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Kopelson K, de Peralta S, Pike NA. The 1-minute preceptor to improve diagnostic reasoning in a primary care nurse practitioner residency program. J Am Assoc Nurse Pract 2024:01741002-990000000-00226. [PMID: 38832876 DOI: 10.1097/jxx.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/22/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND The One-Minute Preceptor (OMP) model to teach diagnostic reasoning and Reporter, Interpreter, Manager, and Educator (RIME) framework to measure progress are used in physician training. Little is known about the use of these tools in nurse practitioner (NP) training. LOCAL PROBLEM Precepting NP trainees at the Veterans Affairs (VA) is not standardized. A standardized approach to precepting NP residency trainees using the OMP model and RIME scoring was evaluated for improvement and helpfulness. METHODS A quality-improvement project with two Plan-Do-Study-Act (PDSA) cycles were conducted over a 12-week period. Mean RIME scores, preceptor self-efficacy, and use of teaching skills were measured preintervention and postintervention. Data were analyzed using a paired sample t-test and descriptive statistics. INTERVENTIONS A convenience sample of preceptors and trainees was recruited from a large VA medical center. A 1-hour workshop educated preceptors with role playing and return demonstrations on OMP techniques and RIME scoring. The teachings were applied to standardize precepting and assess diagnostic reasoning. Trainee self-scoring and results triggered conversations to fulfil the identified gaps. RESULTS Mean RIME scores improved (1.62 [0.17] vs. 2.23 [0.38], p < .001) post 12-week intervention. Mean RIME scores improved between PDSA cycle 1 and cycle 2 (2.07 [0.25] vs. 2.48 [0.39], p < .001). Preceptors (91%) and trainees (100%) found the OMP model and RIME framework helpful. CONCLUSION Use of the OMP improved diagnostic reasoning in NP trainees. The OMP and RIME framework provided standardization of precepting and trainee discussions on improvements.
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Affiliation(s)
- Kristin Kopelson
- Department of Medicine, Veteran's Administration, Greater Los Angeles, CA
- School of Nursing, University of California, Los Angeles, CA
| | - Shelly de Peralta
- Department of Medicine, Veteran's Administration, Greater Los Angeles, CA
- School of Nursing, University of California, Los Angeles, CA
| | - Nancy A Pike
- School of Nursing, University of California, Los Angeles, CA
- Children's Hospital Los Angeles, CA
- Sue & Bill Gross School of Nursing, University of California, Irvine
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Durning SJ, Jung E, Kim DH, Lee YM. Teaching clinical reasoning: principles from the literature to help improve instruction from the classroom to the bedside. KOREAN JOURNAL OF MEDICAL EDUCATION 2024; 36:145-155. [PMID: 38835308 DOI: 10.3946/kjme.2024.292] [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: 03/18/2024] [Accepted: 04/30/2024] [Indexed: 06/06/2024]
Abstract
Clinical reasoning has been characterized as being an essential aspect of being a physician. Despite this, clinical reasoning has a variety of definitions and medical error, which is often attributed to clinical reasoning, has been reported to be a leading cause of death in the United States and abroad. Further, instructors struggle with teaching this essential ability which often does not play a significant role in the curriculum. In this article, we begin with defining clinical reasoning and then discuss four principles from the literature as well as a variety of techniques for teaching these principles to help ground an instructors' understanding in clinical reasoning. We also tackle contemporary challenges in teaching clinical reasoning such as the integration of artificial intelligence and strategies to help with transitions in instruction (e.g., from the classroom to the clinic or from medical school to residency/registrar training) and suggest next steps for research and innovation in clinical reasoning.
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Affiliation(s)
- Steven J Durning
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, MD, USA
| | - Eulho Jung
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, MD, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Do-Hwan Kim
- Department of Medical Education, Hanyang University College of Medicine, Seoul, Korea
| | - Young-Mee Lee
- Department of Medical Education, Korea University College of Medicine, Seoul, Korea
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Schenarts PJ, Scarborough AJ, Abraham RJ, Philip G. Teaching Before, During, and After a Surgical Resuscitation. Surg Clin North Am 2024; 104:451-471. [PMID: 38453313 DOI: 10.1016/j.suc.2023.10.004] [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] [Indexed: 03/09/2024]
Abstract
Teaching during a surgical resuscitation can be difficult due to the infrequency of these events. Furthermore, when these events do occur, the trainee can experience cognitive overload and an overwhelming amount of stress, thereby impairing the learning process. The emergent nature of these scenarios can make it difficult for the surgical educator to adequately teach. Repeated exposure through simulation, role play, and "war games" are great adjuncts to teaching and preparation before crisis. However, surgical educators can further enhance the knowledge of their trainees during these scenarios by using tactics such as talking out loud, targeted teaching, and debriefing.
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Affiliation(s)
- Paul J Schenarts
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA.
| | - Alec J Scarborough
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
| | - Ren J Abraham
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
| | - George Philip
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
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Steinhilber SS, Snyder ED, Estrada CA, Kraemer RR. Implementation of a Problem-Based Presentation Format to Improve Residents' Ambulatory Patient Presentations. J Grad Med Educ 2023; 15:373-377. [PMID: 37363683 PMCID: PMC10286930 DOI: 10.4300/jgme-d-22-00690.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 02/19/2023] [Accepted: 04/17/2023] [Indexed: 06/28/2023] Open
Abstract
Background The format for residents to present hospitalized patients to teaching faculty is well defined; however, guidance for presenting in clinic is not uniform. Objective We report the development, implementation, and evaluation of a new standardized format for presenting in clinic: the Problem-Based Presentation (PBP). Methods After a needs assessment, we implemented the format at the teaching clinics of our internal medicine residency program. We surveyed participants on innovation outcomes, feasibility, and acceptability (pre-post design; 2019-2020; 5-point scale). Residents' primary outcomes were confidence in presentation content and presentation order, presentation efficiency, and presentation organization. Faculty were asked about the primary outcomes of resident presentation efficiency, presentation organization, and satisfaction with resident presentations. Results Participants were 111 residents and 22 faculty (pre-intervention) and 110 residents and 20 faculty (post-intervention). Residents' confidence in knowing what the attending physician wants to hear in an outpatient presentation, confidence in what order to present the information, and how organized they felt when presenting in clinic improved (all P<.001; absolute increase of the top 2 ratings of 25%, 28%, and 31%, respectively). Residents' perceived education in their outpatient clinic also improved (P=.002; absolute increase of the top 2 ratings of 19%). Faculty were more satisfied with the structured presentations (P=.008; absolute increase of the top 2 ratings of 27%). Conclusions Implementation of a new format for presenting in clinic was associated with increased resident confidence in presentation content, order of items, overall organization, and a perceived increase in the frequency of teaching points reviewed by attending physicians.
