Assessing confidence and competence of senior medical students in an obstetrics and gynaecology clerkship using an OSCE

A Scoping Review of Pharmacogenomic Educational Interventions to Improve Knowledge and Confidence

OBJECTIVES

Poor knowledge and confidence in pharmacogenomics are key barriers to implementation. Education of future health care professionals is required to enhance appropriate use of pharmacogenomics; however, the optimal education approach is unclear. This systematic scoping review evaluates pharmacogenomic educational interventions to improve knowledge and confidence.

FINDINGS

A total of 24 studies were included. Most (90%) studies delivered pharmacogenomic education to pharmacy students and consisted of didactic lectures and workshops with case studies. To supplement case studies, self or class aggregated (52%, 12 of 23), mock (43%, 10 of 23) or faculty member provided (4%, 1 of 23) pharmacogenomic data were used in the case scenarios. All studies used quantitative methods, including student assessments and scaled surveys to assess the impact of the educational intervention on knowledge and/or confidence in pharmacogenomics. On average, the educational interventions improved knowledge acquisition by 21%, confidence in pharmacogenomic data interpretation by 37%, confidence in communication of pharmacogenomic information to patients by 41% and to health care professionals by 44%. Improvement in communication with other health care professionals was greater in students involved in interprofessional learning compared to self-pharmacogenomic testing.

SUMMARY

The measures used to determine the effect of educational interventions on student knowledge and confidence varied. Innovative pedagogy, specifically interactive case-based learning and simulation such as interprofessional learning, enhances the knowledge and confidence of students in pharmacogenomics. Course-embedded self-pharmacogenomic testing may offer a supplementary, interactive component to case-based learning by using real-life reports as the foundation of knowledge and confidence acquisition.

Evaluation of an OSCE's implementation and a two-step approach for a theoretical and practical training program in Obstetrics and Gynecology

Objective structured clinical examination (OSCE) is a well-known assessment method to evaluate clinical skills and competence in healthcare. Following the recently reformed National Competence-Based Catalog of Learning Objectives in Medicine, the implementation of this assessment method in the training program for medical students is now obligatory in Germany. This major change requires a reorganization not only of the training programs but also of the students themselves and the way they learn. We performed a poll evaluating the students' opinions regarding these major changes and the implementation of the OSCE with a new training program. To implement this assessment method and to evaluate the OSCE, Kern's six-step approach comprising (1) problem identification and general needs assessment, (2) needs assessment of the targeted learners, (3) goals and objectives, (4) educational strategies, (5) implementation, and (6) evaluation and feedback was applied. To evaluate and gather feedback, a poll was used to analyze the student's opinions regarding OSCE in gynecology and obstetrics and OSCE in general, in addition to the regular analysis of the students' results. To reform the educational strategy, a two-step approach was developed: First, the students completed the regular training program and a written examination, and second, they participated in a 1-week clerkship, in small group teaching, and in the OSCE. The OSCE stations were developed primarily based on the National Competence-Based Catalog and the German Catalog of Learning Objectives in Medicine, as well as on the feedback of experts reflecting their expectations for physicians beginning their careers. The students performed well in the OSCE and gave positive feedback regarding this examination method. Furthermore, they welcomed the upcoming changes by considering OSCE a valuable assessment tool, and they showed appreciation for the two-step approach by supporting the combination of an OSCE and a written examination. Thus, this article presents the implementation of an OSCE and a strategy for the adaptation of the curriculum to fulfill the new OSCE requirements and-to our knowledge-reveals students' primary opinions regarding the changes in their medical training program for the first time.

The performance and confidence of clinicians in training in the analysis of ophthalmic images within a work-integrated teaching model

PURPOSE

A fundamental clinical skill is the recognition of artefacts within the outputs of advanced imaging modalities. However, current teaching programmes of healthcare practitioners are becoming increasingly challenged to provide practical exposure within an already crowded curriculum. This study evaluates the impact of a novel work-integrated teaching model on the confidence and competence of clinicians in the use of optical coherence tomography (OCT) and the recognition of its artefacts. The outcomes were then used to develop a model to predict performance and guide teaching strategies.

