des étudiants de première année de médecine souhaitent choisir la médecine d’urgence comme spécialité. Ils ne sont plus qu’un pour cent en sixième année. Le mode de vie est considéré de façon croissante entre le début et la fin des études prégraduées comme particulièrement dissuasif. La variété des pathologies rencontrées et le défi intellectuel sont des facteurs attractifs et stables.
Conclusion : L’attractivité de la médecine d’urgence pourrait être renforcée en communiquant auprès des étudiants en médecine de deuxième cycle sur les facteurs sources de motivation et en poursuivant la réflexion visant à améliorer la qualité de vie des médecins urgentistes.
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Le Bel J, Pelaccia T, Ray P, Mayaud C, Brun AL, Hausfater P, Casalino E, Benjoar M, Claessens YE, Duval X. Impact of emergency physician experience on decision-making in patients with suspected community-acquired pneumonia and undergoing systematic thoracic CT scan. Emerg Med J 2019; 36:485-492. [PMID: 31239315 PMCID: PMC6678054 DOI: 10.1136/emermed-2018-207842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 05/05/2019] [Accepted: 05/17/2019] [Indexed: 11/17/2022]
Abstract
Objectives To determine whether the impact of a thoracic CT scan on community-acquired pneumonia (CAP) diagnosis and patient management varies according to emergency physician’s experience (≤10 vs >10 years). Methods Early thoracic CT Scan for Community-Acquired Pneumonia at the Emergency Department is an interventional study conducted from November 2011 to January 2013 in four French emergency departments, and included suspected patients with CAP. We analysed changes in emergency physician CAP diagnosis classification levels before and after CT scan; and their agreement with an adjudication committee. We performed univariate analysis to determine the factors associated with modifying the diagnosis classification level to be consistent with the radiologist’s CT scan interpretation. Results 319 suspected patients with CAP and 136 emergency physicians (75% less experienced with ≤10 years, 25% with >10 years of experience) were included. The percentage of patients whose classification was modified to become consistent with CT scan radiologist’s interpretation was higher among less-experienced than experienced emergency physicians (54.2% vs 40.2%; p=0.02). In univariate analysis, less emergency physician experience was the only factor associated with changing a classification to be consistent with the CT scan radiologist’s interpretation (OR 1.77, 95% CI 1.01 to 3.10, p=0.04). After CT scan, the agreement between emergency physicians and adjudication committee was moderate for less-experienced emergency physicians and slight for experienced emergency physicians (k=0.457 and k=0.196, respectively). After CT scan, less-experienced emergency physicians modified patient management significantly more than experienced emergency physicians (36.1% vs 21.7%, p=0.01). Conclusions In clinical practice, less-experienced emergency physicians were more likely to accurately modify their CAP diagnosis and patient management based on thoracic CT scan than more experienced emergency physicians. Trial registration number NCT01574066
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Affiliation(s)
- Josselin Le Bel
- Department of General Practice, Universite Paris Diderot UFR de Medecine Site Xavier-Bichat, Paris, France
- UMR 1137, IAME, INSERM, Paris, France
| | - Thierry Pelaccia
- Faculty of Medicine, Centre for Training and Research in Health Sciences Education (CFR-PS), University of Strasbourg, Strasbourg, France
- Prehospital Emergency Care Service (SAMU 67), Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - Patrick Ray
- Department of Emergency Medicine and Surgery, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Charles Mayaud
- Department of Respiratory Diseases, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Anne-Laure Brun
- Department of Radiodiagnosis, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Pierre Hausfater
- GRC-14 BIOSFAST Qet APHP, Sorbonne Université UPMC-Univ Paris 06, Paris, France
- Emergency Department, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Enrique Casalino
- Emergency Department, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Mikhael Benjoar
- Department of Radiodiagnosis, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | | | - Xavier Duval
- UMR 1137, IAME, INSERM, Paris, France
- CIC 1425, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
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Pelaccia T. Ten Principles for More Conservative, Care-Full Diagnosis. Ann Intern Med 2019; 170:823. [PMID: 31158868 DOI: 10.7326/l19-0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Thierry Pelaccia
- Centre for Training and Research in Health Sciences Education, University of Strasbourg, Strasbourg, France (T.P.)