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Affiliation(s)
- Starr S. Steinhilber
- Starr S. Steinhilber, MD, MPH, is Associate Professor of Medicine, Division of General Internal Medicine, and Associate Program Director, Tinsley Harrison Internal Medicine Residency, University of Alabama at Birmingham Heersink School of Medicine
| | - Erin D. Snyder
- Erin D. Snyder, MD, is Professor of Medicine, Division of General Internal Medicine, and Assistant Program Director, Tinsley Harrison Internal Medicine Residency, University of Alabama at Birmingham Heersink School of Medicine
| | - Carlos A. Estrada
- Carlos A. Estrada, MD, MS, is Professor of Medicine, Division of General Internal Medicine, University of Alabama at Birmingham Heersink School of Medicine, and Section Chief, General Internal Medicine, Birmingham VA Medical Center
| | - Ryan R. Kraemer
- Ryan R. Kraemer, MD, is Associate Professor of Medicine, Division of General Internal Medicine, and Director, Tinsley Harrison Internal Medicine Residency, University of Alabama at Birmingham Heersink School of Medicine
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Sharma R, Badyal DK, Sharma R, Seth S, Singh M. Implementation of One-Minute Preceptor for Clinical Teaching in Obstetrics and Gynaecology. J Obstet Gynaecol India 2023; 73:69-76. [PMID: 36879933 PMCID: PMC9984615 DOI: 10.1007/s13224-022-01718-8] [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: 02/08/2022] [Accepted: 10/05/2022] [Indexed: 03/06/2023] Open
Abstract
Background In absence of a dedicated teaching curriculum for non-PG residents in Obstetrics and Gynecology department, a concise teaching learning method, One-Minute Preceptor (OMP) with feedback being its core component may be introduced to translate their theoretical knowledge into clinical practice. Methods This descriptive cross-sectional study included four faculty members and 20 residents. Each resident was exposed to three OMP sessions pertaining to common gynecological case scenarios with a gap of at least two days in between the sessions with faculties acting as preceptor and as observer. After three OMP sessions, feedback from residents and faculty regarding their teaching and learning experience after implementing this tool was obtained through separate pre-validated questionnaires graded on Likert's scale. Results The satisfaction index of the residents and faculties for OMP was found to be 96.3% and 95%, respectively. All residents and faculty members had consensus that OMP addressed the learning gaps (mean score 4.45 ± 0.51 and mean score 4.5 ± 0.57, respectively) and expressed being highly satisfied with OMP in busy clinical settings as compared to traditional method of teaching with mean score of 4.9 ± 0.30 and 4.75 ± 0.5, respectively. The faculties had consensuses that OMP can assess all domains of learning (mean score 4.75 ± 0.5). All residents and faculties opined that the time allotted to address all micro-skills was less and 60% residents advocated allotting at least 5 min time to the teaching encounter. Conclusion Our study indicates the beneficial role of OMP in time-constraint clinical environment and warrants further research to review the time frame keeping in view the learners' needs and the discipline.
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Affiliation(s)
- Ritu Sharma
- Department of Obstetrics & Gynecology, Government Institute of Medical Sciences, Greater Noida, UP 201310 India
| | - Dinesh K. Badyal
- Department of Pharmacology& Medical Education, Christian Medial College, Ludhiana, 141008 India
| | - Rakhee Sharma
- Department of Obstetrics & Gynecology, Government Institute of Medical Sciences, Greater Noida, UP 201310 India
| | - Shikha Seth
- Department of Obstetrics & Gynecology, Government Institute of Medical Sciences, Greater Noida, UP 201310 India
| | - Monika Singh
- Department of Obstetrics & Gynecology, Government Institute of Medical Sciences, Greater Noida, UP 201310 India
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Logan AA, Rao M, Evans G. Twelve tips for teaching and supervising post-graduate trainees in clinic. MEDICAL TEACHER 2022; 44:720-724. [PMID: 33872095 DOI: 10.1080/0142159x.2021.1912307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
By providing quality teaching and supervision, medical educators can contribute to productive and fulfilling outpatient experiences for postgraduate trainees (sometimes called residents, registrars, or GP trainees). The recent literature addressing practical steps to improve outpatient teaching is limited. Here we present specific trainee-centric behaviors, techniques, and language that educators can employ to enhance their teaching in the outpatient clinic, in the form of twelve tips. The first two tips pertain to navigating the patient-trainee-supervisor dynamic in the exam room, the next four address listening to an oral presentation, and the last six are tips on being an effective teacher and coach.
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Affiliation(s)
- Alexander A Logan
- Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Mayuree Rao
- Department of Medicine, VA Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - Ginger Evans
- Department of Medicine, VA Puget Sound Health Care System, University of Washington, Seattle, WA, USA
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Kahn MJ, Estrada CA, Willett LL, Kraemer RR. Creating Clinician Educators: Evaluation of a One-Month Medical Education Curriculum for Senior Residents. Am J Med Sci 2021; 362:606-611. [PMID: 34161826 DOI: 10.1016/j.amjms.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/10/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clinician-educator tracks improve teaching behaviors in trainees. However, detailed curriculum descriptions to fully understand, compare, and reproduce them are often lacking. We aimed to describe and evaluate a medical education curriculum for senior residents. METHODS Based on Kolb's experiential learning model, we designed a one-month curriculum to increase teaching effectiveness. PGY 2-4 internal medicine and medicine-pediatrics residents in a university-based training program participated in the course from 2015-2019. In a pre-post design, participants completed a survey to evaluate the curriculum. Survey items related to four constructs in medical education: knowledge, confidence, skills, and importance (5-point Likert scale; 1=low, 5=high). We assessed the difference in the means for each construct before and after the curriculum. RESULTS Thirty-nine residents completed the curriculum (19% of total residents), and 100% of participants completed the surveys. We observed an increase in the mean self-rated level of teaching knowledge (2.63 [SD 0.57] vs. 4.43 [SD 0.42], p<0.005), confidence (3.31 [SD 0.4] vs. 4.29 [SD 0.32], p<0.005), and skills (2.9 [SD 0.63] vs. 4.14 [SD 0.38], p<0.005) after completing the course. Residents consistently graded individual curricular components highly. CONCLUSIONS We describe a one-month medical education curriculum with a strong foundation in learning theory. The curriculum is feasible and presented in sufficient detail to allow reproduction. Our findings suggest that it increases participants' self-perceptions of teaching knowledge, confidence, and skills.
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Affiliation(s)
- Mauricio J Kahn
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Carlos A Estrada
- Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Section of General Internal Medicine, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Lisa L Willett
- Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ryan R Kraemer
- Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Section of General Internal Medicine, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.
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Watsjold B, Zhong D. Clinical Coaching Cards: A Game of Active Learning Theory and Teaching Techniques. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11042. [PMID: 33274297 PMCID: PMC7703484 DOI: 10.15766/mep_2374-8265.11042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/23/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Clinical Coaching Cards is a serious game for faculty development in which players take turns as Teacher and Coach to apply teaching techniques on game cards to identify new approaches to teaching in the clinical environment. The game employs active learning theory and coaching frameworks. METHODS Based on a literature search and local faculty practices, we identified 14 techniques for clinical teaching and created a deck of cards summarizing each. We adapted rules from social judgment games so that participants proposed and selected techniques for applicability to their own teaching. The game was presented as a subsession of larger faculty development workshops hosted by the University of Washington, and players included faculty, residents, and medical students. Evaluations focused on the applicability of techniques to participants' clinical practice and preferred new techniques. RESULTS Seventy-four players provided evaluations out of over 150 participants across six workshops. Participants rated the session as mostly or very organized in 70 of 74 evaluations (95%), the introductory material as mostly or very relevant in 67 evaluations (91%), and the teaching techniques as most or several being useful in 69 evaluations (93%). Although some techniques were more popular than others, every technique was selected as a Top 3 technique for future practice. DISCUSSION Clinical Coaching Cards is a card game that applies active learning within a framework of peer coaching to teach bedside and clinical teaching techniques.
