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Albahari D. Learning Clinical Reasoning: The Experience of Postgraduate Psychiatry Trainee Doctors in Qatar. TEACHING AND LEARNING IN MEDICINE 2024; 36:323-336. [PMID: 37154482 DOI: 10.1080/10401334.2023.2209076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
Phenomenon: As a core competency in medical education, clinical reasoning is a pillar for reducing medical errors and promoting patient safety. Clinical reasoning is a complex phenomenon studied through the lens of multiple theories. Although cognitive psychology theories transformed our understanding of clinical reasoning, the theories fell short of explaining the variations in clinical reasoning influenced by contextual factors. Social cognitive theories propose a dynamic relationship between learners' cognitive process and their social and physical environments. This dynamic relationship highlights the essential role of formal and informal learning environments for learning clinical reasoning. Approach: My research aimed to explore the personal experience of learning clinical reasoning in a sample of postgraduate psychiatry trainee doctors using cognitive psychology and social cognitive theories. A stratified convenience sample of seven psychiatry trainee doctors working in the Mental Health Services in Qatar completed semi-structured interviews in 2020. I analyzed the data manually using theoretical thematic analysis. Findings: I identified three overarching themes with multiple subthemes. The first theme was the hierarchical cultural impact on perceived learning opportunities and learning behavior. The first theme had two subthemes that explored the relationship with team members and the expected hierarchy roles. The second theme was the impact of emotions on the learning and execution of clinical reasoning.The second theme had three subthemes that explored the personal approach to managing emotions related to perceived self-efficacy and professional image. The third theme was characteristics of learning environments and their role in learning clinical reasoning. The last theme included three subthemes that explored stressful, autonomous, and interactive environments. Insights: The results accentuate the complexity of clinical reasoning. Trainees' experience of learning clinical reasoning was influenced by factors not controlled for in the curricula. These factors constitute a hidden curriculum with a significant influence on learning. Our local postgraduate training programmes will benefit from addressing the points raised in this study for effective and culturally sensitive clinical reasoning learning.
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Affiliation(s)
- Dalia Albahari
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
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Coelho DL, Amaral RC, Silva IC, Oliveira AVOB, Neto AS, Silva JFP, Joviano-Santos JV. Realistic simulation and medical students' performance in the Advanced Cardiac Life Support course: a comparative study. ADVANCES IN PHYSIOLOGY EDUCATION 2024; 48:61-68. [PMID: 37994405 DOI: 10.1152/advan.00113.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
Clinical practice has benefited from new methodologies such as realistic simulation (RS). RS involves recreating lifelike scenarios to more accurately reflect real clinical practice, enhancing learners' skills and decision-making within controlled environments, and experiencing remarkable growth in medical education. However, RS requires substantial financial investments and infrastructure. Hence, it is essential to determine the effectiveness of RS in the development of skills among medical students, which will improve the allocation of resources while optimizing learning. This cross-sectional study was carried out in the simulation laboratory of a medical school, and the performance of students who underwent two different curriculum matrices (without RS and with RS, from 2021 to 2022) in the Advanced Cardiac Life Support (ACLS) course was compared. This test was chosen considering that the competencies involved in cardiac life support are essential, regardless of the medical specialty, and that ACLS is a set of life-saving protocols used worldwide. We observed that the impact of RS can be different for practical abilities when compared with the theoretical ones. There was no correlation between the general academic performance and students' grades reflecting the RS impact. We conclude that RS leads to less remediation and increased competence in practical skills. RS is an important learning strategy that allows repeating, reviewing, and discussing clinical practices without exposing the patient to risks.NEW & NOTEWORTHY Realistic simulation (RS) positively affected the performance of the students differently; it had more influence on practical abilities than theoretical knowledge. No correlation between the general academic performance and grades of the students without RS or with RS was found, providing evidence that RS is an important tool in Advanced Cardiac Life Support education.
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Affiliation(s)
- Débora L Coelho
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rosana C Amaral
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Isabella C Silva
- Student of the Course in Medicine, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Virgínia O B Oliveira
- Student of the Course in Medicine, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Augusto Scalabrini Neto
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - José Felippe P Silva
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Julliane V Joviano-Santos
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Laboratório de Investigações NeuroCardíacas, Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Ng IKS, Mok SF, Teo D. Competency in medical training: current concepts, assessment modalities, and practical challenges. Postgrad Med J 2024:qgae023. [PMID: 38376156 DOI: 10.1093/postmj/qgae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/23/2024] [Indexed: 02/21/2024]
Abstract
In the past two decades, competency-based medical education (CBME) has rapidly become the cornerstone of medical training and accreditation programmes worldwide. It has increasingly replaced traditional time-based educational approaches which were often rigid, fragmented, and overly emphasized clinical content knowledge over practical skillsets and attitudes. CBME adoption was in the hope of better preparing medical graduates for the demands and responsibilities of real-world clinical practice. For all the supposed merits of CBME, there hitherto remains difficulties in arriving at comprehensive and practical 'competency' definitions, and actual challenges with implementation of clinical competency assessment modalities pertaining to construct validity, reliability, and applicability with the use and interpretation of evaluation metrics. Therefore, in this article, we describe the various conceptualizations of 'competency' in medical education literature and attempt to refine its usage in practice to meet the evolving needs and expectations of healthcare stakeholders, as well as incorporate emerging concepts in the medical education discourse. We herein propose that clinical 'competencies' should be defined as multi-domain clinical expertise, comprising medical knowledge, skills, attitudes and metacognitive capabilities that reflects the prevailing needs of healthcare stakeholders, and is inferred from performance evaluations of medical trainees. In order to attain 'competence', there must then be a process of integrating multi-domain competencies into meaningful professional identity formation that is commensurate with the context and stage of medical training. In addition, we review the current competency assessment modalities, including common pitfalls with their usage, and sought to provide practical strategies to mitigate the identified challenges.
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Affiliation(s)
- Isaac K S Ng
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore 117597, Singapore
| | - Shao Feng Mok
- Yong Loo Lin School of Medicine, National University of Singapore 117597, Singapore
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Desmond Teo
- Yong Loo Lin School of Medicine, National University of Singapore 117597, Singapore
- Fast and Chronic Programmes, Alexandra Hospital, Singapore 159964, Singapore
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore
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Ng IKS, Lin NHY, Goh WGW, Teo DB, Tan LF, Ban KHK. 'Insight' in medical training: what, why, and how? Postgrad Med J 2024; 100:196-202. [PMID: 38073326 DOI: 10.1093/postmj/qgad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/08/2023] [Accepted: 10/15/2023] [Indexed: 02/20/2024]
Abstract
The term 'insight' is generically defined in English language as the ability to perceive deeper truths about people and situations. In clinical practice, patient insight is known to have important implications in treatment compliance and clinical outcomes, and can be assessed clinically by looking for the presence of illness awareness, correct attribution of symptoms to underlying condition, and acceptance of treatment. In this article, we suggest that cultivating insight is actually a highly important, yet often overlooked, component of medical training, which may explain why some consistently learn well, communicate effectively, and quickly attain clinical competency, while others struggle throughout their clinical training and may even be difficult to remediate. We herein define 'insight' in the context of medical training as having an astute perception of personal cognitive processes, motivations, emotions, and ability (strengths, weaknesses, and limitations) that should drive self-improvement and effective behavioural regulation. We then describe the utility of cultivating 'insight' in medical training through three lenses of (i) promoting self-regulated, lifelong clinical learning, (ii) improving clinical competencies and person-centred care, and (iii) enhancing physician mental health and well-being. In addition, we review educational pedagogies that are helpful to create a medical eco-system that promotes the cultivation of insight among its trainees and practitioners. Finally, we highlight several tell-tale signs of poor insight and discuss psychological and non-psychological interventions that may help those severely lacking in insight to become more amenable to change and remediation.
