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Khawar A, Frederiks F, Nasori M, Mak M, Visser M, van Etten-Jamaludin F, Diemers A, Van Dijk N. What are the characteristics of excellent physicians and residents in the clinical workplace? A systematic review. BMJ Open 2022; 12:e065333. [PMID: 36127103 PMCID: PMC9490566 DOI: 10.1136/bmjopen-2022-065333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In order to recognise and facilitate the development of excellent medical doctors (physicians and residents), it is important to first identify the characteristics of excellence. Failure to recognising excellence causes loss of talent, loss of role models and it lowers work ethos. This causes less than excellent patient care and lack of commitment to improve the healthcare system. DESIGN Systematic review performed according to the Association for Medical Education in Europe guideline. INFORMATION SOURCES We searched Medline, Embase, Psycinfo, ERIC and CINAHL until 14 March 2022. ELIGIBILITY CRITERIA We included original studies describing characteristics of excellent medical doctors, using a broad approach as to what is considered excellence. Assuming that excellence will be viewed differently depending on the interplay, and that different perspectives (peers, supervisors and patients) will add to a complete picture of the excellent medical doctor, we did not limit this review to a specific perspective. DATA EXTRACTION AND SYNTHESIS Data extraction and quality assessment were performed independently by two researchers. We used the Quality Assessment Tool for Different Designs for quality assessment. RESULTS Eleven articles were eligible and described the characteristics from different perspectives: (1) physicians on physicians, (2) physicians on residents, (3) patients on physicians and (4) mixed group (diverse sample of participants on physicians). The included studies showed a wide range of characteristics, which could be grouped into competencies (communication, professionalism and knowledge), motivation (directed to learning and to patient care) and personality (flexibility, empathy). CONCLUSIONS In order to define excellence of medical doctors three clusters seem important: competence, motivation and personality. This is in line with Renzulli's model of gifted behaviour. Our work adds to this model by specifying the content of these clusters, and as such provides a basis for definition and recognition of medical excellence.
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Affiliation(s)
- Abdullah Khawar
- Department of General Practice, Amsterdam UMC, Locatie AMC, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine and Quality of Care, Amsterdam, the Netherlands
| | - Femke Frederiks
- Department of General Practice, Amsterdam UMC, Locatie AMC, Amsterdam, the Netherlands
| | - Mana Nasori
- Department of General Practice, Amsterdam UMC, Locatie AMC, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine and Quality of Care, Amsterdam, the Netherlands
| | - Marianne Mak
- Department of General Practice, Amsterdam UMC, Locatie AMC, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine and Methodology, Amsterdam, the Netherlands
| | - Mechteld Visser
- Department of General Practice, Amsterdam UMC, Locatie AMC, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine and Quality of Care, Amsterdam, the Netherlands
| | | | - Agnes Diemers
- Faculty of Medical Sciences, Lifelong learning, Education & Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, Netherlands
| | - Nynke Van Dijk
- Department of General Practice, Amsterdam UMC, Locatie AMC, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine and Quality of Care, Amsterdam, the Netherlands
- Amsterdam University of Applied Sciences, Faculty of Health and Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam, Netherlands
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Timmerman A, Oerlemans M, van der Vleuten C, Pawlikowska T, Ram P, Muris J. Exploring typologies of consultation performance using authentic clinical experiences to support learning and assessment in postgraduate medical training. PATIENT EDUCATION AND COUNSELING 2022; 105:2276-2284. [PMID: 34810057 DOI: 10.1016/j.pec.2021.10.035] [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: 02/27/2020] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To validate and refine typologies of consultation performance from previous research to identify learning needs associated with each typology. METHODS We performed a qualitative study in a General Practice Specialty Training programme, using a two-stage design. First, we selected four exemplars from 80 videotaped consultations of 7 first-year and 6 third-year trainees that reflected the four typologies. We subsequently held individual interviews with clinical supervisors (N = 20) who observed these consultations to identify recurrent trainee behaviours. RESULTS The 'doctor-patient interaction' dimension from previous research was specified to encompass relationship-building, exploring, structuring, and shared decision-making competencies. Medical expertise was a moderating factor. The attitude and consultation behaviours included in the typologies were validated and we formulated directions for learning based on learning needs identified per typology. CONCLUSION Supervisors have a shared frame of reference for the behaviours reflecting proficient consultation performance. Serving as a developmental road map, all learning needs emphasised contextual adaptation, calling for an improved balance between patient-centred relationship building and application of medical expertise. PRACTICE IMPLICATIONS By providing rich and tailored feedback on consultation performance, the refined typologies - albeit subject to additional refinement in future research - may promote the monitoring of individual competence development over time.