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Affiliation(s)
- Bjorn Watsjold
- Acting Assistant Professor, Department of Emergency Medicine, University of Washington School of Medicine
| | - Diana Zhong
- Fellow, Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine
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Freed JA, Hale AJ, Rangachari D, Ricotta DN. Twelve tips for teaching oncology to non-oncologists. MEDICAL TEACHER 2020; 42:987-992. [PMID: 31663798 DOI: 10.1080/0142159x.2019.1682534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Teaching subspecialty care to trainees who are not pursuing that subspecialty poses many challenges. These challenges are amplified in the teaching of oncology to non-oncologists because there are more new therapies emerging in oncology than in any other discipline, and there are few oncologic issues managed by generalists without consultation. Concurrently, there is an increasing need for generalists to manage many aspects of care for patients with cancer.Aim: To provide 12 tips for oncologists to use to educate trainees on their oncology rotations.Method: The tips provided are based upon the available literature and the authors' own experience.Results: The 12 tips presented offer specific strategies for oncologists to enhance their teaching by selection of appropriate content and enhancing delivery. Focus is placed on aspects of oncology that trainees are likely to encounter as a generalist or non-cancer subspecialist. While oncology is used as the case study, these strategies are adaptable to any subspecialty area.Conclusion: Oncologists and other subspecialists can be core medical educators.
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Affiliation(s)
- Jason A Freed
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Andrew J Hale
- Division of Infectious Disease, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Deepa Rangachari
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daniel N Ricotta
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Natesan S, Bailitz J, King A, Krzyzaniak SM, Kennedy SK, Kim AJ, Byyny R, Gottlieb M. Clinical Teaching: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors. West J Emerg Med 2020; 21:985-998. [PMID: 32726274 PMCID: PMC7390547 DOI: 10.5811/westjem.2020.4.46060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/30/2020] [Accepted: 04/09/2020] [Indexed: 01/28/2023] Open
Abstract
Clinical teaching is the primary educational tool use to train learners from day one of medical school all the way to the completion of fellowship. However, concerns over time constraints and patient census have led to a decline in bedside teaching. This paper provides a critical review of the literature on clinical teaching with a focus on instructor teaching strategies, clinical teaching models, and suggestions for incorporating technology. Recommendations for instructor-related teaching factors include adequate preparation, awareness of effective teacher attributes, using evidence-based-knowledge dissemination strategies, ensuring good communication, and consideration of environmental factors. Proposed recommendations for potential teaching strategies include the Socratic method, the One-Minute Preceptor model, SNAPPS, ED STAT, teaching scripts, and bedside presentation rounds. Additionally, this article will suggest approaches to incorporating technology into clinical teaching, including just-in-time training, simulation, and telemedical teaching. This paper provides readers with strategies and techniques for improving clinical teaching effectiveness.
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Affiliation(s)
- Sreeja Natesan
- Duke University, Division of Emergency Medicine, Durham, North Carolina
| | - John Bailitz
- Northwestern University, Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Andrew King
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Sara M. Krzyzaniak
- University of Illinois College of Medicine at Peoria/OSF Healthcare, Department of Emergency Medicine, Peoria, Illinois
| | - Sarah K. Kennedy
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Albert J. Kim
- Washington University in Saint Louis School of Medicine, Department of Emergency Medicine, St. Louis, Missouri
| | - Richard Byyny
- Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado
| | - Michael Gottlieb
- Rush Medical Center, Department of Emergency medicine, Chicago, Illinois
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11
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Gatewood E, De Gagne JC, Kuo AC, O’Sullivan P. The One-Minute Preceptor: Evaluation of a Clinical Teaching Tool Training for Nurse Practitioner Preceptors. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Pierce C, Corral J, Aagaard E, Harnke B, Irby DM, Stickrath C. A BEME realist synthesis review of the effectiveness of teaching strategies used in the clinical setting on the development of clinical skills among health professionals: BEME Guide No. 61. MEDICAL TEACHER 2020; 42:604-615. [PMID: 31961206 DOI: 10.1080/0142159x.2019.1708294] [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: 06/10/2023]
Abstract
Background: Literature describing the effectiveness of teaching strategies in the clinical setting is limited. This realist synthesis review focuses on understanding the effectiveness of teaching strategies used in the clinical setting.Methods: We searched ten databases for English language publications between 1 January 1970 and 31 May 2017 reporting effective teaching strategies, used in a clinical setting, of non-procedural skills. After screening, we used consensus to determine inclusion and employed a standardised instrument to capture study populations, methodology, and outcomes. We summarised what strategies worked, for whom, and in what settings.Results: The initial search netted 53,642 references after de-duplication; 2037 were retained after title and abstract review. Full text review was done on 82 references, with ultimate inclusion of 25 publications. Three specific teaching strategies demonstrated impact on educational outcomes: the One Minute Preceptor (OMP), SNAPPS, and concept mapping. Most of the literature involves physician trainees in an ambulatory environment. All three have been shown to improve skills in the domains of medical knowledge and clinical reasoning.Discussion/conclusions: Apart from the OMP, SNAPPS, and concept mapping, which target the formation of clinical knowledge and reasoning skills, the literature establishing effective teaching strategies in the clinical setting is sparse.
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Affiliation(s)
- Cason Pierce
- Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
| | - Janet Corral
- Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
| | - Eva Aagaard
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado Anschutz, Aurora, CO, USA
| | - David M Irby
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Chad Stickrath
- Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
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13
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Richards JB, Hayes MM, Schwartzstein RM. Teaching Clinical Reasoning and Critical Thinking: From Cognitive Theory to Practical Application. Chest 2020; 158:1617-1628. [PMID: 32450242 DOI: 10.1016/j.chest.2020.05.525] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022] Open
Abstract
Teaching clinical reasoning is challenging, particularly in the time-pressured and complicated environment of the ICU. Clinical reasoning is a complex process in which one identifies and prioritizes pertinent clinical data to develop a hypothesis and a plan to confirm or refute that hypothesis. Clinical reasoning is related to and dependent on critical thinking skills, which are defined as one's capacity to engage in higher cognitive skills such as analysis, synthesis, and self-reflection. This article reviews how an understanding of the cognitive psychological principles that contribute to effective clinical reasoning has led to strategies for teaching clinical reasoning in the ICU. With familiarity with System 1 and System 2 thinking, which represent intuitive vs analytical cognitive processing pathways, respectively, the clinical teacher can use this framework to identify cognitive patterns in clinical reasoning. In addition, the article describes how internal and external factors in the clinical environment can affect students' and trainees' clinical reasoning abilities, as well as their capacity to understand and incorporate strategies for effective critical thinking into their practice. Utilizing applicable cognitive psychological theory, the relevant literature on teaching clinical reasoning is reviewed, and specific strategies to effectively teach clinical reasoning and critical thinking in the ICU and other clinical settings are provided. Definitions, operational descriptions, and justifications for a variety of teaching interventions are discussed, including the "one-minute preceptor" model, the use of concept or mechanism maps, and cognitive de-biasing strategies.