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Affiliation(s)
- Isaac K S Ng
- Department of Medicine, National University Hospital, 119228, Singapore
| | - Norman H Y Lin
- Department of Medicine, National University Hospital, 119228, Singapore
| | - Wilson G W Goh
- Division of Infectious Diseases, Department of Medicine, National University Hospital, 119228, Singapore
| | - Desmond B Teo
- Fast and Chronic Programme, Alexandra Hospital, 159964, Singapore
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore
| | - Li Feng Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore
- Healthy Ageing Programme, Alexandra Hospital , 159964, Singapore
| | - Kenneth H K Ban
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 117596, Singapore
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Sapru S, Mitchell K, McFadden T. Combining Physician Expertise and Women's Lived Experience to Educate Health Professionals about Preventing Fetal Alcohol Spectrum Disorders. Matern Child Health J 2024; 28:229-239. [PMID: 37847449 DOI: 10.1007/s10995-023-03786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Physician Champions from the American College of Obstetricians and Gynecologists (ACOG) and trained women Speakers from FASD United, who have given birth to a child with a fetal alcohol spectrum disorder (FASD), co-present to healthcare providers (HCPs) in medical residency programs as part of an educational intervention. They present FASDs as a biological and social problem surrounded by stigma that prevent pregnant women from talking openly to their HCPs about their alcohol use or alcohol use disorder (AUD) and getting the medical help they need. METHODS Semi-structured interviews were conducted with 10 ACOG Champions and nine FASD United Speakers and a thematic analysis assessed how the co-presentations can enhance HCPs' understanding about FASDs and address stigma associated with alcohol use during pregnancy. RESULTS Interview findings indicated that both Champions and Speakers emphasized the need for HCPs to be nonjudgmental and create a safe space for open dialogue. They reported that residents were moved by mothers' personal stories, wanted to understand AUD better, and asked about the type of help HCPs can offer women. DISCUSSION Combining physicians' expertise with mothers' personal stories of lived experiences of FASDs directed at residents, who are more reflective and open at this phase of their careers, moved them from a fact-based to an empathy-based approach to learning that is critical to address the stigma surrounding women who may be using alcohol or struggling with an AUD during pregnancy. Collaboration between national organizations allowed this intervention to be widely implemented across the country.
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Affiliation(s)
| | | | - Tonya McFadden
- American College of Obstetricians and Gynecologists, Washington, DC, USA
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Bagga R, McKee A. Metacognition in oral health education: A pedagogy worthy of further exploration. MEDICAL TEACHER 2023:1-8. [PMID: 38019882 DOI: 10.1080/0142159x.2023.2287399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
AIM This study aimed to investigate the perceptions of dental students and teachers about introducing metacognition pedagogy within an established clinical professional curriculum to provide primary data informing its feasibility. METHODOLOGY AND METHOD A qualitative study using phenomenography methodology was undertaken as part of a master's dissertation. Semi-structured interviews were conducted on 16 participants which included 9 clinical teachers and 7 dental students. FINDINGS Metacognition pedagogy was positively perceived by most of the participants as being beneficial to students' learning in oral health education. A few reported some negativity. All participants identified some challenges to be addressed if a metacognition pedagogy was to be implemented in the undergraduate curriculum. CONCLUSION According to the perceptions of most participants in the study, metacognition emerged as a potential factor in improving student learning and exam performance, and facilitating the development of critical thinking, professionalism, and clinical skills. In the context of rigorous, demanding, and challenging courses, and recognising the complexities and uncertainties inherent in health professional working environments, metacognition emerges as a valuable tool, fostering self-awareness, regulation, and adaptability. Ultimately, metacognition has the capability to shape more adept learners and clinicians, yielding benefits for students, teachers, and patients alike.
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Affiliation(s)
- Rita Bagga
- King's College London, FoDOCS, Guy's Hospital, London, United Kingdom
| | - Anne McKee
- GKT School of Medical Education, London, United Kingdom
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Xuan Nguyen K, Viet Tran T, Duc Nghiem T, Ngoc Tran T, Ba Ta T, Van Nguyen B, Dinh Le T, Tien Nguyen S, Nguyen KT, Trung Dinh H, Pho DC, Nguyen Duy T, Toan PQ. Relationship Between Metacognitive Awareness of Undergraduate Students and Students' Academic Performance at Vietnam Military Medical University. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:791-801. [PMID: 37483526 PMCID: PMC10361283 DOI: 10.2147/amep.s412912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023]
Abstract
Introduction Metacognition plays an essential role in competency-based medical education. Metacognitive skills consist of knowledge and regulation metacognition. This study was conducted to investigate the metacognition of undergraduate students and its correlation with students' academic performance. Methods The metacognitive skills inventory comprised 52 binary-scale items administered to 202 Vietnam Military Medical University medical students. The entire semester and clinical results were used to measure their academic performance. Results Medical students' total metacognitive awareness score was high (median 0.8). The median metacognitive knowledge score was significantly lower than the metacognitive regulation score (0.7 vs 0.8, respectively). The participants with a total metacognition score ≥0.8 had significantly higher academic results (full semester exam results of 7.4 and clinical exam of 7.5). The group of participants in the military, having sports habits and usually searching academic documents in English, had a higher proportion of total metacognitive awareness score ≥0.8 than the group without these above characteristics (with the percentages of 53.3%, 59%, and 64.3%, respectively; p < 0.05). The number of books read by participants with a total metacognitive awareness score ≥ 0.8 was significantly higher than those with a total metacognitive awareness score <0.8 (3.5 compared to 2.4 books). Conclusion Metacognitive awareness of Vietnam Military Medical University medical students was likely to be high. A high score of metacognitive awareness could predict high academic performance. Being a military student, playing sports, reading books, and searching English documents were predictors of better metacognitive awareness.
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Affiliation(s)
- Kien Xuan Nguyen
- Department of Military Medical Command and Organization, Vietnam Military Medical University, Hanoi, 10000, Vietnam
| | - Tien Viet Tran
- Department of Infectious Diseases, Military Hospital 103, Vietnam Military Medical University, Hanoi, 10000, Vietnam
| | - Thuan Duc Nghiem
- Department of Otolaryngology, Military Hospital 103, Vietnam Military Medical University, Hanoi, 10000, Vietnam
| | - Tuan Ngoc Tran
- Department of Military Medical Command and Organization, Vietnam Military Medical University, Hanoi, 10000, Vietnam
| | - Thang Ba Ta
- Respiratory Center, Military Hospital 103, Vietnam Military Medical University, Hanoi, 10000, Vietnam
| | - Ba Van Nguyen
- Department of Oncology, Military Hospital 103, Vietnam Military Medical University, Hanoi, 10000, Vietnam
| | - Tuan Dinh Le
- Department of Rheumatology and Endocrinology, Military Hospital 103, Vietnam Military Medical University, Hanoi, 10000, Vietnam
| | - Son Tien Nguyen
- Department of Rheumatology and Endocrinology, Military Hospital 103, Vietnam Military Medical University, Hanoi, 10000, Vietnam
| | - Kien Trung Nguyen
- Center of Hematology and Blood Transfusion, Military Hospital 103, Vietnam Military Medical University, Hanoi, 10000, Vietnam
| | - Hoa Trung Dinh
- Department of Requested Treatment, National Hospital of Endocrinology, Hanoi, Vietnam
| | - Dinh Cong Pho
- Department of Military Science, Vietnam Military Medical University, Hanoi, 10000, Vietnam
| | - Toan Nguyen Duy
- Cardiovascular Center, Military Hospital 103, Vietnam Medical Military University, Hanoi, 10000, Vietnam
| | - Pham Quoc Toan
- Department of Nephrology, Military Hospital 103, Vietnam Military Medical University, Hanoi, 10000, Vietnam
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Cale AS, Hoffman LA, McNulty MA. Promoting metacognition in an allied health anatomy course. ANATOMICAL SCIENCES EDUCATION 2023; 16:473-485. [PMID: 35951462 DOI: 10.1002/ase.2218] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 05/11/2023]
Abstract
Metacognition, the ability to self-regulate one's learning and performance, has been shown to improve student outcomes. Anatomy is recognized as one of the toughest courses in allied health curricula, and students could benefit from metacognitive activities. The purpose of this study was to explore the changes in metacognition of allied health students in an anatomy course and identify which groups need support with this skill. First-year physician assistant (MPAS), physical therapy (DPT), and occupational therapy (OTD) students (n = 129) were invited to participate. At the beginning and end of the course, students completed a questionnaire including the metacognitive awareness inventory (MAI) that assesses metacognition. Students were also asked to reflect on their examination performances using a modified Likert scale and participated in reflective discussion boards to encourage development of metacognitive skills, which were thematically analyzed. Paired metacognition scores had increased significantly by the end of the course. However, middle-performers anticipated high grades and were less satisfied with their grade, indicating a disconnect in their metacognition compared to high- and low-performers. Students' receptiveness to modifying study strategies to improve performance declined throughout the course; by mid-way through, they relied more on existing strategies. Increasing time constraints were frequently cited as a major factor when considering study strategies and modification of such strategies. To maximize the effectiveness of metacognitive activities, they should be positioned early in the course when students are most receptive. In addition, middle performers may benefit from additional support to improve metacognition.