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Affiliation(s)
- Angelique Timmerman
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands.
| | - Marjolein Oerlemans
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Cees van der Vleuten
- Maastricht University, Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Teresa Pawlikowska
- RCSI University of Medicine and Health Sciences, Health Professions Education Centre, Dublin, Ireland
| | - Paul Ram
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Jean Muris
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
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Brierley DJ, Farthing PM, Zijlstra-Shaw S. Delphi study to determine the key qualities consultant histopathologists look for in their trainees. J Clin Pathol 2020; 73:642-647. [PMID: 32276994 DOI: 10.1136/jclinpath-2019-206345] [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: 11/21/2019] [Revised: 01/28/2020] [Accepted: 02/01/2020] [Indexed: 11/03/2022]
Abstract
AIMS A Delphi study to triangulate and determine the relative importance of the key qualities of trainees identified from qualitative interviews that sought to understand how consultant histopathologists determine diagnostic competences in trainees. METHODS Twelve participants were purposively chosen for the Delphi to form an expert panel of relevant stakeholders. Participants were asked to score and rank the items presented to them. RESULTS A total of 22 out of 27 of the key qualities of trainees (items) reached 'consensus in' after round 2 suggesting participants were able to agree that the majority of the items identified in the qualitative interviews were important to diagnostic competence. Five items reached 'no consensus'. Participants did not suggest any additional items. Participants particularly valued qualities of reflection and professionalism and trainees who understood the process of reaching a diagnosis and how their pathological report could impact on patient care. CONCLUSIONS This study has triangulated findings from our qualitative interviews and show that consultants value a wide variety of qualities when determining diagnostic competence in their trainees. The judgement is complex and is therefore best assessed longitudinally and on a number of cases, so consultants can look for consistency of both approach to diagnosis and of trainee behaviour.
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Affiliation(s)
- Daniel J Brierley
- Unit of Oral and Maxillofacial Pathology, University of Sheffield, Sheffield, UK
| | | | - Sandra Zijlstra-Shaw
- Unit of Oral and Maxillofacial Pathology, University of Sheffield School of Clinical Dentistry, Sheffield, UK
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Jackson D, Davison I, Adams R, Edordu A, Picton A. A systematic review of supervisory relationships in general practitioner training. MEDICAL EDUCATION 2019; 53:874-885. [PMID: 31074063 DOI: 10.1111/medu.13897] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/22/2019] [Accepted: 03/20/2019] [Indexed: 05/14/2023]
Abstract
OBJECTIVES The educational alliance is argued to be at the heart of supervision in medical education. This review aims to map the research field and develop a conceptualisation of the nature of such educational alliances within postgraduate supervision for general practitioners. METHODS An integrative review of the international literature on supervision from 2011 to 2018 was undertaken, and papers assessed for relevance and quality. Data analysis incorporated framework analysis techniques. Bordin's working alliance-based model of supervision was used as a springboard for synthesis, as well as allowing for the emergence of new ideas, theories and concepts from the literature. RESULTS A total of 49 full texts were included for analysis. There was evidence of the importance of trust, agreement and bond in accordance with Bordin's model. The results also highlighted the importance of greater clarity on supervisory goals, and the tasks to support these goals, to effectively address competing priorities and roles within supervision. Non-hierarchical relationships were advocated, although supervisors must remain impartial in their assessment and monitoring roles. The influence of the wider practice community and situated learning through legitimate peripheral participation are documented. A model of General practice (GP) supervision is proposed that integrates the findings. CONCLUSIONS GP supervision requires a greater emphasis than is suggested by the working alliance model, both on the clarity of expectations and the appreciation of the multiple roles and competing priorities of both trainee and supervisor. Furthermore, as GP supervision develops within the rising workload of contemporary general practice, the role of the wider community of practice may become more prominent. We have adapted the working alliance model for postgraduate General practice (GP) supervision, emphasising the explicit sharing of expectations relating to goals, tasks and roles to facilitate negotiation and agreement.