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21
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Riou M, Feral-Pierssens AL, Tourette-Turgis C, Tazarourte K, Freund Y, Pelaccia T, Riou B. Que peuvent apporter les sciences humaines et sociales à la recherche en médecine d’urgence ? Ann Fr Med Urgence 2019. [DOI: 10.3166/afmu-2018-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Pelaccia T. Decisionmaking in Emergency Medicine: Experienced-Based and Contextually Anchored Rather Than Evidence Based and Universal. Ann Emerg Med 2018; 72:624-625. [PMID: 30342738 DOI: 10.1016/j.annemergmed.2018.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Thierry Pelaccia
- Centre for Training and Research in Health Sciences Education (CFRPS), Faculty of Medicine, University of Strasbourg, Strasbourg, France; Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France
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Riou B, Carli P, Charpentier S, de La Coussaye JE, Dumas F, Gueugniaud PY, Maignan M, Pateron D, Pelaccia T. Modalités de fonctionnement du Conseil national des universités (CNU) de médecine d'urgence. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cariou G, Pelaccia T. Are they trained? Prevalence, motivations and barriers to CPR training among cohabitants of patients with a coronary disease. Intern Emerg Med 2017; 12:845-852. [PMID: 27350627 DOI: 10.1007/s11739-016-1493-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Abstract
Out-of-hospital cardiac arrest occurs most often at home and often in the presence of family members of the patient who witness the event. Cardiopulmonary resuscitation (CPR) training of the next of kin of at-risk patients is thus potentially beneficial. The aim of our study was to document the prevalence of appropriate training among cardiac patients' cohabitants, as well as the motivations or obstacles to seeking training. 153 cohabitants of 127 patients who were hospitalized 1 year prior for confirmed coronary disease in a cardiology department (Paris, France) were interviewed using a structured questionnaire between October 2013 and March 2014. 38 % of interrogated cohabitants had received CPR training, and in two-thirds of the cases, their training was undertaken prior to the onset of the patient's heart disease. The training received was often a single instruction session. Half took place more than 5 years prior to the interview. For two-thirds of interrogated families, the reasons they sought training were related to professional or military duties. Training undertaken solely due to cohabitation with a patient affected by coronary disease represented only 3.5 % of the trained respondents. A lack of information regarding existing training programs and a lack of concrete propositions were given as the main barriers to seeking training. The families of patients who are at-risk for cardiac arrests that were interrogated in our study are inadequately trained in CPR. The creation of dedicated training programs at cardiac rehabilitation services for patients' next of kin or the use of alternative methods such as self-instruction kits could potentially remedy this situation.
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Affiliation(s)
- Guillaume Cariou
- Mobile Palliative Care Team, Cochin University Hospital, Paris Hospitals Public Assistance, 27 rue du Faubourg-Saint-Jacques, 75014, Paris, France
| | - Thierry Pelaccia
- Centre for Training and Research in Health Sciences Education (CFR-PS), Faculty of Medicine, University of Strasbourg, 4 rue Kirschleger, 67085, Strasbourg, France.
- Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, PO Box 426, 67200, Strasbourg, France.