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Affiliation(s)
- Andrew S Cale
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leslie A Hoffman
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, Fort Wayne, Indiana, USA
| | - Margaret A McNulty
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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von Hoyer J, Bientzle M, Cress U, Grosser J, Kimmerle J. False certainty in the acquisition of anatomical and physiotherapeutic knowledge. BMC MEDICAL EDUCATION 2022; 22:765. [PMID: 36348330 PMCID: PMC9641864 DOI: 10.1186/s12909-022-03820-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Efficient metacognitive monitoring, that is the monitoring of one's own thought processes and specifically one's state of knowledge, is essential for effective clinical reasoning. Knowing what one does and does not know is a competency that students of health professions need to develop. Students often tend to develop false certainty in their own knowledge in the longer course of their education, but the time frame that is required for this effect to occur has remained unclear. We investigated whether students developed false certainty already after one course unit. METHODS This study analysed data from one sample of medical students and four samples of physiotherapy students in two formal educational settings (total N = 255) who took knowledge tests before and after a course unit. We examined changes in students' confidence separately for correctly and incorrectly answered questions and analysed their ability to assign higher levels of confidence to correct answers than to incorrect answers (discrimination ability). RESULTS Students' knowledge as well as confidence in their correct answers in knowledge tests increased after learning. However, consistently for all samples, confidence in incorrect answers increased as well. Students' discrimination ability improved only in two out of the five samples. CONCLUSIONS Our results are in line with recent research on confidence increase of health professions students during education. Extending those findings, our study demonstrated that learning in two different formal educational settings increased confidence not only in correct but also in incorrect answers to knowledge questions already after just one learning session. Our findings highlight the importance of improving metacognition in the education of health professionals-especially their ability to know what they do not know.
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Affiliation(s)
- Johannes von Hoyer
- Knowledge Construction Lab. Leibniz-Institut Für Wissensmedien, Schleichstr. 6, 72076, Tuebingen, Germany.
| | - Martina Bientzle
- Knowledge Construction Lab. Leibniz-Institut Für Wissensmedien, Schleichstr. 6, 72076, Tuebingen, Germany
| | - Ulrike Cress
- Knowledge Construction Lab. Leibniz-Institut Für Wissensmedien, Schleichstr. 6, 72076, Tuebingen, Germany
- Department of Applied Cognitive Psychology and Media Psychology, University of Tuebingen, Schleichstr.4, D-72070 Tuebingen, Germany, Tuebingen, Germany
| | - Johannes Grosser
- Knowledge Construction Lab. Leibniz-Institut Für Wissensmedien, Schleichstr. 6, 72076, Tuebingen, Germany
| | - Joachim Kimmerle
- Knowledge Construction Lab. Leibniz-Institut Für Wissensmedien, Schleichstr. 6, 72076, Tuebingen, Germany
- Department of Applied Cognitive Psychology and Media Psychology, University of Tuebingen, Schleichstr.4, D-72070 Tuebingen, Germany, Tuebingen, Germany
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Bhandari B, Agarwal P, Chopra D, Panwar A, Kaur D, Sidhu TK. Implementation of Self-Directed Learning in Physiology for Phase 1 Undergraduate Medical Students. MEDICAL SCIENCE EDUCATOR 2022; 32:899-906. [PMID: 36035538 PMCID: PMC9411390 DOI: 10.1007/s40670-022-01585-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND One of the primary roles played by Indian medical graduates is that of a lifelong learner. To this end, students must acquire the habit of self-directed learning (SDL). Lack of SDL skills among undergraduate medical students is a concern; hence, this study was designed to introduce SDL in physiology to phase 1 undergraduate medical students and assess its effectiveness through student and faculty perceptions. METHODS The project commenced after obtaining clearance from the institutional ethics committee. The faculty members and students were sensitized on SDL. A feedback questionnaire was framed and the topics for SDL were selected. SDL was implemented for six topics. The effectiveness of the sessions was evaluated by administering the feedback questionnaire to the students and recording perceptions of the students and faculty on SDL. The data were subjected to quantitative and qualitative analysis. RESULTS A total of 96 phase 1 students participated in the study. A majority of the students felt that after SDL sessions, they were more prepared and aware of their learning strengths and had started taking ownership of their learning. However, some students felt that the activity was not useful in improving their analytical skills. Both the students and the faculty were fairly satisfied with this teaching learning innovation. CONCLUSIONS SDL was successfully implemented for phase 1 medical students. Both the students and faculty were satisfied with the SDL strategy. SDL has been shown to make students independent learners who are aware of their learning goals and capable of evaluating their learning.
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Affiliation(s)
- Bharti Bhandari
- Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, 201310 India
| | - Prerna Agarwal
- Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, 201310 India
| | - Deepti Chopra
- Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, 201310 India
| | - Aprajita Panwar
- Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, 201310 India
| | - Daljit Kaur
- All India Institute of Medical Sciences, Rishikesh, Uttrakhand 249203 India
| | - Tanvir K. Sidhu
- Adesh Institute of Medical Sciences & Research, Bathinda, Punjab, 151001 India
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Kyere K, Aremu TO, Ajibola OA. Availability Bias and the COVID-19 Pandemic: A Case Study of Legionella Pneumonia. Cureus 2022; 14:e25846. [PMID: 35832749 PMCID: PMC9273171 DOI: 10.7759/cureus.25846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 11/05/2022] Open
Abstract
Cognitive biases, such as the availability heuristic or availability bias, can inadvertently affect patient outcomes. These biases may be magnified during times of heightened awareness of a particular disease. Failure to identify cognitive biases when managing patients during the coronavirus disease 2019 (COVID-19) pandemic can delay the institution of the right treatment option and result in poor health outcomes. We present a case of delayed diagnosis of Legionella pneumonia due to COVID-19-related availability bias. We discuss some methods to mitigate the effects of this bias and the importance of challenging trainees to recognize these pitfalls in medical training.
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LaRocque JJ, Grossman SN, Kurzweil AM, Lewis A, Zabar S, Balcer L, Galetta SL, Zhang C. Training in Neurology: Objective Structured Clinical Examination Case to Teach and Model Feedback Skills in Neurology Residency. Neurology 2022; 98:684-689. [PMID: 35169006 DOI: 10.1212/wnl.0000000000200223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We describe an educational intervention for neurology residents aimed at developing feedback skills. An objective structured clinical examination case was designed to simulate the provision of feedback to a medical student. After the simulated case session, residents received structured, individualized feedback on their performance and then participated in a group discussion about feedback methods. Survey data were collected from the standardized medical student regarding residents' performance and from residents for assessments of their performance and of the Objective Structured Clinical Examination case. This article aims to describe this educational intervention and to demonstrate the feasibility of this approach for feedback skills development.