METHODS

We prospectively evaluated a 6-week clinical placement for final year optometry students within a diagnostic eye clinic in 2018-2020. Participants completed a quiz on the identification of common OCT artefacts and rated their confidence levels on key areas of OCT application using a five-point Likert scale. Both were completed before (pre-rotation) and after (post-rotation) the placement. The cohort was divided into two groups; the first group was used to assess the impact of the placement and derive the prediction model for post-placement performance, which was then validated against the second group.

RESULTS

A significant improvement in detecting OCT imaging artefacts was seen upon completion of the placement, which was greater in participants with lower entry level performance. Across all OCT artefact subtypes, there was an improvement in detecting segmentation error, delineation error and media opacities. A model predicting post-placement student performance was developed using entry level knowledge base as the key dependent variable. Self-rated confidence improved across all domains of OCT application but was not found to be a direct predictor of actual performance.

CONCLUSIONS

These results highlight the benefit of a work-integrated learning programme on both academic performance and confidence whilst identifying entry level knowledge base as the key variable predicting improvement. Tailored teaching incorporating entering knowledge is the best predictor of improvement during clinical placements. Integrating clinicians into a work-integrated setting with tailored teaching and comprehensive practical exposure can be an effective method for training future or current healthcare professionals.

Can an interactive case-based activity help bridge the theory-practice gap in operative dentistry?

INTRODUCTION

A theory-practice gap in pre-doctoral dental education is a common source of stress for dental students. An interactive, small-group, case-based activity was designed to bridge the gap between pre-clinical and clinical experiences. The aim of our study was to assess the effectiveness of the case-based activity by evaluating students' comfort level in operative procedures.

MATERIALS AND METHODS

Over 5 years, a total of 172 second-year students from the classes of 2017 through 2021 participated in the case-based activity delivered after the completion of the core operative dentistry course. The exercise included a pre-activity online quiz, an in-class case-based session and a laboratory exercise. Students' self-reported comfort levels in performing operative procedures were collected by surveys at three different times. They included the post-course survey distributed after the completion of the core operative dentistry course, the post-activity survey distributed after the completion of the case-based activity, and the follow-up survey distributed after students completed their first operative procedures in clinic.

RESULTS

There was a 93% response rate. The average rating of all eight statements revealed statistically significant increase in students' comfort level after completing the case-based activity and after performing their first operative procedures in the teaching practice.

CONCLUSION

This observation suggests that the case-based activity was effective in raising students' comfort levels. The activity may serve as an important tool in bridging the theory-practice gap between pre-clinical and clinical operative experiences.

Medical student confidence in care of the dying and their family: a systematic review

BACKGROUND

The General Medical Council expects medical graduates to care for dying patients with skill, clinical judgement and compassion. UK surveys continually demonstrate low confidence and increasing distress amongst junior doctors when providing care to the dying.

AIM

This systematic review aims to determine what has been evidenced within worldwide literature regarding medical undergraduate confidence to care for dying patients.

DESIGN

A systematic electronic search was undertaken. Data extraction included measurements of baseline confidence, associated assessment tools and details of applied educational interventions. Pre/postintervention confidence comparisons were made. Factors influencing confidence levels were explored.

DATA SOURCES

MEDLINE, CINAHL, EMBASE, ISI Web of Science, ERIC, PsycINFO, British Education Index and Cochrane Review databases were accessed, with no restrictions on publication year. Eligible studies included the terms 'medical student', 'confidence' and 'dying', alongside appropriate MeSH headings. Study quality was assessed using the Mixed Methods Appraisal Tool.

RESULTS

Fifteen eligible studies were included, demonstrating a diversity of assessment tools. Student confidence was low in provision of symptom management, family support, and psycho-spiritual support to dying patients. Eight interventional studies demonstrated increased postinterventional confidence. Lack of undergraduate exposure to dying patients and lack of structure within undergraduate palliative care curricula were cited as factors responsible for low confidence.