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Weiss A, Jaffrelot M, Bartier JC, Pottecher T, Borraccia I, Mahoudeau G, Noll E, Brunstein V, Delacour C, Pelaccia T. Does the unexpected death of the manikin in a simulation maintain the participants' perceived self-efficacy? An observational prospective study with medical students. BMC Med Educ 2017; 17:109. [PMID: 28683737 PMCID: PMC5501339 DOI: 10.1186/s12909-017-0944-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/11/2017] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The death of a simulated patient is controversial. Some educators feel that having a manikin die is prejudicial to learning; others feel it is a way of better preparing students for these situations. Perceived self-efficacy (PSE) reflects a person's perception of their ability to carry out a task. A high PSE is necessary to manage a task efficiently. In this study, we measured the impact of the death of a simulated patient on medical students' perceived self-efficacy concerning their ability to cope with a situation of cardiac arrest. METHODS We carried out a single-centre, observational, prospective study. In group 1 (n = 27), pre-graduate medical students were warned of the possible death of the manikin; group 2 students were not warned (n = 29). The students' PSE was measured at the end of the simulated situation and after the debriefing. RESULTS The PSE of the two groups was similar before the debriefing (p = 0.41). It had significantly progressed at the end of the debriefing (p < 0,001). No significant difference was noted between the 2 groups (p = 0.382). CONCLUSIONS The simulated death of the manikin did not have a negative impact on the students' PSE, whether or not they had been warned of the possible occurrence of such an event. Our study helps defend the position which supports the inclusion of unexpected death of the manikin in a simulation setting.
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Affiliation(s)
- Anne Weiss
- Centre for Emergency Care Teaching (CESU 67), Strasbourg University Hospital, Strasbourg, France
- Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France
| | | | | | - Thierry Pottecher
- Department of Simulation, Strasbourg Faculty of Medicine, Strasbourg, France
| | - Isabelle Borraccia
- Centre for Emergency Care Teaching (CESU 67), Strasbourg University Hospital, Strasbourg, France
| | - Gilles Mahoudeau
- Department of Simulation, Strasbourg Faculty of Medicine, Strasbourg, France
| | - Eric Noll
- Department of anesthesiology, Strasbourg University Hospital, Strasbourg, France
| | - Véronique Brunstein
- Centre for Emergency Care Teaching (CESU 67), Strasbourg University Hospital, Strasbourg, France
| | - Chloé Delacour
- Centre for Training and Research in Health Sciences Education (CFRPS), Strasbourg Faculty of Medicine, Strasbourg, France
| | - Thierry Pelaccia
- Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France
- Centre for Training and Research in Health Sciences Education (CFRPS), Strasbourg Faculty of Medicine, Strasbourg, France
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Pelaccia T, Tardif J, Triby E, Charlin B. A Novel Approach to Study Medical Decision Making in the Clinical Setting: The "Own-point-of-view" Perspective. Acad Emerg Med 2017; 24:785-795. [PMID: 28449293 DOI: 10.1111/acem.13209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Making diagnostic and therapeutic decisions is a critical activity among physicians. It relies on the ability of physicians to use cognitive processes and specific knowledge in the context of a clinical reasoning. This ability is a core competency in physicians, especially in the field of emergency medicine where the rate of diagnostic errors is high. Studies that explore medical decision making in an authentic setting are increasing significantly. They are based on the use of qualitative methods that are applied at two separate times: 1) a video recording of the subject's actual activity in an authentic setting and 2) an interview with the subject, supported by the video recording. Traditionally, activity is recorded from an "external perspective"; i.e., a camera is positioned in the room in which the consultation takes place. This approach has many limits, both technical and with respect to the validity of the data collected. OBJECTIVES The article aims at 1) describing how decision making is currently being studied, especially from a qualitative standpoint, and the reasons why new methods are needed, and 2) reporting how we used an original, innovative approach to study decision making in the field of emergency medicine and findings from these studies to guide further the use of this method. The method consists in recording the subject's activity from his own point of view, by fixing a microcamera on his temple or the branch of his glasses. An interview is then held on the basis of this recording, so that the subject being interviewed can relive the situation, to facilitate the explanation of his reasoning with respect to his decisions and actions. RESULTS We describe how this method has been used successfully in investigating medical decision making in emergency medicine. We provide details on how to use it optimally, taking into account the constraints associated with the practice of emergency medicine and the benefits in the study of clinical reasoning. CONCLUSION The "own-point-of-view" video technique is a promising method to study clinical decision making in emergency medicine. It is a powerful tool to stimulate recall and help physicians make their reasoning explicit, thanks to a greater psychological immersion.