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Affiliation(s)
- Joshua J LaRocque
- From the Department of Neurology (J.J.L., S.G., A.M.K., A.L., L.B., S.L.G., C.Z.), New York University Langone Medical Center; Department of Neurology and Department of Neurosurgery (A.L.), New York University Langone Medical Center; Department of Medicine (S.Z.), New York University Langone Medical Center; Department of Ophthalmology (L.B., S.L.G.), Department of Neurology, New York University Langone Medical Center; and Department of Population Health (L.B.), New York University Langone Medical Center, New York, NY
| | - Scott N Grossman
- From the Department of Neurology (J.J.L., S.G., A.M.K., A.L., L.B., S.L.G., C.Z.), New York University Langone Medical Center; Department of Neurology and Department of Neurosurgery (A.L.), New York University Langone Medical Center; Department of Medicine (S.Z.), New York University Langone Medical Center; Department of Ophthalmology (L.B., S.L.G.), Department of Neurology, New York University Langone Medical Center; and Department of Population Health (L.B.), New York University Langone Medical Center, New York, NY
| | - Arielle M Kurzweil
- From the Department of Neurology (J.J.L., S.G., A.M.K., A.L., L.B., S.L.G., C.Z.), New York University Langone Medical Center; Department of Neurology and Department of Neurosurgery (A.L.), New York University Langone Medical Center; Department of Medicine (S.Z.), New York University Langone Medical Center; Department of Ophthalmology (L.B., S.L.G.), Department of Neurology, New York University Langone Medical Center; and Department of Population Health (L.B.), New York University Langone Medical Center, New York, NY
| | - Ariane Lewis
- From the Department of Neurology (J.J.L., S.G., A.M.K., A.L., L.B., S.L.G., C.Z.), New York University Langone Medical Center; Department of Neurology and Department of Neurosurgery (A.L.), New York University Langone Medical Center; Department of Medicine (S.Z.), New York University Langone Medical Center; Department of Ophthalmology (L.B., S.L.G.), Department of Neurology, New York University Langone Medical Center; and Department of Population Health (L.B.), New York University Langone Medical Center, New York, NY
| | - Sondra Zabar
- From the Department of Neurology (J.J.L., S.G., A.M.K., A.L., L.B., S.L.G., C.Z.), New York University Langone Medical Center; Department of Neurology and Department of Neurosurgery (A.L.), New York University Langone Medical Center; Department of Medicine (S.Z.), New York University Langone Medical Center; Department of Ophthalmology (L.B., S.L.G.), Department of Neurology, New York University Langone Medical Center; and Department of Population Health (L.B.), New York University Langone Medical Center, New York, NY
| | - Laura Balcer
- From the Department of Neurology (J.J.L., S.G., A.M.K., A.L., L.B., S.L.G., C.Z.), New York University Langone Medical Center; Department of Neurology and Department of Neurosurgery (A.L.), New York University Langone Medical Center; Department of Medicine (S.Z.), New York University Langone Medical Center; Department of Ophthalmology (L.B., S.L.G.), Department of Neurology, New York University Langone Medical Center; and Department of Population Health (L.B.), New York University Langone Medical Center, New York, NY
| | - Steven L Galetta
- From the Department of Neurology (J.J.L., S.G., A.M.K., A.L., L.B., S.L.G., C.Z.), New York University Langone Medical Center; Department of Neurology and Department of Neurosurgery (A.L.), New York University Langone Medical Center; Department of Medicine (S.Z.), New York University Langone Medical Center; Department of Ophthalmology (L.B., S.L.G.), Department of Neurology, New York University Langone Medical Center; and Department of Population Health (L.B.), New York University Langone Medical Center, New York, NY
| | - Cen Zhang
- From the Department of Neurology (J.J.L., S.G., A.M.K., A.L., L.B., S.L.G., C.Z.), New York University Langone Medical Center; Department of Neurology and Department of Neurosurgery (A.L.), New York University Langone Medical Center; Department of Medicine (S.Z.), New York University Langone Medical Center; Department of Ophthalmology (L.B., S.L.G.), Department of Neurology, New York University Langone Medical Center; and Department of Population Health (L.B.), New York University Langone Medical Center, New York, NY
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Development and Assessment of a Multi-User Virtual Environment Nursing Simulation Program: A Mixed Methods Research Study. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Brondfield S, Blum AM, Lee K, Linn MC, O'Sullivan PS. The Cognitive Load of Inpatient Consults: Development of the Consult Cognitive Load Instrument and Initial Validity Evidence. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1732-1741. [PMID: 34039851 DOI: 10.1097/acm.0000000000004178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Fellows and residents provide inpatient consultations. Though consults vary considerably, measuring the associated cognitive load (CL) is key to guiding faculty on how to optimize learning during consults. However, existing CL instruments, such as the unidimensional Paas scale, cannot separate the 3 components of CL and may miss the nuances of consult CL. Therefore, the authors developed the Consult Cognitive Load (CCL) instrument to measure the 3 CL components during consults. METHOD In 2018-2019, the authors developed the CCL at the University of California, San Francisco, using Wilson's constructive approach to measurement. To generate content and response process validity evidence, the authors consulted the literature and experts to generate construct maps, items, and a scoring rubric and conducted cognitive interviews. They administered the CCL to internal medicine and psychiatry trainees across 5 University of California campuses and used Rasch family and linear regression models to assess internal structure validity and relationships to key predictor variables. They compared the CCL with the Paas scale using Wright maps and used latent correlations to support separating CL into 3 components. RESULTS Analysis revealed appropriate fit statistics, appropriate mean respondent location increases across all levels, threshold banding, and expected relationships with key predictor variables. The CCL provided more coverage of the 3 CL components compared with the Paas scale. Correlations among the 3 CL components were not strong, suggesting that the CCL offers more nuance than a unidimensional measure of CL in the context of consults. CONCLUSIONS This study generated initial validity evidence to support the CCL's use as a measure of consult CL and supports measuring the 3 CL components separately rather than as a single construct in the context of consults. Learners and faculty could compare learner CCL scores with reference scores to promote reflection, metacognition, and coaching.
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Affiliation(s)
- Sam Brondfield
- S. Brondfield is assistant professor, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Alexander Mario Blum
- A.M. Blum is lecturer, Department of Special Education, San Francisco State University, San Francisco, California
| | - Kewchang Lee
- K. Lee is professor, Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Marcia C Linn
- M.C. Linn is professor, Graduate School of Education, University of California, Berkeley, Berkeley, California
| | - Patricia S O'Sullivan
- P.S. O'Sullivan is professor, Departments of Medicine and Surgery, University of California, San Francisco, San Francisco, California
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Dewsnap MA, Arroliga AC, Adair-White BA. The lived experience of medical training and emotional intelligence. Proc (Bayl Univ Med Cent) 2021; 34:744-747. [PMID: 34744303 DOI: 10.1080/08998280.2021.1941582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The shifting health care landscape in the United States has surfaced challenges related to increased accountability, interprofessional health care teams, and changes in federal policy-all of which compel physicians to adopt roles beyond clinician such as clinical investigator, team leader, and manager. To address these challenges, leadership development programs across the continuum of medical education aim to develop critical leadership skills and competencies, such as emotional intelligence. Such skills and competencies are largely taught through didactic approaches (e.g., classroom). These approaches often neglect the context of learning. From medical residency to a hospital or clinic, the contextual lived experience is habitually overlooked as a vehicle for developing emotional intelligence. This article highlights lived experience, such as medical residency, as an approach to develop emotional intelligence. First, we address the need for developing emotional intelligence as a leadership skill as well as the suitability of medical residency for such development. Next, we discuss the background of lived experience and emotional intelligence. Lastly, we identify future directions for leveraging lived experiences of medical residency to develop emotional intelligence.