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Affiliation(s)
- Jeremy B Richards
- Center for Education, Shapiro Institute for Education and Research, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Margaret M Hayes
- Center for Education, Shapiro Institute for Education and Research, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Richard M Schwartzstein
- Center for Education, Shapiro Institute for Education and Research, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
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14
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Development and Implementation of a Novel Learner-driven Precepting Model for Pulmonary Fellowship. ATS Sch 2020; 1:161-169. [PMID: 33870280 PMCID: PMC8043292 DOI: 10.34197/ats-scholar.2019-0011in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Ambulatory education is currently underemphasized in pulmonary and critical care medicine (PCCM) fellowship training. Existing clinic precepting models, originally developed for students and residents, do not meet the unique needs of fellow-level trainees. Objective: We aimed to develop and implement a novel fellow-led precepting model to improve ambulatory education for PCCM trainees. Methods: We performed a mixed-methods needs assessment, including surveys, focus groups, and direct observations, to explore perceptions of ambulatory training, define current precepting practices, and identify target areas for improvement. On the basis of these findings, we developed, implemented, and evaluated a novel model for PCCM outpatient precepting. Results: A targeted needs assessment identified that current precepting practices did not meet fellows’ needs for graduated autonomy, development of assessment and management skills, and self-directed learning. We developed and implemented a novel, learner-driven precepting model (Set the Stage, Tell the Story, Educational Goals, Preliminary Plan, Uncertainties, Plan Recap [STEP-UP]), designed to prioritize clinical reasoning skills and self-identification of learning goals. Implementation of the STEP-UP model improved perceptions of overall outpatient training and precepting. However, we faced several barriers to uptake of the new model, including increased cognitive burden of integrating a new process. Conclusion: A robust assessment of ambulatory education at a single PCCM fellowship program identified a need to align precepting processes with the unique goals of advanced trainees. We developed a learner-driven precepting model focused on development of clinical reasoning skills and self-directed educational objectives. Additional study is warranted to refine, adapt, and test the model in different setting.
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15
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Petri CR, Anandaiah A, Schwartzstein RM, Hayes MM. Enhancing teaching and learning in the ICU. CLINICAL TEACHER 2019; 17:464-470. [PMID: 31869526 DOI: 10.1111/tct.13126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Camille R Petri
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Asha Anandaiah
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard M Schwartzstein
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Carl J Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret M Hayes
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Carl J Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Lyons K, McLaughlin JE, Wolcott MD, Grandy R, Williams CR. How Pharmacist Preceptors Foster Students' Therapeutic Reasoning Using the One-Minute Preceptor Method. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:7212. [PMID: 31831901 PMCID: PMC6900809 DOI: 10.5688/ajpe7212] [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: 06/14/2018] [Accepted: 03/24/2019] [Indexed: 06/10/2023]
Abstract
Objective. To compare whether preceptors trained in the One-Minute Preceptor (OMP) method versus preceptors not trained in the OMP method use OMP methods, and whether their students demonstrate more frequent expression of therapeutic reasoning processes during case presentations. Methods. A pilot quasi-experimental study was conducted. In 2015, four preceptors attended an OMP training session. The OMP preceptors and three preceptors not trained in OMP were asked to collect audio recordings of their students presenting patient cases. The audio recordings were coded for preceptors' use of OMP methods and students' expression of therapeutic reasoning processes. Results. In total, we collected 42 audio recordings from 27 students presenting a patient case to one of seven preceptors. Preceptors trained in OMP more frequently asked students to commit to a therapeutic assessment and plan, probed for their supporting reasoning, and reinforced what was done well. However, non-OMP preceptors' students more frequently articulated assessments and treatment plans in their case presentations. The non-OMP students also more frequently initiated discussion about the reasoning behind their assessments and plans without prompting from their preceptor. Conclusion. Implementing OMP workshops for preceptors to elicit students' therapeutic reasoning processes requires further consideration. Future research is needed on pragmatic and effective precepting methods.
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Affiliation(s)
- Kayley Lyons
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina
- University of North Carolina at Chapel Hill, School of Education, Chapel Hill, North Carolina
| | - Jacqueline E McLaughlin
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Michael D Wolcott
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina
- University of North Carolina at Chapel Hill, School of Education, Chapel Hill, North Carolina
| | - Rebecca Grandy
- Mountain Area Health Education Center, Asheville, North Carolina
- University of North Carolina at Asheville, Eshelman School of Pharmacy, Asheville, North Carolina
| | - Charlene R Williams
- University of North Carolina at Asheville, Eshelman School of Pharmacy, Asheville, North Carolina
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Huang PH, Haywood M, O'Sullivan A, Shulruf B. A meta-analysis for comparing effective teaching in clinical education. MEDICAL TEACHER 2019; 41:1129-1142. [PMID: 31203692 DOI: 10.1080/0142159x.2019.1623386] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aim: Many factors affect learning outcomes, however studies comparing the effectiveness of different clinical teaching methods are limited. We utilize the list of influences on educational achievement compiled by John Hattie to inform a meta-analysis of learning effect sizes (ESs) associated with teaching-learning factors (TLFs) in clinical education. Methods: A literature search was conducted in PubMed to identify articles examining clinically relevant TLFs. Selection criteria were applied to identify learner-focused studies, with subsequent categorization by study design (pretest-posttest or controlled group). The Cohen's ES (d) for each TLF was extracted and a pooled ES determined. Results: From 3454 studies, 132 suitable articles enabled analysis of 16 TLFs' ESs. In general, ESs derived from pretest-posttest data were larger than those from controlled group designs, probably due to learner maturation effect. The TLFs of mastery learning, small group learning and goal settings possessed the largest ESs (d ≥ 0.8), while worked examples, play programs, questioning, concept mapping, meta-cognitive strategies, visual-perception programs and teaching strategies demonstrated ESs between 0.4 and 0.8. Conclusions: This is the first study to provide a rigorous and comprehensive overview of the effectiveness of TLFs in clinical education. We discuss the practical traits shared by effective TLFs which may assist teaching design.