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Affiliation(s)
- Thierry Pelaccia
- Centre for Training and Research in Health Sciences Education (CFRPS); Faculty of Medicine; University of Strasbourg; Strasbourg France
- Prehospital Emergency Care Service (SAMU 67); Strasbourg University Hospital; Strasbourg France
| | - Jacques Tardif
- Department of Pedagogy; Faculty of Education; University of Sherbrooke; Sherbrooke, Québec Canada
| | - Emmanuel Triby
- Faculty of Educational Sciences; University of Strasbourg; Strasbourg France
| | - Bernard Charlin
- Centre of Pedagogy Applied to Health Sciences (CPASS); Faculty of Medicine; University of Montreal; Montréal, Québec Canada
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Pelaccia T, Lorenzo M, Delacour C, Amsallem C, Ammirati C. An innovative approach to assess teaching skills in medical students. Med Teach 2017; 39:563. [PMID: 28281856 DOI: 10.1080/0142159x.2017.1299929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Thierry Pelaccia
- a Strasbourg Faculty of Medicine , Centre for Training and Research in Health Sciences Education (CFRPS) , Strasbourg , France
| | - Mathieu Lorenzo
- a Strasbourg Faculty of Medicine , Centre for Training and Research in Health Sciences Education (CFRPS) , Strasbourg , France
| | - Chloé Delacour
- a Strasbourg Faculty of Medicine , Centre for Training and Research in Health Sciences Education (CFRPS) , Strasbourg , France
| | - Carole Amsallem
- b Centre for Active Learning with Simulation (SimUSanté) , Amiens University Hospital , Amiens , France
| | - Christine Ammirati
- b Centre for Active Learning with Simulation (SimUSanté) , Amiens University Hospital , Amiens , France
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Uffler S, Bartier JC, Pelaccia T. Are health sciences students who sit at the back of the lecture hall not motivated? PLoS One 2017; 12:e0174947. [PMID: 28362833 PMCID: PMC5376317 DOI: 10.1371/journal.pone.0174947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/19/2017] [Indexed: 11/20/2022] Open
Abstract
Objectives Motivation is a crucial determinant in learning and performance. It would therefore be advantageous for teachers to use strategies intended to have a positive effect on their students' motivation. With this in mind, the first thing to do is to identify students with motivation problems, which can be a complex exercise when there are large groups. We wanted to explore whether the place chosen by health sciences students in a classroom or lecture hall showed any correlation with their motivation. Methods We carried out a multicentre, prospective, observational study of 596 health sciences students in 9 training institutes. The students filled in a self-administered questionnaire to measure the different components of their motivation to take part in a mandatory lesson. These components were correlated with the row in which they sat in a classroom or lecture hall, when they had a free choice of where to sit. Results Apart from extrinsic motivation, all the components of motivation for the health sciences students recruited were significantly correlated with the row. The further the students were from the first row, the less they were motivated. Conclusion In accordance with teachers' views, the level of motivation of the students was less the further their position in a classroom or lecture hall was from the first row. A student's position in the classroom could provide a useful indicator for teachers looking to target their motivational strategies for students with potential motivation problems in the environment, where identifying student motivation levels is impossible.
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Affiliation(s)
- Sébastien Uffler
- Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France
- Centre for Emergency Care Teaching (CESU 67), Strasbourg University Hospital, Strasbourg, France
| | | | - Thierry Pelaccia
- Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France
- Centre for Training and Research in Health Sciences Education (CFR-PS), Faculty of Medicine, University of Strasbourg, Strasbourg, France
- * E-mail:
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Abstract
Motivation is a concept which has fascinated researchers for many decades. The field of medical education has become interested in motivation recently, having always assumed that medical students must be motivated because of their commitment to highly specific training, leading to a very specific profession. However, motivation is a major determinant of the quality of learning and success, the lack of which may well explain why teachers sometimes observe medical students who are discouraged, have lost interest or abandon their studies, with a feeling of powerlessness or resignation. After describing the importance of motivation for learning in medicine, this Guide will define the concept of motivation, setting it within the context of a social cognitive approach. In the second part of this Guide, recommendations are made, based upon the so-called "motivational dynamic model", which provides a multitude of various strategies with positive effects on students' motivation to learn.