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Affiliation(s)
- Michael A Dewsnap
- Department of Humanities in Medicine, Texas A&M University College of Medicine, Bryan, Texas
| | - Alejandro C Arroliga
- Department of Medicine, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Bobbie Ann Adair-White
- Department of Health Professions Education, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts
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Developing Eighth-Grade Students’ Computational Thinking with Critical Reflection. SUSTAINABILITY 2021. [DOI: 10.3390/su132011192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As computer science has become a vital power in facilitating the rapid and sustainable development of various fields, equipping everyone with computational thinking (CT) has been recognized as one of the core pillars supporting the sustainable development of individuals and our digital world. However, it remains challenging for secondary school students to assimilate CT. Recently, critical reflection has been proposed as a useful metacognitive strategy for regulating students’ thinking to solve current and future problems. In this study, a quasi-experiment was conducted to investigate the role of critical reflection in advancing eighth-grade students’ CT. The participants were 95 eighth-grade students, comprising an experimental group (n = 49) and a control group (n = 46). The students’ CT was evaluated based on their learning performance in computational concepts, computational practices, and computational perspectives. The results showed that critical reflection, compared with traditional instruction from teachers, could significantly advance eighth-grade students’ CT. Interestingly, the two groups showed significantly different learning performance in computational practices during the learning process. Furthermore, interaction with peers and instructors played an essential role in helping students engage as active agents in critical reflection. The results of this study emphasize the need to develop students’ CT by practicing critical reflection in eighth-grade education.
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Omprakash A, Kumar AP, Kuppusamy M, Sathiyasekaran BWC, Ravinder T, Ramaswamy P. Validation of Metacognitive Awareness Inventory from a Private Medical University in India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:324. [PMID: 34761010 PMCID: PMC8552251 DOI: 10.4103/jehp.jehp_39_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Metacognition is the awareness and the capability to regulate one's own thinking process. Metacognition is critical in medical education for clinical reasoning and management. Hence, the objective of this study is to evaluate the construct validity and reliability of the Metacognitive Awareness Inventory (MAI) among first-year medical and dental students, from a private medical university in India, using confirmatory analysis and internal consistency method. MATERIALS AND METHODS This was a cross-sectional study using convenient sampling. Fifty-two-item MAI was administered to 933 first-year medical and dental students from a private medical university in India. Exploratory factor analysis (EFA), principal component analysis, Cronbach's α, and confirmatory factor analysis with global fit indices were performed. Structural equation modeling (SEM) was performed to evaluate the relationship between the structural path and factors using AMOS version 22. RESULTS During EFA, 12 items with <0.40 factor loadings were trimmed sequentially. The remaining items with respective factors had a good internal consistency of ≥ 0.9. Comparative fit index (0.78), goodness-of-fit index (0.8), adjusted goodness of fit index (0.77), Tucker-Lewis index (0.7), standardized root mean square residual (0.06), and root mean square error of approximation (0.09) values showed that six-factor model fits to satisfactory. Pearson's correlation coefficient was found to be high between factors (>0.80). SEM for each item (observed) and factor (unobserved) illustrated the hypothesized model. CONCLUSION The resultant 40-item model based on MAI designed by Schraw is a valid and reliable tool for assessing the metacognitive awareness of Indian students. Employing a valid and reliable tool in assessing the metacognitive awareness will help the academicians in incorporating appropriate curricular interventions.
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Affiliation(s)
- Abirami Omprakash
- Department of Physiology, Sri Ramachandra Medical College and Research Institute, SRIHER, Chennai, Tamil Nadu, India
| | - Archana Prabu Kumar
- Department of Physiology, Sri Ramachandra Medical College and Research Institute, SRIHER, Chennai, Tamil Nadu, India
- Medical Education Unit, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Maheshkumar Kuppusamy
- Department of Biochemistry and Physiology, Government Yoga and Naturopathy Medical College and Hospital, Chennai, Tamil Nadu, India
| | - B. W. C. Sathiyasekaran
- Department of Community Medicine, Sri Ramachandra Medical College and Research Institute, SRIHER, Chennai, Tamil Nadu, India
| | - Thyagarajan Ravinder
- Department of Microbiology, Government Kilpauk Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Padmavathi Ramaswamy
- Department of Physiology, Sri Ramachandra Medical College and Research Institute, SRIHER, Chennai, Tamil Nadu, India
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Ganapati NE, Mostafavi A. Cultivating Metacognition in Each of Us: Thinking About "Thinking" in Interdisciplinary Disaster Research. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2021; 41:1136-1144. [PMID: 30408208 PMCID: PMC6506402 DOI: 10.1111/risa.13226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Abstract
Although there is an emerging literature on interdisciplinary disaster research (IDR), one of the overlooked aspects relates to our thinking itself: how to actively think about our thinking-metacognition-while embarking on our interdisciplinary journeys. This article argues that metacognition has an instrumental value both for IDR projects and for individual researchers involved in IDR. For IDR projects, metacognition can help: (1)overcome disciplinary barriers in IDR by revealing cognitive abilities and inabilities for each team member through identifying what is hindering or enabling individuals and the group to transcend disciplinary boundaries toward true integration across the disciplines; (2)deal with "wicked" problems that characterize disaster contexts in a more effective and creative manner; (3)oversee team functioning; and (4)monitor and evaluate progress toward meeting project goals and objectives. For individual researchers, metacognition can help them grow intellectually, and understand the fallacies and limitations in their thinking. It can also encourage them to live an authentic and unified life as an individual. The article concludes with guidance on how individual researchers, principal investigators of IDR projects, and institutions such as universities and funding agencies can cultivate metacognition. To our knowledge, this is the first article that introduces metacognition as a tool for enhancing our thinking on IDR.
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Rodriguez N, Kintzer E, List J, Lypson M, Grochowalski JH, Marantz PR, Gonzalez CM. Implicit Bias Recognition and Management: Tailored Instruction for Faculty. J Natl Med Assoc 2021; 113:566-575. [PMID: 34140145 DOI: 10.1016/j.jnma.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implicit bias instruction is becoming more prevalent across the continuum of medical education. Little guidance exists for faculty on recognizing and debriefing about implicit bias during routine clinical encounters. OBJECTIVE To assess the impact and feasibility of single seminars on implicit bias and the approach to its management in clinical settings. METHODS Between September 2016 and November 2017, the authors delivered five departmental/divisional grand rounds across three different academic medical centers in New York, USA. Instruction provided background information on implicit bias, highlighted its relevance to clinical care, and discussed proposed interventions. To evaluate the impact of instruction participants completed a twelve-item retrospective pre-intervention/post-intervention survey. Questions related to comfort and confidence in recognizing and managing implicit bias, debriefing with learners, and role-modeling behaviors. Participants identified strategies for recognizing and managing potentially biased events through free text prompts. Authors qualitatively analyzed participants' identified strategies. RESULTS We received 116 completed surveys from 203 participants (57% response rate). Participants self-reported confidence and comfort increased for all questions. Qualitative analysis resulted in three themes: looking inward, looking outward, and taking action at individual and institutional levels. CONCLUSION After a single session, respondents reported increased confidence and comfort with the topic. They identified strategies relevant to their professional contexts which can inform future skills-based interventions. For healthcare organizations responding to calls for implicit bias training, this approach has great promise. It is feasible and can reach a wide audience through usual grand rounds programming, serving as an effective early step in such training.
