#ClinTeach Conversation Kickstarter with Karen Scott

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e-Editor Intern’s note: Here we have another conversation starter by one of our e-council members. Karen Scott discusses the article by Miah et al. entitled “Evolving priorities of medical students“.

Understanding the training priorities of medical graduates

by Karen Scott

It is important for medical schools to know what factors influence medical graduates’ choice of postgraduate training program. As found by Miah et al.1, the factors influencing student choice of medical school2 appear to change as medical students move through their undergraduate degree. It is understandable that as students get older, they may form relationships and friendships in specific regions where they wish to practice; location thus becomes a strong factor influencing choice.

It would be useful to explore whether these findings are applicable to other regions: Are the factors influencing choice of medical school and postgraduate training similar in other parts of the UK? Are they the same in other countries, such as the US, Australia, Europe and Asia?

Similarly, are medical graduates who wish to specialise in particular disciplines more likely to make a choice based on location or other factors, such as reputation? Would the reputation of the postgraduate training school influence entry into competitive training programs, such as surgery?

 

References

  1. Miah S, Pang K, Grant T, Rubakumar Z, Rebello W, Begum H. Evolving priorities of medical students. The Clinical Teacher. 2014.
  2. Foster K. Medical school choice: what influences applicants? The Clinical Teacher. 2014;11(4):307-310.

#ClinTeach Conversation Starter with Daniel Brandt-Vegas

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e-Editor Intern’s note:  This week we bring you a post by Dr. Daniel Brandt-Vegas, a clinical scholar at McMaster University (Ontario, Canada), and a Masters candidate at the University of Illinois at Chicago’s MHPE program.

Reflections on Patient-centered Care

by Daniel Brandt-Vegas MD, FRCPC, MHPE(c)

The article by Teodorczuk et al. (“Learning about the Patient: An innovative Interprofessional dementia and delirium education programme”) illustrates an attempt to re-focus the care of confused patients in hospital to the patient’s experience rather than our own. It also highlights the complexity in caring for patients with delirium or dementia, as well as the critical role of the healthcare team in providing such care. Overall, it raises the fundamental question, “Are we actually listening to our patients?”

Patient-centered healthcare may be one of the largest oxymorons currently in western society. If you consider the pervasive role of provider-driven healthcare interventions in the daily clinical context, it’s hard to argue that our current patient-centered practice is in fact centered on the patient’s values or preferences. The problem is multi-factorial and complex, but I’ll highlight a few components that I think largely drive this resistant contradiction.

First is the issue of health literacy. Despite the prophesized influence the Internet, laptops, and smart-phones would have on people’s knowledge and understanding of health, disease, and how to navigate the healthcare system, the reality is that information bias, marketing trends, accessibility to technology, and the growing complexity of medical concepts has protected the impenetrable barrier of medical knowledge and continued to limit the average person’s health literacy. Most people still don’t understand basic healthcare concepts and we, as a profession, have failed to educate them. The knowledge, and therefore power, difference between physician and patient is still looming.

Second is the issue of influencing factors for change in healthcare. The role that government funding and legislation, media coverage, administrative agendas, and academic reputation play in guiding the changes taking place in different clinical settings is clearly strong, and fairly obvious. Unfortunately, the role that patient’s preferences and experiences play in this context is less clear and strongly debatable.

The third issue is our overall inability to deal with uncertainty. As we navigate clinical questions, diagnostic dilemmas, and therapeutic decisions in a perpetually grey and ambiguous context on a daily basis, we tend to present things to our patients and their families in simplistic, often binary terms. The problem arises when the simplified version of reality we present is more a reflection of our own values and perspectives than theirs.

 

So what will it take to begin refocusing healthcare in general on the patient? How can we actually achieve a patient-centered model?

Should we?

Join our conversation by dropping a comment below!

Standard setting in OSCEs: a borderline approach

by Kingston Rajiah, Sajesh Kalkandi Veettil and Suresh Kumar

Link to article here.

Background

The evaluation of clinical skills and competencies is a high-stakes process carrying significant consequences for the candidate. Hence, it is mandatory to have a robust method to justify the pass score in order to maintain a valid and reliable objective structured clinical examination (OSCE). The aim was to trial the borderline approach using the two-domain global rating scale for standard setting in the OSCE.

Methods

For each domain, a set of six-point (from 5 to 0) scales were used to reflect high and low divisions within the ‘pass’, ‘borderline’ and ‘fail’ categories. Scores on the two individual global scales were summed to create a ‘summed global rating’. Similarly task-based checklists for individual stations were summed to get a total score.

It is mandatory to have a robust method to justify the pass score in order to maintain a valid and reliable OSCE

Results

The Pearson’s correlation between task-based checklist scoring and the two-domain global rating scale were moderate and significant. The highest R2 coefficient of 0.479 was obtained for station 7, and the lowest R2 value was 0.241 for station 14.

Discussion

There was a significant positive correlation between the two scales; however, the R2 value was not satisfactory except for station 7. The pass mark for the OSCE according to the borderline method was 64 per cent, which is higher than the arbitrarily set pass mark of 50 per cent.