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Affiliation(s)
- Pin-Hsiang Huang
- Office of Medical Education, University of New South Wales , Sydney , Australia
| | - Matthew Haywood
- Office of Medical Education, University of New South Wales , Sydney , Australia
| | - Anthony O'Sullivan
- Faculty of Medicine, University of New South Wales , Sydney , Australia
- Department of Endocrinology, St George and Sutherland Clinical School , Sydney , Australia
| | - Boaz Shulruf
- Office of Medical Education, University of New South Wales , Sydney , Australia
- Centre for Medical and Health Sciences Education, University of Auckland , Auckland , New Zealand
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Alyami H, Alawami M, Lyndon M, Alyami M, Coomarasamy C, Henning M, Hill A, Sundram F. Impact of Using a 3D Visual Metaphor Serious Game to Teach History-Taking Content to Medical Students: Longitudinal Mixed Methods Pilot Study. JMIR Serious Games 2019; 7:e13748. [PMID: 31573895 PMCID: PMC6788337 DOI: 10.2196/13748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/17/2019] [Accepted: 07/17/2019] [Indexed: 11/23/2022] Open
Abstract
Background History taking is a key component of clinical practice; however, this skill is often poorly performed by students and doctors. Objective The study aimed to determine whether Metaphoria, a 3D serious game (SG), is superior to another electronic medium (PDF text file) in learning the history-taking content of a single organ system (cardiac). Methods In 2015, a longitudinal mixed methods (quantitative and qualitative) pilot study was conducted over multiple sampling time points (10 weeks) on a group of undergraduate medical students at The University of Auckland Medical School, New Zealand. Assessors involved in the study were blinded to group allocation. From an initial sample of 83, a total of 46 medical students were recruited. Participants were assigned to either a PDF group (n=19) or a game group (n=27). In total, 1 participant left the PDF group after allocation was revealed and was excluded. A total of 24 students in the game group and 14 students in the PDF group completed follow-up 7 weeks later.
Using an iterative design process for over a year, with input from a variety of clinical disciplines, a cardiac history-taking game and PDF file were designed and informed by Cognitive Load Theory. Each group completed its intervention in 40 min. A total of 3 levels of Kirkpatrick training evaluation model were examined using validated questionnaires: affective (perception and satisfaction), cognitive (knowledge gains and cognitive load), and behavioral attitudes (Objective Structured Clinical Exam) as well as qualitative assessment. A priori hypotheses were formulated before data collection. Results Compared with baseline, both groups showed significant improvement in knowledge and self-efficacy longitudinally (P<.001). Apart from the game group having a statistically significant difference in terms of satisfaction (P<.001), there were no significant differences between groups in knowledge gain, self-efficacy, cognitive load, ease of use, acceptability, or objective structured clinical examination scores. However, qualitative findings indicated that the game was more engaging and enjoyable, and it served as a visual aid compared with the PDF file. Conclusions Students favored learning through utilization of an SG with regard to cardiac history taking. This may be relevant to other areas of medicine, and this highlights the importance of innovative methods of teaching the next generation of medical students.
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Affiliation(s)
- Hussain Alyami
- South Auckland Clinical Campus, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,College of Medicine, Taif University, Taif, Saudi Arabia
| | | | - Mataroria Lyndon
- South Auckland Clinical Campus, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Mohsen Alyami
- South Auckland Clinical Campus, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Marcus Henning
- South Auckland Clinical Campus, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Andrew Hill
- South Auckland Clinical Campus, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Frederick Sundram
- South Auckland Clinical Campus, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Santhosh L, Brown W, Ferreira J, Niroula A, Carlos WG. Practical Tips for ICU Bedside Teaching. Chest 2019; 154:760-765. [PMID: 30290929 DOI: 10.1016/j.chest.2018.06.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/02/2018] [Accepted: 06/25/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lekshmi Santhosh
- Department of Medicine, University of California-San Francisco, San Francisco, CA.
| | - Wade Brown
- Department of Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - Juliana Ferreira
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - W Graham Carlos
- Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN
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Schwartz AC, Cotes RO, Kim J, Ward MC, Manning KD. Bite-Sized Teaching: Engaging the Modern Learner in Psychiatry. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:315-318. [PMID: 30607895 DOI: 10.1007/s40596-018-1014-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Affiliation(s)
| | | | | | - Martha C Ward
- Emory University School of Medicine, Atlanta, GA, USA
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El-Sourady M, Chen H, Martin SF, Ritchie J, Ellis K, Richeson A, Moore D, Karlekar M, Misra S. Effects of a Primary Palliative Care Educational System for Teaching Learners at Different Levels of Training. Am J Hosp Palliat Care 2019; 36:675-681. [PMID: 30845811 DOI: 10.1177/1049909119834854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Interest and appreciation for palliative care (PC) has resulted in increased demand for both PC services and education. The PC rotation has been shown to improve PC knowledge in medical students (MS) and internal medicine (IM) residents, and PC specialists stand poised to direct the primary PC education of learners at different levels of training. To concurrently teach learners of different levels of training on a busy PC service, we created an educational system that emphasizes management of learner schedules, organization of teaching activities, faculty development to improve teaching skills, and learner self-evaluation. Both MS and IM residents showed an improvement in self-assessed competence as well as increased comfort level with seriously ill patients after PC rotation. Careful adjustment of learner schedules has accommodated an increasing number of learners, while maintaining a low learner to faculty ratio. The PC educators face an exciting and daunting challenge as the number of patients with PC needs and the number of learners requesting PC experience grow. We continue to improve milestone-based PC assessment tools, to invest in faculty development, and to explore innovative ways to support PC educators as they strive to provide consistent PC education that is both useful for learners and can be incorporated into busy PC clinical practice.
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Affiliation(s)
- Maie El-Sourady
- 1 Vanderbilt University Medical Center, The Vanderbilt Clinic, Nashville, TN, USA
| | - Heidi Chen
- 2 Vanderbilt Center for Health Services Research, Nashville, TN, USA
| | - Sara F Martin
- 1 Vanderbilt University Medical Center, The Vanderbilt Clinic, Nashville, TN, USA
| | | | | | | | - Don Moore
- 6 Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mohana Karlekar
- 1 Vanderbilt University Medical Center, The Vanderbilt Clinic, Nashville, TN, USA
| | - Sumi Misra
- 1 Vanderbilt University Medical Center, The Vanderbilt Clinic, Nashville, TN, USA
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Sidhu NS, Edwards M. Deliberate teaching tools for clinical teaching encounters: A critical scoping review and thematic analysis to establish definitional clarity. MEDICAL TEACHER 2019; 41:282-296. [PMID: 29703088 DOI: 10.1080/0142159x.2018.1463087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE AND METHOD We conducted a scoping review of tools designed to add structure to clinical teaching, with a thematic analysis to establish definitional clarity. RESULTS Six thousand and forty nine citations were screened, 434 reviewed for eligibility, and 230 identified as meeting study inclusion criteria. Eighty-nine names and 51 definitions were identified. Based on a post facto thematic analysis, we propose that these tools be named "deliberate teaching tools" (DTTs) and defined as "frameworks that enable clinicians to have a purposeful and considered approach to teaching encounters by incorporating elements identified with good teaching practice." We identified 46 DTTs in the literature, with 38 (82.6%) originally described for the medical setting. Forty justification articles consisted of 16 feedback surveys, 13 controlled trials, seven pre-post intervention studies with no control group, and four observation studies. Current evidence of efficacy is not entirely conclusive, and many studies contain methodology flaws. Forty-nine clarification articles comprised 12 systematic reviews and 37 narrative reviews. The most number of DTTs described by any review was four. A common design theme was identified in approximately three-quarters of DTTs. CONCLUSIONS Applicability of DTTs to specific alternate settings should be considered in context, and appropriately designed justification studies are warranted to demonstrate efficacy.