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Affiliation(s)
- Natalia Rodriguez
- Perelman School of Medicine, University of Pennsylvania, United States
| | - Emily Kintzer
- Department of Obstetrics and Gynecology, Montefiore Medical Center, United States
| | - Julie List
- Department of Family and Social Medicine, Albert Einstein College of Medicine, United States
| | - Monica Lypson
- F. Edward Hébert School of Medicine, George Washington University School of Medicine and Health Sciences, University of Michigan Medical School, Uniformed Services University of the Health Sciences, United States
| | | | - Paul R Marantz
- Department of Epidemiology & Population Health, Department of Medicine, Albert Einstein College of Medicine, United States
| | - Cristina M Gonzalez
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, United States.
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Bagić AI, Funke ME, Kirsch HE, Tenney JR, Zillgitt AJ, Burgess RC. The 10 Common Evidence-Supported Indications for MEG in Epilepsy Surgery: An Illustrated Compendium. J Clin Neurophysiol 2021; 37:483-497. [PMID: 33165222 DOI: 10.1097/wnp.0000000000000726] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Unfamiliarity with the indications for and benefits of magnetoencephalography (MEG) persists, even in the epilepsy community, and hinders its acceptance to clinical practice, despite the evidence. The wide treatment gap for patients with drug-resistant epilepsy and immense underutilization of epilepsy surgery had similar effects. Thus, educating referring physicians (epileptologists, neurologists, and neurosurgeons) both about the value of epilepsy surgery and about the potential benefits of MEG can achieve synergy and greatly improve the process of selecting surgical candidates. As a practical step toward a comprehensive educational process to benefit potential MEG users, current MEG referrers, and newcomers to MEG, the authors have elected to provide an illustrated guide to 10 everyday situations where MEG can help in the evaluation of people with drug-resistant epilepsy. They are as follows: (1) lacking or imprecise hypothesis regarding a seizure onset; (2) negative MRI with a mesial temporal onset suspected; (3) multiple lesions on MRI; (4) large lesion on MRI; (5) diagnostic or therapeutic reoperation; (6) ambiguous EEG findings suggestive of "bilateral" or "generalized" pattern; (7) intrasylvian onset suspected; (8) interhemispheric onset suspected; (9) insular onset suspected; and (10) negative (i.e., spikeless) EEG. Only their practical implementation and furtherance of personal and collective education will lead to the potentially impactful synergy of the two-MEG and epilepsy surgery. Thus, while fulfilling our mission as physicians, we must not forget that ignoring the wealth of evidence about the vast underutilization of epilepsy surgery - and about the usefulness and value of MEG in selecting surgical candidates - is far from benign neglect.
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Affiliation(s)
- Anto I Bagić
- University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), Department of Neurology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, U.S.A
| | - Michael E Funke
- MEG Center, McGovern Medical School, UT Houston, Houston, Texas, U.S.A
| | - Heidi E Kirsch
- UCSF Biomagnetic Imaging Laboratory, UCSF, San Francisco, California, U.S.A
| | - Jeffrey R Tenney
- MEG Center, Cincinnati Children's Hospital Medical Center , Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Andrew J Zillgitt
- Department of Neurology, Beaumont Health Adult Comprehensive Epilepsy Center, Neurosicence Center, Royal Oak, Michigan, U.S.A.; and
| | - Richard C Burgess
- Magnetoencephalography Laboratory, Cleveland Clinic Epilepsy Center, Cleveland, Ohio, U.S.A
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21
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Ventres WB, Frankel RM. Personalizing the BioPsychoSocial Approach: "Add-Ons" and "Add-Ins" in Generalist Practice. Front Psychiatry 2021; 12:716486. [PMID: 34899410 PMCID: PMC8652412 DOI: 10.3389/fpsyt.2021.716486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Generalist practitioners often find interacting with patients deeply satisfying and joyful; they also experience encounters that are challenging and complex. In both cases, they must be aware of the many issues that affect the processes and outcomes of patient care. Although using the BioPsychoSocial approach is an important, time-tested framework for cultivating one's awareness of patients' presenting concerns, recent developments suggest that additional frames of reference may enhance communication and relationships with patients. In this article, we describe several additions to the BioPsychoSocial approach, considerations we call "add-ons" and "add-ins". We invite generalist practitioners and, indeed, all health care practitioners, to consider how they can improve their ongoing care of patients by personalizing these and other additions in their day-to-day work with patients.
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Affiliation(s)
- William B Ventres
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Richard M Frankel
- Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN, United States
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Leeds FS, Atwa KM, Cook AM, Conway KA, Crawford TN. Teaching heuristics and mnemonics to improve generation of differential diagnoses. MEDICAL EDUCATION ONLINE 2020; 25:1742967. [PMID: 32182197 PMCID: PMC7144285 DOI: 10.1080/10872981.2020.1742967] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/02/2020] [Indexed: 06/02/2023]
Abstract
Background: Differential diagnosis (DDx) is one of the key cognitive skills that medical learners must develop. However, little is known regarding the best methods for teaching DDx skills. As metacognition plays a fundamental role in the diagnostic process, we hypothesized that the teaching of specific heuristics and mnemonics collectively termed metamemory techniques (MMTs) would enhance the capacity of medical students to generate differential diagnoses.Methods: In a 90-min DDx workshop, third-year medical students (N = 114) were asked to generate differentials before and after learning each of four MMTs. Differential sizes were compared using a linear mixed-effect model. Students also completed a post-session questionnaire which included a subjective ranking of the MMTs, as well as Likert-scale and free-text sections for course feedback.Results: One MMT (the Mental CT Scan, an anatomic visualization technique) significantly increased the size of student differentials (+13.3%, p =.0005). However, a marked cumulative increase across all four MMTs was noted (+36.5%, p <.0001). A majority of students ranked the Mental CT Scan the most useful MMT (51.5%). They found the workshop both worthwhile (4.51/5, CI 4.33-4.69) and enjoyable (4.33/5, CI 4.12-4.55), and considered the MMTs they learned useful and practical (4.49/5, CI 4.32-4.67).Conclusion: The MMT-based DDx workshop was effective in enhancing the skill of DDx generation, and was rated very favorably by students.
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Affiliation(s)
- F. Stuart Leeds
- Family Medicine, Wright State University Boonshoft School of Medicine (WSUBSOM), Fairborn, OH, USA
| | - Kareem M. Atwa
- PGY-1 Resident, Bethesda Hospital Family Medicine Residency Program, Cincinnati, OH, USA
| | - Alexander M. Cook
- PGY-1 Resident, University of Chicago Family Medicine Residency Program, Chicago, IL, USA
| | - Katharine A. Conway
- Family Medicine, Wright State University Boonshoft School of Medicine (WSUBSOM), Fairborn, OH, USA
| | - Timothy N. Crawford
- Family Medicine, Wright State University Boonshoft School of Medicine (WSUBSOM), Fairborn, OH, USA
- Population and Public Health Sciences, Wright State University Boonshoft School of Medicine (WSUBSOM), Fairborn, OH, USA
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Hill M, Peters M, Salvaggio M, Vinnedge J, Darden A. Implementation and evaluation of a self-directed learning activity for first-year medical students. MEDICAL EDUCATION ONLINE 2020; 25:1717780. [PMID: 32009583 PMCID: PMC7034512 DOI: 10.1080/10872981.2020.1717780] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background: It is critical that medical students develop self-directed, life-long learning skills to navigate medical school successfully and to become competent healthcare professionals. Moreover, the Liaison Committee on Medical Education (LCME), the USA medical school accrediting body, requires activities designed to help students develop self-directed learning (SDL) skills in the preclinical years.Objective: We evaluated the feasibility and effectiveness of a self-directed learning activity in a 6-week first-year medical student course.Design: The course director assigned infectious disease case studies to teams of first-year medical students who individually assessed their knowledge gaps of the case, identified scholarly sources to fill their knowledge gaps, shared the information with their teammates, and reflected on their ability to guide their own learning. Students were asked to rate workload, team effort, acquisition of new clinical knowledge, and life-long learning skills. Students were also asked to reflect on how this assignment affected their perception of their SDL skills. Descriptive statistics were used to analyze responses to the Likert scale questions. Thematic analysis was applied to the comments.Results: Survey response rate was 80% (131/163). Students strongly or moderately agreed that 1) they spent an appropriate amount of time on the project (94%), 2) the workload was evenly distributed among their teammates (95%), 3) their teammates made significant and timely contributions to the project (97%), 4) the project contributed to learning new clinical knowledge (92%), and 5) the project contributed to the acquisition of life-long learning skills (85%). The analysis team identified four themes from student reflections on their perception of their self-directed learning skills: self-learning skills, collaboration, application, and meta-cognition,Conclusions: Study results demonstrated that we successfully implemented a case-based SDL activity in a first-year medical school course and that students perceived the activity as a valuable learning experience.