Conclusions

This study confirms that the two-domain global rating scale is appropriate to assess the abilities of students within the framework of an OSCE. The strong relationships between the two-domain global rating scale and task-based checklists provide evidence that the two-domain global rating scale can be used to genuinely assess students’ proficiencies.

DOI: 10.1111/tct.12213

Successful collaboration in education: the UMeP

by Laura-Jane Smith, Rosie Belcher, Will Coppola, Deborah Gill, Hilary Spencer, Chris Cooper, Nigel Rawlinson, Jane Williams, Alex Haig, Joel Smith, Inam Haq, Anna Jones, Julia Montgomery and Tim Vincent

Link to article here

Background

As the health care education landscape in the UK changes rapidly and dramatically, collaboration across institutions bridging undergraduate and postgraduate fields is increasingly necessary. Collaboration entails both risks and benefits. There is a paucity of advice on how to ensure collaborative projects in medical education are effective.

There is a paucity of advice on how to ensure collaborative projects in medical education are effective

Context

In 2011 three medical schools began a collaborative project along with NHS Education for Scotland (NES) to modify, develop and deliver a medical school version of the NES foundation programme ePortfolio, called UMeP. The underlying principal was the introduction of an authentic ePortfolio early in undergraduate life. The challenge of three diverse medical schools with significantly different curricula and assessment approaches working together with a single postgraduate ePortfolio was complex and demanding.

Discussion

We reveal the complexities of collaboration on education projects and draw on our experiences to provide illustrative examples of collaboration. Despite the increased complexity and need for compromise, we argue that successful collaborative partnerships are key to maximising the circumstances in which education innovation can be successful, and create the potential for robust evaluation and research.

DOI: 10.1111/tct.12212

Evaluating peer teaching about chronic disease

by Sylvia Guenther, Narelle Shadbolt, Chris Roberts and Tyler Clark

Link to article here.

Background

The primary care areas of priority (PCAP) activity was developed to engage medical students in learning about chronic disease management in a clinical context from their peers. It is one of several summative assessment tasks that occur during a primary care community term rotation in a graduate-entry medical programme. We evaluated the acceptability and effectiveness of the PCAP activity as a combined teaching, learning and assessment innovation.

Methods

Evaluation and assessment data from students who rotated through the four community term blocks during the 2011–2012 academic year was analysed using both qualitative and quantitative methods.

PCAP peer teaching activity is an effective format for teaching about the management of chronic conditions in the community

Results

Analysis indicated that 89 per cent (n = 148/166) of responding students rated the PCAP as satisfactory, good or excellent. The marking rubric contained 11 assessable components, including teaching skills, mastery of clinical knowledge, developing a management plan, disease prevention and health promotion opportunities, identifying patient safety issues, the impact of the clinical presentation on the patient and family, and consideration of health equity factors. Analysis of the assessment scores indicated that the majority of students achieved the specified learning outcomes.

Discussion

The PCAP peer teaching activity was an acceptable and effective format for teaching about the management of chronic conditions in the community, and is adaptable to other teaching contexts. Students enjoyed teaching and being taught by their peers, and assessment results indicated that they developed their clinical knowledge as well as their teaching ability regarding chronic disease management.

DOI: 10.1111/tct.12211

Error management training and simulation education

by Aimee Gardner and Michelle Rich

Link to article here.

Background

The integration of simulation into the training of health care professionals provides context for decision making and procedural skills in a high-fidelity environment, without risk to actual patients. It was hypothesised that a novel approach to simulation-based education – error management training – would produce higher performance ratings compared with traditional step-by-step instruction.

Method

Radiology technology students were randomly assigned to participate in traditional procedural-based instruction (= 11) or vicarious error management training (= 11). All watched an instructional video and discussed how well each incident was handled (traditional instruction group) or identified where the errors were made (vicarious error management training). Students then participated in a 30–minute case-based simulation. Simulations were videotaped for performance analysis. Blinded experts evaluated performance using a predefined evaluation tool created specifically for the scenario.

Blinded experts evaluated performance using a predefined evaluation tool created specifically for the scenario

Results

The vicarious error management group scored higher on observer-rated performance (Mean = 9.49) than students in the traditional instruction group (Mean = 9.02; p < 0.01).

Conclusions

These findings suggest that incorporating the discussion of errors and how to handle errors during the learning session will better equip students when performing hands-on procedures and skills. This pilot study provides preliminary evidence for integrating error management skills into medical curricula and for the design of learning goals in simulation-based education.

DOI: 10.1111/tct.12217

Defining a competency map for a practical skill

by Dorothy Breen, George Shorten, Annette Aboulafia, Dajie Zhang, Cord Hockemeyer and Dietrich Albert

Link to article here.

Background

In recent years there has been a move towards a competency-based model for assessing the performance of practical procedures in clinical medicine rather than the traditional assumption that competency is achieved with increasing experience. For such an assessment to be valid, the necessary competencies comprising that skill must be identified. Our aim was to map the individual competencies necessary to perform a given procedural skill using spinal anaesthesia as the example, and to explore the relationship of individual competencies with each other.