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Affiliation(s)
- Thierry Pelaccia
- a Faculty of Medicine, Centre for Training and Research in Health Sciences Education (CFR-PS) , University of Strasbourg , Strasbourg , France
- b Prehospital Emergency Care Service (SAMU 67) , Strasbourg University Hospital , Strasbourg , France
| | - Rolland Viau
- c Faculty of Education , University of Sherbrooke , Sherbrooke , Canada
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Abstract
Objectives Teachers often wonder what students are doing during lectures, behind their computers, mobile phones and other digital tools. This study aimed to document the type of tools used during lectures by nursing students and what they do with them. Methods We carried out a descriptive, prospective, multicentre study including 1446 nursing students in Alsace (France). The students filled in an anonymous questionnaire at the end of a lesson they had just attended. Results 99% of the students had taken at least one digital tool to the lesson. 90% had a mobile phone with them. It was mainly used for entertainment (particularly for sending and/or receiving text messages and consulting emails). 52% had a laptop with them. It was essentially used for academic tasks (taking notes, working on other teaching units or revising for exams). Conclusion Most nursing students take a phone or laptop to lectures with them with the intention of using them for entertainment and learning respectively. These results could guide training establishments in drafting their institutional policy concerning the use of digital tools in class.
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Affiliation(s)
| | | | - Thierry Pelaccia
- Centre for Training and Research in Health Sciences Education (CFRPS), Faculty of Medicine, University of Strasbourg, Strasbourg, France.,Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France
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Pelaccia T, Tardif J, Triby E, Ammirati C, Bertrand C, Dory V, Charlin B. From Context Comes Expertise: How Do Expert Emergency Physicians Use Their Know-Who to Make Decisions? Ann Emerg Med 2016; 67:747-751. [DOI: 10.1016/j.annemergmed.2015.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/06/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022]
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Abstract
The primary focus of research on the physician-patient relationship has been on patients' trust in their physicians. In this study, we explored physicians' trust in their patients. We held semi-structured interviews with expert emergency physicians concerning a patient they had just been managing. The physicians had been equipped with a head-mounted micro camera to film the encounter from an "own point of view perspective". The footage was used to stimulate recall during the interviews. Several participants made judgments on the reliability of their patients' accounts from the very beginning of the encounter. If accounts were not deemed reliable, participants implemented a variety of specific strategies in pursuing their history taking, i.e. checking for consistency by asking the same question at several points in the interview, cross-referencing information, questioning third-parties, examining the patient record, and systematically collecting data held to be objective. Our study raises the question of the influence of labeling patients as "reliable" or "unreliable" on their subsequent treatment in the emergency department. Further work is necessary to examine the accuracy of these judgments, the underlying cognitive processes (i.e. analytic versus intuitive) and their influence on decision-making.
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Affiliation(s)
- Thierry Pelaccia
- Centre for Training and Research in Health Sciences Education (CFR-PS), Faculty of Medicine, University of Strasbourg, 67085, Strasbourg, France.
- Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, PO Box 426, 67200, Strasbourg, France.