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Affiliation(s)
- Molly Hill
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- CONTACT Molly Hill Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Megan Peters
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michelle Salvaggio
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jay Vinnedge
- St. Anthony Hospital Family Medicine Residency Program, PGY1, Family Medicine, St. Anthony’s Hospital, Oklahoma City, OK, USA
| | - Alix Darden
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Margolius SW, Papp KK, Altose MD, Wilson-Delfosse AL. Students perceive skills learned in pre-clerkship PBL valuable in core clinical rotations. MEDICAL TEACHER 2020; 42:902-908. [PMID: 32799598 DOI: 10.1080/0142159x.2020.1762031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose: Problem-based learning (PBL) is an instructional method widely used by medical educators that promotes an environment in which students effectively learn the foundational knowledge and skills that are prerequisites for graduation. This study evaluated medical students' perceptions of the helpfulness of skills acquired in PBL to core clerkship rotations.Methods: A 25-item survey was designed to assess students' perceptions of skills learned in PBL that were helpful on core clerkships and transferable to the clinical setting. A random sample of students with at least 8 months of clerkship experience were invited to complete the survey.Results: Of 68 students, 35 (52%) returned questionnaires. Results suggest a clustering of themes based on their perceived value. Skills learned in PBL that students rated most highly as helpful or very helpful during core clinical rotations include: comfort discussing concepts, identifying key information, presentation skills, interpersonal skills, diagnostic thinking, finding information, self-awareness, and organizing information. Other items rated highly included: forming questions, time management, primary literature (engaging with published original research articles), and leadership. The skills acquired in PBL were associated with multiple competency domains.Conclusions: Although conditions of the pre-clerkship curriculum are substantially different from the learning environment of clerkship rotations, skills learned in PBL are perceived as applicable to authentic clinical training.
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Affiliation(s)
- S W Margolius
- Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - K K Papp
- Department of General Medical Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - M D Altose
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA Ohio
| | - A L Wilson-Delfosse
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Hinz L, Sigal RJ, Paolucci EO, McLaughlin K. Factors Influencing Inpatient Insulin Management of Adults With Type 1 and Type 2 Diabetes by Residents and Medical Students. Can J Diabetes 2020; 45:167-173.e1. [PMID: 33039327 DOI: 10.1016/j.jcjd.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The day-to-day management of diabetes is often the responsibility of resident physicians in teaching hospitals, yet studies have consistently shown that learners lack confidence and knowledge of inpatient insulin titration. We sought to elucidate factors that influence inpatient management of diabetes by medical learners. We predicted that there would be conscious and unconscious variables at play, and we sought to determine the process by which learners arrived at insulin titration decisions. METHODS We administered a survey using a hypothetical case based on script concordance testing in 88 medical students and residents at the University of Calgary. We used multilevel, mixed-effects linear regression and random-effects meta-analysis to compare clerks' and residents' insulin prescribing, confidence in prescribing decisions and concordance with endocrinologists. RESULTS Residents had higher confidence than clerks, yet were less concordant with the insulin decisions of staff endocrinologists. Both residents and clerks prescribed more insulin when the reported blood glucose was higher, or the patient had positive ketones and prescribed less insulin when the patient had hypoglycemic unawareness. Residents prescribed a higher dose of insulin when the charge nurse reported the result compared with a student nurse, but this variable did not significantly impact prescribing by clerks. CONCLUSIONS We propose a model in which learner factors (knowledge, confidence, experience), patient variables and perceived expectations influence insulin titration decisions via analytical and heuristic processes. We propose that educational interventions designed to improve inpatient glycemic control must, therefore, address both knowledge and systems factors.
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Affiliation(s)
- Laura Hinz
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Ronald J Sigal
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Kevin McLaughlin
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Leach R, Crichton S, Morton N, Leach M, Ostermann M. Fluid management knowledge in hospital physicians: 'Greenshoots' of improvement but still a cause for concern. Clin Med (Lond) 2020; 20:e26-e31. [PMID: 32414738 DOI: 10.7861/clinmed.2019-0433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fluid management is an essential competency for hospital doctors, but previous studies suggest junior clinicians lack the necessary 'knowledge' and 'prescription skills' to complete this task, resulting in preventable morbidity and mortality. In this study, preregistration (n=146), core (n=66) and specialty (n=133) medical trainees and general medical consultants (n=11) completed a structured questionnaire exploring fluid management training, confidence, serious adverse event experience and a 20-item fluid management 'knowledge' test. Results were compared with those of intensive care consultants (n=20). Most clinicians reported limited training and extensive 'unreported' serious adverse events experience. Knowledge about fluid and electrolyte requirements, fluid composition and chloride toxicity had improved compared to historical reports but overall test scores (median (interquartile range (IQR)): with a maximum score of 20) were low. Foundation year trainees scored 7 (IQR 5-8), core medical trainees scored 9 (IQR 6-10), specialist registrars scored 8 (IQR 6-10) and general medical consultants scored 8 (IQR 6-12) compared with the intensive care consultant score of 16 (IQR 14-16). Although weakly correlated, fluid management 'confidence' appeared higher than 'knowledge' tests would justify. These results suggest that physicians' fluid management knowledge is inadequate, including that of senior colleagues, compounded by poor training and failure to learn from serious adverse events.
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Affiliation(s)
- Richard Leach
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Neil Morton
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Marc Leach
- Keele School of Medicine, Stoke-on-Trent, UK
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Stalnikowicz R, Brezis M. Meaningful shared decision-making: complex process demanding cognitive and emotional skills. J Eval Clin Pract 2020; 26:431-438. [PMID: 31989727 DOI: 10.1111/jep.13349] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 12/14/2019] [Accepted: 12/16/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Shared decision-making (SDM) takes place when clinicians help patient identify best course of action in the context of their preferences. METHODS The aim of this paper is a narrative review of the literature with special focus on the humanistic dimensions of SDM. RESULTS We show that SDM is largely underused in practice, because of many barriers such as time constraints and poor skills. CONCLUSIONS We suggest that listening and empathy are key challenges in communicating uncertainty, which require emotional intelligence and trust building skills. To promote implementation, we propose the development of tools, simulation-based training and the design of improved measures for SDM quality. While essential for patients, we believe that SDM may restore meaning in healthcare.