Methods

In the first part of the study an extensive hierarchical task analysis (HTA) was undertaken to determine the competencies necessary for the performance of spinal anaesthesia. Secondly, the concept of competency-based knowledge space theory (CbKST) was applied to the map. CbKST is based on the principle that acquisition of a specific skill is usually preceded by a number of dependent or prerequisite skills.

Our aim was to map the individual competencies necessary to perform a given procedural skill

Results

The analysis yielded a comprehensive HTA of the skills necessary to perform spinal anaesthesia, comprising 509 individual competencies. Applying the concept of CbKST yielded 194 key competences with at least one dependent or prerequisite skill.

Discussion

We have defined a comprehensive HTA or competency map for use in the assessment of the performance of spinal anaesthesia. This CbKST approach will provide clinicians who undertake medical procedures to better understand their own performance, and to improve over time.

DOI: 10.1111/tct.12194

Annual planning meetings: views and perceptions

by Taruna Bindal, David Wall and Helen Goodyear

Link to article here.

Background
In 2009, annual face to face planning meetings (APMs) were introduced as an optional meeting for all paediatric trainees. APMs are a formative assessment process whereby the trainee meets with a panel of consultants and sets the agenda for discussion.

Method
A questionnaire about APMs was given to all participating trainees and trainers in 2011.

Results
The response rate was 93 per cent (139/150) and 67 per cent (12/18) for trainees and trainers, respectively. All trainers had received panel member training. Ninety-one per cent of trainees (126/139) felt adequately prepared for the meeting. Issues discussed included career plans (93%), future training placements (73%), ePortfolio (61%) and previous training posts (61%). Trainees felt that the APM was a helpful formative assessment process (with a mean score of five on a six–point Likert scale: 1, strongly disagree; 6, strongly agree), and that panels were fair, supportive, communicated clearly, listened to concerns and focused on individual learning needs. Sixty-seven per cent (8/12) of trainers would have liked more information about the process beforehand.

Discussion
The main benefits of APMs were trainees feeling supported in their training and better informed regarding career options. APMs would be of value to all specialties to enable annual formative assessment to be undertaken at a different time to the summative assessment process. APMs facilitate reflection on learning needs, and the formulation of personal development plans and career goals for trainees.

Trainees felt that the APM was a helpful formative assessment process

DOI: 10.1111/tct.12193

Top tips for a teaching fellowship

by David Roberts, George Morris, Amy Crees, Timothy Slade and Nicola Jakeman

Link to article here.

Background

Dedicated medical education posts are an exciting opportunity for doctors to focus on their development as clinical teachers. Within the seven hospital trusts that host students from the University of Bristol there are now 19 clinical teaching fellowship (CTF) posts. On starting a dedicated medical education post, the opportunities available can seem overwhelming, and on reflection many of the local 2012–13 CTFs would have changed their initial practice. The purpose of this article was to explore and collate the experiences of CTFs to produce a selection of practical ‘top tips’.

Methods

A questionnaire was sent to all 19 CTFs via e–mail, asking them to state what they would do the same and what they would do differently if they had their time again.

Dedicated medical education posts are an exciting opportunity for doctors to focus on their development as clinical teachers

Results

Eight themes were drawn from the 13 (68%) returned questionnaires, with each theme mentioned between four and 11 times. The themes included: keeping a portfolio of evidence; personal development; undertaking educational research; developing as a clinical teacher; and administration.

Conclusion

Our aim for this article was to generate practical top tips for those doctors considering, about to start or having just commenced a dedicated teaching role, helping individuals to get the most from their time. It also explains what these teaching fellowships can involve, and gives those thinking of undertaking a dedicated teaching role a better idea of what to expect.

DOI: 10.1111/tct.12200

A regional teaching fellow community of practice

by David Little, Katrina Butcher, Simon Atkinson, Duncan Still and Julia Vasant

Link to article here.

Background

Increasing numbers of clinical teaching fellows are responsible for a significant proportion of undergraduate teaching nationally. Developing a regional community of practice can help overcome the isolation of these posts, with potential benefits for all involved.

Context

A community of practice relies on the mutual engagement of people in a similar situation working towards a common goal. Working together and sharing resources enables teaching fellows to make the most of their post, which ultimately benefits those that they are teaching.

Innovation

We developed a regional clinical teaching fellow community of practice in Bristol in 2010/11. Our community has continued to develop since completing our posts as clinical teaching fellows, and has provided a platform for new communities to develop amongst the groups of subsequent teaching fellows coming through.

We encourage all regions who have clinical teaching fellows to develop a regional community of practice

Implications

We encourage all regions who have clinical teaching fellows to develop a regional community of practice. We also encourage trainees to join TASME (Trainees in the Association for the Study of Medical Education), a new national community of practice for trainees involved in medical education.

DOI: 10.1111/tct.12229