| | - Jacques Tardif
- Department of Pedagogy, Faculty of Education, University of Sherbrooke, Sherbrooke, QC, J1K 2R1, Canada
| | - Emmanuel Triby
- Faculty of Educational Sciences, University of Strasbourg, 67000, Strasbourg, France
| | - Christine Ammirati
- Department of Emergency Medicine, Amiens University Hospital, 80054, Amiens, France
| | - Catherine Bertrand
- Prehospital Emergency Care Service (SAMU 94), Henri-Mondor Hospital, Public Hospitals of Paris, 94000, Créteil, France
| | - Bernard Charlin
- Centre of Pedagogy Applied to Health Sciences (CPASS), Faculty of Medicine, University of Montreal, Montreal, QC, H3T 1J4, Canada
| | - Valérie Dory
- Undergraduate Medical Education and Centre for Medical Education, McGill University, Montreal, QC, H3A 2T5, Canada
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Pelaccia T, Tardif J, Triby E, Ammirati C, Bertrand C, Charlin B, Dory V. Insights into emergency physicians' minds in the seconds before and into a patient encounter. Intern Emerg Med 2015; 10:865-73. [PMID: 26232196 DOI: 10.1007/s11739-015-1283-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022]
Abstract
Clinical reasoning is a core competency in medical practice. No study has explored clinical reasoning occurring before a clinical encounter, when physicians obtain preliminary information about the patient, and during the first seconds of the observation phase. This paper aims to understand what happens in emergency physicians' minds when they acquire initial information about a patient, and when they first meet a patient. The authors carried out in-depth interviews based on the video recordings of emergency situations filmed in an "own-point-of-view-perspective". 15 expert emergency physicians were interviewed between 2011 and 2012. Researchers analysed data using an interpretive approach based on thematic analysis and constant comparison. Almost all participants used a few critical pieces of information to generate hypotheses even before they actually met the patient. Pre-encounter hypotheses played a key role in the ensuing encounter by directing initial data gathering. Initial data, collected within the first few seconds of the encounter, included the patient's position on the stretcher, the way they had been prepared, their facial expression, their breathing, and their skin colour. Physicians also rapidly appraised the seriousness of the patient's overall condition, which determined their initial goals, i.e. initiating emergency treatment or pursuing the diagnostic investigation. The study brings new insights on what happens at the very beginning of the encounter between emergency physicians and patients. The results obtained from an innovative methodological approach open avenues for the development of clinical reasoning in learners.
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Affiliation(s)
- Thierry Pelaccia
- Faculty of Medicine, Centre for Training and Research in Health Sciences Education (CFR-PS), University of Strasbourg, 67000, Strasbourg, France.
- Prehospital Emergency Care Service (SAMU 67), Centre for Emergency Care Teaching (CESU 67), Strasbourg University Hospital, PO Box 426, 67200, Strasbourg, France.
| | - Jacques Tardif
- Department of Pedagogy, Faculty of Education, University of Sherbrooke, Sherbrooke, QC, J1K 2R1, Canada.
| | - Emmanuel Triby
- Faculty of Educational Sciences, University of Strasbourg, 67000, Strasbourg, France.
| | - Christine Ammirati
- Department of Emergency Medicine, Amiens University Hospital, 80054, Amiens, France.
| | - Catherine Bertrand
- Prehospital Emergency Care Service (SAMU 94), Henri-Mondor Hospital, Public Hospitals of Paris, 94000, Créteil, France.
| | - Bernard Charlin
- Faculty of Medicine, Centre of Pedagogy Applied to Health Sciences (CPASS), University of Montreal, Montréal, QC, H3T 1J4, Canada.
| | - Valérie Dory
- Undergraduate Medical Education and Centre for Medical Education, McGill University, Montreal, QC, H3A 1A3, Canada.
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Maisonneuve H, Chambe J, Lorenzo M, Pelaccia T. How do general practice residents use social networking sites in asynchronous distance learning? BMC Med Educ 2015; 15:154. [PMID: 26391989 PMCID: PMC4578679 DOI: 10.1186/s12909-015-0435-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/10/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Blended learning environments - involving both face-to-face and remote interactions - make it easier to adapt learning programs to constraints such as residents' location and low teacher-student ratio. Social networking sites (SNS) such as Facebook®, while not originally intended to be used as learning environments, may be adapted for the distance-learning part of training programs. The purpose of our study was to explore the use of SNS for asynchronous distance learning in a blended learning environment as well as its influence on learners' face-to-face interactions. METHODS We conducted a qualitative study and carried out semi-structured interviews. We performed purposeful sampling for maximal variation to include eight general practice residents in 2(nd) and 3(rd) year training. A thematic analysis was performed. RESULTS The social integration of SNS facilitates the engagement of users in their learning tasks. This may also stimulate students' interactions and group cohesion when members meet up in person. CONCLUSIONS Most of the general practice residents who work in the blended learning environment we studied had a positive appraisal on their use of SNS. In particular, we report a positive impact on their engagement in learning and their participation in discussions during face-to-face instruction. Further studies are needed in order to evaluate the effectiveness of SNS in blended learning environments and the appropriation of SNS by teachers.