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Affiliation(s)
- Navdeep S Sidhu
- a Department of Anaesthesia and Perioperative Medicine , North Shore Hospital , Auckland , New Zealand
- b Department of Anaesthesiology , University of Auckland , Auckland , New Zealand
| | - Morgan Edwards
- a Department of Anaesthesia and Perioperative Medicine , North Shore Hospital , Auckland , New Zealand
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Egan CA, Webster CA, Stewart GL, Weaver RG, Russ LB, Brian A, Stodden DF. Case study of a health optimizing physical education-based comprehensive school physical activity program. EVALUATION AND PROGRAM PLANNING 2019; 72:106-117. [PMID: 30326329 DOI: 10.1016/j.evalprogplan.2018.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/17/2018] [Accepted: 10/03/2018] [Indexed: 06/08/2023]
Abstract
In this article, we report a qualitative case study, in which we examined enablers and barriers related to the development, implementation, and sustainability of a comprehensive school physical activity program (CSPAP) aligned with the Health Optimizing Physical Education (HOPE) curriculum model at a middle school. Literature on program-diffusion and school-university partnerships guided data collection and analysis. Data sources included semi-structured interviews with the program implementation team (n = 9) and the school's health and physical education teachers (n = 7); a focus group interview with students; documents (e.g., lesson plans), and observations. Constant comparison techniques were used to code and draw out themes from the data. Findings revealed the extensive effort needed for program implementation and highlighted the importance of strong external support mechanisms, conducting needs assessments, and training teachers to market physical activity programming. Partnerships may provide critical support for schools in their efforts to generate and sustain CSPAPs.
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Affiliation(s)
- Cate A Egan
- University of Idaho 875 Perimeter Drive, Moscow, Idaho, 83844, United States.
| | - Collin A Webster
- University of South Carolina 902 Sumter Street, Columbia, SC, 29208, United States.
| | - Gregory L Stewart
- Methodist University 540 Ramsey Street, Fayetteville, NC, 28311, United States.
| | - R Glenn Weaver
- University of South Carolina 902 Sumter Street, Columbia, SC, 29208, United States.
| | - Laura B Russ
- University of South Carolina 902 Sumter Street, Columbia, SC, 29208, United States.
| | - Ali Brian
- University of South Carolina 902 Sumter Street, Columbia, SC, 29208, United States.
| | - David F Stodden
- University of South Carolina 902 Sumter Street, Columbia, SC, 29208, United States.
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Abstract
BACKGROUND AND PURPOSE Teaching models provide a systemic framework for didactic and clinical teaching. The One-Minute Preceptor (OMP) is one teaching model, providing five microskills to organize a learning experience for students in the clinical environment. This review aims to integrate the literature on the OMP model by highlighting potential use for nurse practitioners while identifying directions for future research. METHODS Electronic databases were searched from December 2017 to January 2018 for articles published in English. The databases included PubMed, CINAHL, and MEDLINE using terms including "preceptor," "clinical teaching," "time-efficient teaching," and "precepting." Of 32 articles in the final search, only 12 experimental quantitative studies were included in the synthesis and 20 descriptive studies in the discussion. CONCLUSIONS The OMP model is supported by literature for its effectiveness as a teaching model and preference by students and preceptors. It has been shown to increase teaching techniques including feedback and assessment of students' clinical reasoning. IMPLICATIONS FOR PRACTICE The OMP model has the potential to overcome clinicians' barriers to precepting nurse practitioner students. Future research may evaluate the use of this model specific to nurse practitioner preceptors and students, perceived time benefits in clinical teaching, overall improvement in clinical teaching, and use in interprofessional precepting.
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Hausmann JS, Schwartzstein RM. Using Questions to Enhance Rheumatology Education. Arthritis Care Res (Hoboken) 2018; 71:1304-1309. [PMID: 30221476 DOI: 10.1002/acr.23753] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/11/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan S Hausmann
- Beth Israel Deaconess Medical Center and Boston Children's Hospital, Boston, Massachusetts
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Savassi LCM, Melo CGL, Gonçalves DA, Oliveira DOPS, Lopes HR, Fregonezi RLH, Turcotte S. Proposta de residência em Atenção Domiciliar como área de atuação. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2018. [DOI: 10.5712/rbmfc13(40)1599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A Atenção Domiciliar (AD) configura-se numa área de atuação de diversos especialistas, como Médicos de Família e Comunidade, Geriatras, Pediatras e Internistas. Por suas especificidades e dentro do seu campo de práticas, demanda competências que não estão contempladas isoladamente em nenhuma especialidade médica, sendo que o tempo e a estrutura necessários para a aquisição destas ultrapassa a capacidade de inserção ao longo dos programas atuais. A expansão desta modalidade de cuidados representa uma demanda crescente de formação, exigindo a inclusão da AD como potencial campo de trabalho destes especialistas, concebendo a necessidade de terceiro ano de residência, enquanto área de atuação. Discutem-se as estratégias de formação, campos da prática e estrutura programática, necessários para a consolidação desta proposta. Espera-se que este artigo possa subsidiar a natural construção desta especialidade no âmbito da atuação médica em saúde.
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Chinai SA, Guth T, Lovell E, Epter M. Taking Advantage of the Teachable Moment: A Review of Learner-Centered Clinical Teaching Models. West J Emerg Med 2017; 19:28-34. [PMID: 29383053 PMCID: PMC5785198 DOI: 10.5811/westjem.2017.8.35277] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 06/15/2017] [Accepted: 08/27/2017] [Indexed: 12/04/2022] Open
Abstract
When working in a chaotic Emergency Department (ED) with competing priorities, clinical teaching may be sacrificed for the sake of patient flow and throughput. An organized, efficient approach to clinical teaching helps focus teaching on what the learner needs at that moment, incorporates regular feedback, keeps the department on track, and prevents over-teaching. Effective clinical teaching in a busy environment is an important skill for senior residents and faculty to develop. This review will provide a critique and comparison of seven structured teaching models to better prepare readers to seize the teachable moment.