CONCLUSION

This review clarifies the objective documentation of medical undergraduate confidence to care for the dying. Identifying where teaching fails to prepare graduates for realities in clinical practice will help inform future undergraduate palliative care curriculum planning.

PROSPERO REGISTRATION NUMBER

CRD42019119057.

The confidence of undergraduate dental students in Saudi Arabia in performing endodontic treatment

Objective:

This study examined the endodontic experience, perceptions of endodontic practice, and self-rated confidence of dental students enrolled in Taibah University, Saudi Arabia.

Materials and Methods:

A questionnaire was distributed to 41 undergraduate dental students registered in endodontic courses in the 2015 academic year. The questionnaire evaluated their confidence performing nonsurgical root canal treatment. The level of confidence was classified using a 5-point scale as “very confident,” “confident,” “neutral,” “not very confident,” or “not at all confident.” The data were analyzed using SPSS version 20.0 (SPSS, Chicago, IL, USA).

Results:

The participation rate was 93%. The maxillary incisor was the most common first tooth treated. The students were relatively confident, but their confidence levels were lower regarding endodontic radiology, evaluation of root canal obturation, and determining the correct recall period for the patient.

Conclusion:

The confidence of undergraduates in endodontics must be enhanced to increase their clinical competence when performing root canal treatment.

Subjective awareness of ultrasound expertise development: individual experience as a determinant of overconfidence

Medical decision-making requires years of experience in order to develop an adequate level of competence to successfully engage in safe practice. While diagnostic and technical skills are essential, an awareness of the extent and limits of our own knowledge and skills is critical. The present study examines clinicians' subjective awareness in a diagnostic cardiac ultrasound task. Clinicians answered diagnostic and treatment related questions for a range of pathologies. Following these questions, clinicians indicated their level of confidence in their response. A comparison of response accuracy and confidence revealed that clinicians were generally overconfident in their responses. Critically, we observed that a clinician's overconfidence was negatively correlated with prior experience: clinicians that had more prior experience expressed less overconfidence in their performance such that some clinicians were in fact underconfident. We discuss the implications for training in medical education and decision-making.

Development and psychometric evaluation of scales to measure professional confidence in manual medicine: a Rasch measurement approach

Background

Health professionals in athletic training, chiropractic, osteopathy, and physiotherapy fields, require high-level knowledge and skills in their assessment and management of patients. This is important when communicating with patients and applying a range of manual procedures. Prior to embarking on professional practice, it is imperative to acquire optimal situation-specific levels of self-confidence for a beginner practitioner in these areas. In order to foster this professional self-confidence within the higher education context, it is necessary to have valid and reliable scales that can measure and track levels and how they change. This study reports on the development and psychometric analysis of two new scales, Patient Communication Confidence Scale (PCCS) and the Clinical Skills Confidence Scale (CSCS), to measure confidence in these two areas for students in manual medicine programs. The Rasch measurement model was used to guide the development of the scales and establish their psychometric properties.

Methods

The responses to 269 returned questionnaires over two occasions were submitted to psychometric analysis, with various aspects of the scales examined including: item thresholds; item fit; Differential Item Functioning; targeting; item locations; item dependencies; and reliability. To provide further evidence of validity, scores were correlated with two existing valid scales.

Results

Analyses showed that the scales provided valid and reliable measures of confidence for this sample of persons. High Person Separation Indices (0.96 for PCCS; 0.93 for SCSC) provided statistical evidence of reliability, meaning the scales are able to discriminate amongst persons with different levels of confidence. For the PCCS, item categories were operating as required, and for the CSCS only two items’ thresholds were slightly disordered. Three tests of fit revealed good fit to the model (indicating the internal consistency of both scales) and results of the correlations with two existing valid scales were consistent with expectations.