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Affiliation(s)
- Dawn Jackson
- Medical School, University of Birmingham, Birmingham, UK
| | - Ian Davison
- School of Education, University of Birmingham, Birmingham, UK
| | - Rachel Adams
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Adaeze Edordu
- Primary Care and Health Sciences, University of Keele, Keele, UK
| | - Aled Picton
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Schmelter V, März E, Adolf C, Wölfel TL, Lottspeich C, Fischer MR, Schmidmaier R. Ward rounds in internal medicine: Validation of an Entrustable Professional Activity (EPA) observation checklist. GMS JOURNAL FOR MEDICAL EDUCATION 2018; 35:Doc17. [PMID: 29963607 PMCID: PMC6022584 DOI: 10.3205/zma001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/08/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
Objectives: Ward rounds serve a crucial daily activity in hospitals. Building on the Entrustable Professional Activity "Conducting internal medicine ward rounds" consisting of ten competencies and 25 corresponding activities, this study aims at assessing content and external validity of an observation checklist for this EPA. Methods: A focus group aimed at content validation of the checklist. Five participants therefore evaluated it with respect to comprehensiveness and comprehensibility. To investigate external validity, 14 authentic ward rounds were video-taped and rated by two raters with the adapted observation checklist in terms of the appearance of certain activities in the videos. Results: After some adaptions, participants of the focus group agreed on a checklist consisting of nine competencies, 25 activities and 110 examples of observable behaviours supporting content validity. External validity was studied by using the observation checklist for ratings of ward round videos. The checklist was regarded as a valuable tool to structure observation. Along with the high frequencies of observed behaviour and interrater-reliability, external validity can be assumed. Conclusion: The first scientifically developed comprehensive observation checklist for the EPA conducting a ward round in internal medicine is presented. The checklist is a valuable tool for providing elaborated feedback in undergraduate and graduate medical education. Focussing on multi-institutional validation and the cut offs of the checklist to determine the levels of entrustment are recommended for future research.
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Affiliation(s)
- Valerie Schmelter
- Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Germany
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, München, Germany
| | - Esther März
- Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Germany
| | - Christian Adolf
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, München, Germany
| | - Teresa L. Wölfel
- Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Germany
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, München, Germany
| | - Christian Lottspeich
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, München, Germany
| | - Martin R. Fischer
- Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Germany
| | - Ralf Schmidmaier
- Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Germany
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, München, Germany
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Abstract
This study examined the presence of grade inflation in clinical courses 9 years after implementing strategies to improve grading precision. A comparison of clinical grades for cohort I (1997-2002) with cohort II (2009-2016) showed statistically lower grades in 2 courses (Adult 1 and Maternity) for cohort II. Suggestions for changing the way clinical experiences are planned, executed, and evaluated are provided.
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Heeneman S, Driessen EW. The use of a portfolio in postgraduate medical education - reflect, assess and account, one for each or all in one? GMS JOURNAL FOR MEDICAL EDUCATION 2017; 34:Doc57. [PMID: 29226225 PMCID: PMC5704619 DOI: 10.3205/zma001134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/07/2017] [Accepted: 03/20/2017] [Indexed: 05/26/2023]
Abstract
Competency-based education has become central to the training and assessment of post-graduate medical trainees or residents [1]. In competency-based education, there is a strong focus on outcomes and professional performance. Typically, holistic tasks are used to train, practice and assess the defined outcomes or competencies. In residency training, these tasks are part of the day-to-day clinical practice. The performance of residents in the workplace needs to be captured and stored. A portfolio has been used as an instrument for storage and collection of workplace-based assessment and feedback in various countries, like the Netherlands and the United States. The collection of information in a portfolio can serve or be used for a variety of purposes. These are: The collection of work samples, assessment, feedback and evaluations in a portfolio enables the learner to look back, analyze and reflect. The content is used for assessment or making decisions about progress. And the portfolio is used as an instrument for quality assurance processes. In post-graduate medical education, these purposes can be combined but this is not always reported transparently. In this paper, we will discuss the different perspectives, how a portfolio can serve these three purposes and what are opportunities and challenges of combining multiple purposes.
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Affiliation(s)
- Sylvia Heeneman
- Maastricht University/MUMC, Department of Pathology, HX Maastricht, The Netherlands
- Maastricht University, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Erik W. Driessen
- Maastricht University, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
- Maastricht University/MUMC, Department of Educational Development and Research, HX Maastricht, The Netherlands
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