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Affiliation(s)
- Sneha A Chinai
- University of Massachusetts School of Medicine, Department of Emergency Medicine, Worcester, Massachusetts
| | - Todd Guth
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Elise Lovell
- University of Illinois at Chicago School of Medicine, Department of Emergency Medicine, Chicago, Illinois.,Advocate Christ Medical Center, Department of Emergency Medicine, Oak Lawn, Illinois
| | - Michael Epter
- Maricopa Medical Center, Department of Emergency Medicine, Phoenix, Arizona
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Ignoffo R, Chan L, Knapp K, Chan E, Ip E, Bandy J, Besinque K, Colbert J, Duby JJ, Galanto JS, Gloudeman M, Havard P, Lackey G, Lozano E, Scott J, Stewart TL. Efficient and effective precepting of pharmacy students in acute and ambulatory care rotations: A Delphi expert panel study. Am J Health Syst Pharm 2017; 74:1570-1578. [PMID: 28830868 DOI: 10.2146/ajhp170181] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Using the Delphi process, a panel of experienced preceptors achieved consensus on best practices to increase preceptor efficiency and effectiveness. METHODS The Delphi panelists completed 3 survey rounds and a face-to-face meeting. Survey questions covered several topics, including preparation of students for rotations, preceptor efficiency and effectiveness, potential resident contributions to precepting, methods of developing critical-thinking skills and providing assessment and feedback, precepting time metrics, and barriers to preceptor effectiveness. Panel consensus was defined as agreement of ≥80%. RESULTS Fifteen of 36 invited preceptors (42%) completed all 3 survey rounds. The expert panel reached consensus on 6 essentials for effective rotations, 8 precepting contributions that could be made by appropriately trained residents, precepting barriers, 4 strategies for teaching critical thinking, and 5 valuable characteristics of the One Minute Preceptor model. Panelists reported on time spent with students presenting new patient cases (median, 10 minutes per case), time devoted to assessment of students' clinical performance (median, 22 minutes per student weekly), and time dedicated to student professional development (median, 20 minutes per student weekly). CONCLUSION Important strategies for preceptors identified by the panel included (1) a thorough orientation to logistics, expectations, and scheduling of activities, (2) using appropriately trained residents in student training, (3) providing opportunities for critical thinking and therapeutic decision-making, (4) giving frequent, quality feedback on clinical activities, and (5) giving feedback to learners on a regular basis.
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Affiliation(s)
- Robert Ignoffo
- Touro University California College of Pharmacy, Vallejo, CA
| | - Lucinda Chan
- Touro University California College of Pharmacy, Vallejo, CA
| | - Katherine Knapp
- Touro University California College of Pharmacy, Vallejo, CA.
| | - Emily Chan
- Touro University California College of Pharmacy, Vallejo, CA.,Lifelong Medical Care-East Oakland, Oakland, CA
| | - Eric Ip
- Touro University California College of Pharmacy, Vallejo, CA
| | - Jason Bandy
- Thomas J. Long School of Pharmacy and Health Sciences, Stockton, CA
| | | | - James Colbert
- University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, CA
| | - Jeremiah J Duby
- University of California Davis Medical Center, Sacramento, CA
| | | | - Mark Gloudeman
- Touro University California College of Pharmacy, Vallejo, CA
| | - Patty Havard
- California Health Sciences University, Clovis, CA
| | - Grant Lackey
- College of Medicine and Pharmacy, California Northstate University, Elk Grove, CA
| | - Eric Lozano
- Touro University California College of Pharmacy, Vallejo, CA
| | - James Scott
- Western University of Health Sciences, Pomona, CA
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Cohen DA, Truglio J. Fitting It All In: An Interactive Workshop for Clinician-Educators to Improve Medical Education in the Ambulatory Setting. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10611. [PMID: 30800813 PMCID: PMC6374744 DOI: 10.15766/mep_2374-8265.10611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 06/24/2017] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Despite the demonstrated benefits that ambulatory teaching has for patients, learners, and preceptors, there have recently been significant reductions in time allocated to bedside teaching. In response to this decline, multiple techniques have been developed to improve the ability of clinician-educators to teach effectively within busy learner-focused continuity clinics. METHODS This 90-minute interactive workshop helps participants improve their ability to effectively teach in the ambulatory care setting. The session opens with learners exploring the benefits of and barriers to ambulatory teaching within their unique environment. Two evidence-based techniques are then presented: the Five Microskills model and Summarize, Narrow, Analyze, Probe, Plan, Select (SNAPPS) model. Participants analyze videos depicting these techniques, then practice in structured role-plays. Participants then revisit their initial reflections and discuss ways to both overcome common challenges and integrate the newly learned skills into their roles as clinician-educators. RESULTS This workshop has been presented five times at academic medical centers, at a medical school in the U.S. during departmental and divisional grand rounds, and at an internationally attended medical education conference. Institutional survey data are available from 98 learners. Over 90% of respondents rated the session very good or excellent. Comments suggested the need for more detailed techniques to overcome barriers and additional time for practice. These suggestions have been included in the current session. DISCUSSION This interactive workshop is designed for clinician-educators in ambulatory medical education. It has been well received in a variety of national academic settings and modified to be applicable in a variety of educational environments.
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Affiliation(s)
- David A. Cohen
- Practicing Adult Endocrinologist, Beth Israel Deaconess Medical Center
- Co-Director, Academy for Medical Educators Educators and Core Education Faculty, Beth Israel Deaconess Medical Center
- Instructor of Medicine, Harvard Medical School
| | - Joseph Truglio
- Practicing Internist and Pediatrician, Mount Sinai Hospital
- Assistant Professor, Icahn School of Medicine at Mount Sinai
- Co-Director of the Art and Science of Medicine, Icahn School of Medicine at Mount Sinai
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Rashid P, Churchill JA, Gendy R. Improving clinical teaching for busy clinicians: integration of the one-minute preceptor into mini-clinical examination. ANZ J Surg 2017; 87:535-536. [PMID: 28768386 DOI: 10.1111/ans.14038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, New South Wales, Australia
| | - James A Churchill
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, New South Wales, Australia
| | - Rasha Gendy
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, New South Wales, Australia
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Feeley I, Kelly M, Healy EF, Murray F, O’Byrne JM. Surgical tuition within Irish hospitals: a national survey. Ir J Med Sci 2017; 187:177-182. [DOI: 10.1007/s11845-017-1610-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
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Farrell SE, Hopson LR, Wolff M, Hemphill RR, Santen SA. What's the Evidence: A Review of the One-Minute Preceptor Model of Clinical Teaching and Implications for Teaching in the Emergency Department. J Emerg Med 2016; 51:278-83. [PMID: 27377967 DOI: 10.1016/j.jemermed.2016.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/29/2016] [Accepted: 05/05/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND The 2012 Academic Emergency Medicine Consensus Conference, "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success" noted that emergency medicine (EM) educators often rely on theory and tradition in molding their approaches to teaching and learning, and called on the EM education community to advance the teaching of our specialty through the performance and application of research in teaching and assessment methods, cognitive function, and the effects of education interventions. OBJECTIVE The purpose of this article is to review the research-based evidence for the effectiveness of the one-minute preceptor (OMP) teaching method, and to provide suggestions for its use in clinical teaching and learning in EM. DISCUSSION This article reviews hypothesis-testing education research related to the use of the OMP as a pedagogical method applicable to clinical teaching. Evidence indicates that the OMP prompts the teaching of higher level concepts, facilitates the assessment of students' knowledge, and prompts the provision of feedback. Students indicate satisfaction with this method of clinical case-based discussion teaching. CONCLUSION Advancing EM education will require that high quality education research results be translated into actual curricular, pedagogical, assessment, and professional development changes. The OMP is a pedagogical method that is applicable to teaching in the emergency department.