Conclusions

The importance of confidence cannot be overlooked in health education because students learning new information and skills, and dealing with challenging situations can be negatively impacted by a lack of confidence which can result in students disengaging from placements or leaving a program. Valid and reliable instruments are essential in tracking change in levels of confidence in specific skills over time and the examination of the degree of congruence between confidence and competence. Analysis of responses to the two confidence scales established that they are valid and reliable instruments.

The relationship between confidence and competence in the development of surgical skills

BACKGROUND

Confidence is a crucial trait of any physician, but its development and relationship to proficiency are still unknown. This study aimed to evaluate the relationship between confidence and competency of medical students undergoing basic surgical skills training.

METHODS

Medical students completed confidence surveys before and after participating in an introductory workshop across 2 samples. Performance was assessed via video recordings and compared with pretraining and posttraining confidence levels.

RESULTS

Overall, 150 students completed the workshop over 2 years and were evaluated for competency. Most students (88%) reported improved confidence after training. Younger medical students exhibited lower pretraining confidence scores but were just as likely to achieve competence after training. There was no association between pretraining confidence and competence, but confidence was associated with demonstrated competence after training (p < 0.001).

CONCLUSIONS

Most students reported improved confidence after a surgical skills workshop. Confidence was associated with competency only after training. Future training should investigate this relationship on nonnovice samples and identify training methods that can capitalize on these findings.

Assessment for simulation learning outcomes: a comparison of knowledge and self-reported confidence with observed clinical performance

BACKGROUND

With extensive use of simulation in nursing education, researchers around the world are evaluating learning outcomes from simulation. Numerous studies reported the use of knowledge tests and self-reported measures to evaluate simulation outcomes.

AIM

To determine whether self-reported confidence and knowledge measures are indicators of clinical performance observed in a simulation-based assessment.

METHOD

Thirty-one third year nursing students were randomized into intervention and control group. The intervention group received a six hour simulation-based programme in care of a patient with physiological deterioration. Pre and post-tests using knowledge test, confidence scale and simulation-based assessment were conducted immediately before and after the simulation program.

RESULTS

The intervention group had a significantly higher post-test mean score than the control group for knowledge and clinical performances. Both groups demonstrated a significant improvement on post-test scores from pre-test scores for self-confidence with no significant differences detected among the two groups. Correlation tests indicated no significant correlation between self-confidence and clinical performance, and between knowledge and clinical performance.

CONCLUSION

The study did not provide evidence to support the validity of the knowledge test and self-confidence measures for predicting clinical performance. Most importantly, it revealed potential danger of a simulation-based assessment that could lead toward overestimation of self-confidence.

Student self-assessment of essential skills in dental surgery

OBJECTIVE

To assess whether student self-assessments of essential skills in dental surgery are reliable indicators of the strengths and weaknesses of the clinical aspects of the dental school curriculum. This was done as part of an ongoing evaluation of the curriculum of the Faculty of Dental Sciences of the University of Peradeniya in Sri Lanka.

DESIGN

Cross-sectional surveys of 5 different classes of students using a pre-tested questionnaire.

SETTING

The Faculty of Dental Sciences of the University of Peradeniya, Sri Lanka, which is the only dental school in the island.

MATERIALS & METHODS

A questionnaire was developed specifically for the purpose of eliciting student self-confidence in 46 essential skills on a three point scale. It was administered to 5 different classes of students, immediately or soon after their respective Final BDS examinations. The 5 classes had followed similar curricular formats. The surveys were conducted on a voluntary and anonymous basis.

RESULTS

Results show a remarkable consistency in the self-ratings done by the five different classes of students who followed the same curriculum during five different time periods. Students were least confident in the skills related to the management of medical emergencies and of oral manifestations of systemic diseases while they were most confident in skills related to the care of periodontal disease and caries.

CONCLUSION

Student self-assessments of skills is a useful tool for evaluating the clinical training provided in the dental school curriculum. Students were most confident in managing problems that they most frequently encountered in the dental school. The areas in which they were least confident require curricular reform.