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Affiliation(s)
| | - Juliette Chambe
- Department of General Medicine, Faculty of Medicine, Strasbourg, France.
| | - Mathieu Lorenzo
- Department of General Medicine, Faculty of Medicine, Strasbourg, France.
| | - Thierry Pelaccia
- Health Sciences Education Research Laboratory, Department of Medical Education, Faculty of Medicine, Strasbourg, France.
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Pelaccia T, Tardif J, Triby E, Ammirati C, Bertrand C, Charlin B, Dory V. In reply. Ann Emerg Med 2015; 65:620-1. [PMID: 25910769 DOI: 10.1016/j.annemergmed.2015.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Thierry Pelaccia
- Centre for Training and Research in Health Sciences Education (CFR-PS), Faculty of Medicine, University of Strasbourg, Strasbourg, France; Prehospital Emergency Care Service (SAMU 67)-Centre for Emergency Care Teaching (CESU 67), Strasbourg University Hospital, Strasbourg, France
| | - Jacques Tardif
- Department of Pedagogy, Faculty of Education, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Emmanuel Triby
- Faculty of Educational Sciences, University of Strasbourg, Strasbourg, France
| | - Christine Ammirati
- Department of Emergency Medicine, Amiens University Hospital, Amiens, France
| | - Catherine Bertrand
- Prehospital Emergency Care Service (SAMU 94), Henri-Mondor Hospital, Public Hospitals of Paris, Créteil, France
| | - Bernard Charlin
- Centre of Pedagogy Applied to Health Sciences (CPASS), Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada
| | - Valérie Dory
- Undergraduate Medical Education and Centre for Medical Education, McGill University, Montreal, Quebec, Canada
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Pelaccia T, Tardif J, Triby E, Ammirati C, Bertrand C, Dory V, Charlin B. How and When Do Expert Emergency Physicians Generate and Evaluate Diagnostic Hypotheses? A Qualitative Study Using Head-Mounted Video Cued-Recall Interviews. Ann Emerg Med 2014; 64:575-85. [DOI: 10.1016/j.annemergmed.2014.05.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 04/24/2014] [Accepted: 05/05/2014] [Indexed: 01/15/2023]
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Claessens YE, Wannepain S, Gestin S, Magdelein X, Ferretti E, Guilly M, Charlin B, Pelaccia T. How emergency physicians use biomarkers: insights from a qualitative assessment of script concordance tests. Emerg Med J 2013; 31:238-41. [DOI: 10.1136/emermed-2012-202303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pelaccia T, Tardif J, Triby E, Charlin B. An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory. Med Educ Online 2011; 16:10.3402/meo.v16i0.5890. [PMID: 21430797 PMCID: PMC3060310 DOI: 10.3402/meo.v16i0.5890] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [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: 12/06/2010] [Revised: 02/07/2011] [Accepted: 02/07/2011] [Indexed: 05/13/2023]
Abstract
CONTEXT Clinical reasoning plays a major role in the ability of doctors to make diagnoses and decisions. It is considered as the physician's most critical competence, and has been widely studied by physicians, educationalists, psychologists and sociologists. Since the 1970s, many theories about clinical reasoning in medicine have been put forward. PURPOSE This paper aims at exploring a comprehensive approach: the "dual-process theory", a model developed by cognitive psychologists over the last few years. DISCUSSION After 40 years of sometimes contradictory studies on clinical reasoning, the dual-process theory gives us many answers on how doctors think while making diagnoses and decisions. It highlights the importance of physicians' intuition and the high level of interaction between analytical and non-analytical processes. However, it has not received much attention in the medical education literature. The implications of dual-process models of reasoning in terms of medical education will be discussed.