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Affiliation(s)
- Ruth Stalnikowicz
- Department of Emergency Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mayer Brezis
- Hadassah-Hebrew University Medical Center & Israel Center for Medical Simulation (MSR), Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Ali S, Yasmeen R. Practice to preach self-regulation: Use of metacognitive strategies by medical teachers in their learning practices. Pak J Med Sci 2019; 35:1642-1646. [PMID: 31777508 PMCID: PMC6861495 DOI: 10.12669/pjms.35.6.550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To explore use of metacognitive skills by medical teachers in relation to Zimmerman’s model of self-regulation. Methods: A qualitative phenomenological study was conducted at Riphah International University from February 2017 to August 2017. A semi structured interview of ten medical teachers was planned to uncover the lived experiences of selected teachers to demonstrate how these teachers use metacognitive strategies in different phases of learning. Data was collected by asking five open ended questions after expert validation. Data was analyzed by using N-Vivo software. Results: Total eight themes were extracted. For prediction and planning three themes, brainstorming, making concept map and sufficient time required were isolated while teachers selected learning objectives and level of students for resource selection while for motivation theme selected was previous experience. Two themes, self- questioning to improve the learning and extra effort required to meet the timeline were isolated for monitoring and reflection during and after learning for evaluation of learning process. Conclusion: During forethought phase, medical teachers predict their learning process through learning objectives and plan after brainstorming to make a concept map and use suitable learning resources. During learning, they monitor learning process through self-questioning and put extra-effort to meet the deadlines. During and after learning, teachers reflect on their performance.
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Affiliation(s)
- Shabana Ali
- Dr. Shabana Ali, M Phil (Anatomy), MHPE. Associate Professor of Anatomy, Riphah International University, Rawalpindi, Pakistan
| | - Raheela Yasmeen
- Dr. Raheela Yasmeen, MHPE. Professor of Medical Education, Riphah International University, Rawalpindi, Pakistan
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Vu TR, Ferris AH, Sweet ML, Angus SV, Ismail NJ, Stewart E, Appelbaum JS, Kwan B. The New Internal Medicine Subinternship Curriculum Guide: a Report from the Alliance for Academic Internal Medicine. J Gen Intern Med 2019; 34:1342-1347. [PMID: 30937669 PMCID: PMC6614304 DOI: 10.1007/s11606-019-04957-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The internal medicine (IM) subinternship has been a long-established clinical experience in the final phase of medical school deemed by key stakeholders as a crucial rotation to prepare senior medical students for internship. Medical education has changed greatly since the first national curriculum for this course was developed in 2002 by the Clerkship Directors in Internal Medicine (CDIM). Most notably, competency-based medical education (CBME) has become a fixture in graduate medical education and has gradually expanded into medical school curricula. Still, residency program directors and empirical studies have identified gaps and inconsistencies in knowledge and skills among new interns. Recognizing these gaps, the Association of Program Directors in Internal Medicine (APDIM) surveyed its members in 2010 and identified four core skills essential for intern readiness. The Association of American Medical Colleges (AAMC) also published 13 core entrustable professional activities (EPAs) for entering residency to be expected of all medical school graduates. Results from the APDIM survey along with the widespread adoption of CBME informed this redesign of the IM subinternship curriculum. The authors provide an overview of this new guide developed by the Alliance for Academic Internal Medicine (AAIM) Medical Student-to-Resident Interface Committee (MSRIC).
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Affiliation(s)
- T Robert Vu
- Indiana University School of Medicine, 1120 West Michigan St., Gatch Hall CL630, Indianapolis, IN, USA.
| | - Allison H Ferris
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Steven V Angus
- University of Connecticut School of Medicine, Farmington, CT, USA
| | | | - Emily Stewart
- Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Brian Kwan
- University of California, San Diego, School of Medicine, San Diego, CA, USA
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Malone E. Challenges & Issues: Evidence-Based Clinical Skills Teaching and Learning: What Do We Really Know? JOURNAL OF VETERINARY MEDICAL EDUCATION 2019; 46:379-398. [PMID: 31145646 DOI: 10.3138/jvme.0717-094r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The recent programmatic focus on skills development in veterinary medicine means that many programs are devoting increased time to formal clinical skills teaching. This expansion makes it essential that we use the time as effectively as possible. This review examines current practices and veterinary training principles using the broader field of evidence-based motor skills learning as a lens. In many areas, current practices may be hindering learning. Proposed practices include using videos and discussions for pre-laboratory training, focusing on a single complex skill at a time, using more near-peer instructors rather than faculty, including assessments in each teaching or practice session, and encouraging supervised distributed practice by incorporating practice sessions into the formal curriculum. Ensuring mastery of a few core skills rather than exposure to many may be the new goal. Further research is urgently needed on block versus spiral curricula, optimum instructor-to-student ratios, learning and practice schedules, hours required for proficiency, and the benefits of exercise on motor skills learning.
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Auseon AJ. Early Career Habits of Master Clinicians: Can Publication Lead to Democratization? ( Commentary). J Grad Med Educ 2018; 10:507-508. [PMID: 30377480 PMCID: PMC6194881 DOI: 10.4300/jgme-d-18-00640.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
AIM Recently, a growing awareness has developed of the extraordinary complexity of factors that influence the clinical reasoning underpinning the diagnostic process. The aim of the present report is to delineate these factors and suggest strategies for dealing more effectively with this complexity. METHOD Six major clusters of factors are described here: (A) individual characteristics of the decision maker, (B) individual intellectual and cognitive styles, (C) ambient and homeostatic factors, (D) factors in the work environment including team factors, (E) characteristics of the medical condition, and (F) factors associated with the patient. Additional factors, such as health care systems, culture, politics, and others are also important. RESULTS A review of the literature suggests that most clinicians trained under existing methods achieve a level of expertise presently referred to as "routine" or "classic." The results of studies of diagnostic failure, however, suggest that this level of expertise has proved insufficient. A growing literature suggests that more effective clinical decision might be achieved through adaptive reasoning, leading to enhanced levels of expertise and mastery. CONCLUSIONS It is proposed here that adaptive expertise may be achieved through emphasizing additional features of the reasoning process: being aware of the inhibitors and facilitators of rationality; pursuing the standards of critical thinking; developing a comprehensive awareness of cognitive and affective biases and how to mitigate them; developing a similar depth and understanding of logic and its fallacies; engaging metacognitive processes such as reflection and mindfulness; and through approaches embracing creativity, lateral thinking, and innovation.
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Affiliation(s)
- Pat Croskerry
- a Continuing Professional Development and Department of Emergency Medicine, Faculty of Medicine , Dalhousie University , Halifax , Canada
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Cho KK, Marjadi B, Langendyk V, Hu W. Medical student changes in self-regulated learning during the transition to the clinical environment. BMC MEDICAL EDUCATION 2017; 17:59. [PMID: 28327147 PMCID: PMC5361773 DOI: 10.1186/s12909-017-0902-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 03/14/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND Self-regulated learning (SRL), which is learners' ability to proactively select and use different strategies to reach learning goals, is associated with academic and clinical success and life-long learning. SRL does not develop automatically in the clinical environment and its development during the preclinical to clinical learning transition has not been quantitatively studied. Our study aims to fill this gap by measuring SRL in medical students during the transitional period and examining its contributing factors. METHODS Medical students were invited to complete a questionnaire at the commencement of their first clinical year (T0), and 10 weeks later (T1). The questionnaire included the Motivated Strategies for Learning Questionnaire (MSLQ) and asked about previous clinical experience. Information about the student's background, demographic characteristics and first clinical rotation were also gathered. RESULTS Of 118 students invited to participate, complete paired responses were obtained from 72 medical students (response rate 61%). At T1, extrinsic goal orientation increased and was associated with gender (males were more likely to increase extrinsic goal orientation) and type of first attachment (critical care and community based attachments, compared to hospital ward based attachments). Metacognitive self-regulation decreased at T1 and was negatively associated with previous clinical experience. CONCLUSIONS Measurable changes in self-regulated learning occur during the transition from preclinical learning to clinical immersion, particularly in the domains of extrinsic goal orientation and metacognitive self-regulation. Self-determination theory offers possible explanations for this finding which have practical implications and point the way to future research. In addition, interventions to promote metacognition before the clinical immersion may assist in preserving SRL during the transition and thus promote life-long learning skills in preparation for real-world practice.
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Affiliation(s)
- Kenneth K Cho
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Brahm Marjadi
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Vicki Langendyk
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
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