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Affiliation(s)
- Thierry Pelaccia
- Prehospital Emergency Care Service (SAMU 67)-Centre for Emergency Care Teaching (CESU 67), Strasbourg University Hospital, Strasbourg, France.
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Pelaccia T, Delplanq H, Triby E, Bartier JC, Leman C, Hadef H, Pottecher T, Dupeyron JP. Gender stereotypes: an explanation to the underrepresentation of women in emergency medicine. Acad Emerg Med 2010; 17:775-9. [PMID: 20653594 DOI: 10.1111/j.1553-2712.2010.00793.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Women are underrepresented in emergency medicine (EM) residency programs in comparison with many other specialties. The reasons for this are unclear. One hypothesis is that negative gender stereotypes about EM careers might exist among female medical students. In the field of education, negative gender stereotypes are known to lead to career avoidance, because they tend to decrease self-efficacy perception. The aims of this study were to assess the prevalence of negative gender stereotypes about EM practice among medical students and to measure the effects of these stereotypes on females' self-efficacy perception toward EM learning. METHODS A survey was conducted of the 255 third-year medical students from three medical schools who attended a mandatory EM academic program in France. They completed an anonymous questionnaire exploring their gender stereotypes about EM practice and their self-efficacy perception toward EM learning. RESULTS Gender stereotypes are common among medical students, especially in women. Self-efficacy perception is negatively correlated to female students' belief that EM careers are better suited for men (p < 0.05). CONCLUSIONS Negative gender stereotypes among female medical students may lead to EM career avoidance, because of the decrease in their self-efficacy perception toward EM learning.
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Pelaccia T, Delplancq H, Triby E, Bartier JC, Leman C, Hadef H, Meyer N, Dupeyron JP. Can teaching methods based on pattern recognition skill development optimise triage in mass-casualty incidents? Emerg Med J 2009; 26:899-902. [DOI: 10.1136/emj.2008.067215] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pelaccia T, Delplancq H, Triby E, Bartier JC, Leman C, Dupeyron JP. Impact of training periods in the emergency department on the motivation of health care students to learn. Med Educ 2009; 43:462-469. [PMID: 19422494 DOI: 10.1111/j.1365-2923.2009.03356.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Motivation is one of the most important factors for learning and achievement. The perceived value of the task, perceptions of self-efficacy and beliefs about control of learning are the main determinants of motivation. They are highly influenced by the individual's personal history and especially by significant past experiences. We assessed the impact of training periods in the emergency department on the motivation of health care students to learn in the field of emergency medicine. METHODS A survey was conducted in 2008 with 112 undergraduate medical students and 201 undergraduate nursing students attending an emergency medicine academic programme. At the beginning of the course, the students completed an anonymous 26-item questionnaire to assess their motivational orientations. RESULTS Perceived task value was higher for students who had previously attended a training period in the emergency department (P = 0.002). Perceived self-efficacy was depressed when the respondent had been confronted with negative outcome events (P < 0.001). Control of learning beliefs was affected negatively in students who had attended a training period in the emergency department (P < 0.001). CONCLUSIONS Motivation is a major contributor to the success of learning. Training periods in the emergency department can have positive and negative impacts on the learning motivation of medical and nursing students in the field of emergency medicine. Ideally, and in terms of increasing motivation, health care students should gain experiential learning in the emergency department before attending a corresponding academic course. During this period, tutors should provide appropriate supervision and feedback in order to support self-efficacy perception and learning control beliefs.
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Affiliation(s)
- Thierry Pelaccia
- Prehospital Emergency Care Service (SAMU 67), and Centre for Emergency Care Teaching (CESU 67), Strasbourg University Hospital, Strasbourg, France.
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Affiliation(s)
- Thierry Pelaccia
- Service d'Aide Medicale Urgente et Centre d'Enseignement des Soins d'Urgence, Hôpitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, 67000 Strasbourg, France.
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