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Affiliation(s)
- Susan E Farrell
- Partners Healthcare International, Harvard Medical School, Boston, Massachusetts
| | - Laura R Hopson
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Margaret Wolff
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Robin R Hemphill
- Veterans Affairs National Center for Patient Safety, Washington, District of Columbia
| | - Sally A Santen
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Bösner S, Roth LM, Duncan GF, Donner-Banzhoff N. Verification and feedback for medical students: an observational study during general practice rotations. Postgrad Med J 2016; 93:3-7. [DOI: 10.1136/postgradmedj-2015-133420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/11/2016] [Accepted: 05/13/2016] [Indexed: 11/03/2022]
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Clement T, Brown J, Morrison J, Nestel D. Ad hoc supervision of general practice registrars as a 'community of practice': analysis, interpretation and re-presentation. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2016; 21:415-37. [PMID: 26384813 DOI: 10.1007/s10459-015-9639-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 09/13/2015] [Indexed: 05/26/2023]
Abstract
General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also provide an opportunity for learning and teaching. Wenger's (Communities of practice: learning, meaning, and identity. Cambridge University Press, New York, 1998) social theory of learning ('communities of practice') guided a secondary analysis of audio-recordings of ad hoc encounters. Data from one encounter is re-presented as an extended sequence to maintain congruence with the theoretical perspective and enhance vicariousness. An interpretive commentary communicates key features of Wenger's theory and highlights the researchers' interpretations. We argue that one encounter can reveal universal understandings of clinical supervision and that the process of naturalistic generalisation allows readers to transfer others' experiences to their own contexts. The paper raises significant analytic, interpretive, and representational issues. We highlight that report writing is an important, but infrequently discussed, part of research design. We discuss the challenges of supporting the learning and teaching that arises from adopting a socio-cultural lens and argue that such a perspective importantly captures the complex range of issues that work-based practitioners have to grapple with. This offers a challenge to how we research and seek to influence work-based learning and teaching in health care settings.
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Affiliation(s)
- T Clement
- Southern GP Training, Warrnambool, VIC, Australia.
- Deakin University, Warrnambool, VIC, Australia.
| | - J Brown
- Southern GP Training, Warrnambool, VIC, Australia
- HealthPEER (Health Professions Education and Educational Research), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - J Morrison
- Southern GP Training, Warrnambool, VIC, Australia
- Deakin University, Warrnambool, VIC, Australia
| | - D Nestel
- HealthPEER (Health Professions Education and Educational Research), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Duncan GF, Roth LM, Donner-Banzhoff N, Boesner S. Teaching points-do they occur and what do they contain? An observation study concerning the general practice rotation. BMC MEDICAL EDUCATION 2016; 16:113. [PMID: 27091199 PMCID: PMC4834827 DOI: 10.1186/s12909-016-0636-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/11/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND A general practice rotation is mandatory in most undergraduate medical education programs. However, little is known about the student-teacher interaction which takes place in this setting. In this study we analyzed occurrence and content of teaching points. METHODS From April to December 2012, 410 individual patient consultations were observed in twelve teaching practices associated with the Philipps University Marburg, Germany. Material was collected using structured field-note forms and videotaping. Data analysis was descriptive in form. A teaching point is defined here as a general rule or specific, case-related information divulged by the teaching practitioner. RESULTS According to the analysis of 410 consultations, teaching points were made in 66.3% of consultations. During these consultations, 74.3% general- and 46.3% case related teaching points occurred; multiple categorizations were possible. Of seven possible topics, therapy was most common, followed, in frequency of occurrence, by patient history, diagnostic procedure, physical examination, disease pathology, differential diagnosis, risk factors and case presentation. CONCLUSIONS The majority of consultations conducted within student presence contained teaching points, most frequently concerning therapy. General teaching points were more common than specific teaching points. Whilst it is encouraging that most consultations included teaching points, faculty development aimed at raising awareness for teaching and learning techniques is important.
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Affiliation(s)
- Gertrude Florence Duncan
- />Department of Anesthesiology and Intensive Care Medicine, Philipps University Marburg, Baldingerstrasse, D-35033 Marburg, Germany
| | - Lisa Marie Roth
- />Jung-Stilling-Krankenhaus, Department of Anesthesiology and Intensive Care Medicine, Siegen, Germany
| | - Nobert Donner-Banzhoff
- />Department of General Practice/Family Medicine, Philipps University Marburg, Marburg, Germany
| | - Stefan Boesner
- />Department of General Practice/Family Medicine, Philipps University Marburg, Marburg, Germany
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Seki M, Otaki J, Breugelmans R, Komoda T, Nagata-Kobayashi S, Akaishi Y, Hiramoto J, Ohno I, Harada Y, Hirayama Y, Izumi M. How do case presentation teaching methods affect learning outcomes?--SNAPPS and the One-Minute preceptor. BMC MEDICAL EDUCATION 2016; 16:12. [PMID: 26762292 PMCID: PMC4712551 DOI: 10.1186/s12909-016-0531-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 01/06/2016] [Indexed: 05/26/2023]
Abstract
BACKGROUND Various techniques have been developed to enable preceptors to teach residents effectively in outpatient settings to promote active learning, including SNAPPS and the One-Minute Preceptor (OMP). This study aimed to ascertain the differences between SNAPPS and the OMP in case presentation content and learner evaluation when used to teach residents about case presentation. METHODS From 2011 to 2013, participants were 71 junior clinical residents employed in two hospitals for clinical training. They were randomly allocated to two groups, one using SNAPPS and the other the OMP. From recorded discussions, the "differential diagnoses", "questions and uncertainties", "treatment plans", and "learning issues" were counted. Also, a self-evaluation form was distributed at the end of the study to evaluate the residents' satisfaction with the case presentation. RESULTS Members of the SNAPPS group used significantly more meaning units related to questions and uncertainties compared with those of the OMP group (P < 0.001). Self-evaluation sheets revealed that members of the SNAPPS group had significantly higher positive responses than those of the OMP group in terms of the following evaluations: "It was easy to bring up questions and uncertainties" (P = 0.046), "It was easy to present the case efficiently" (P = 0.002), "It was easy to present the case in the sequence given" (P = 0.029), and "I was able to give an in-depth case presentation" (P = 0.005). CONCLUSIONS SNAPPS may induce more meaning units related to questions and uncertainties and give more satisfaction to residents than the OMP.
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Affiliation(s)
- Masayasu Seki
- />Department of Medical Education, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
- />Department of Primary Care and General Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
- />Department of General Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461 Japan
| | - Junji Otaki
- />Department of Medical Education, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
- />Department of Primary Care and General Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
- />Center for Medical Education, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8638 Japan
| | - Raoul Breugelmans
- />Department of Medical Education, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Takayuki Komoda
- />Educational Institutional Research Center, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Shizuko Nagata-Kobayashi
- />Department of Primary Care and General Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Yu Akaishi
- />Department of Primary Care and General Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Jun Hiramoto
- />Department of General Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461 Japan
| | - Iwao Ohno
- />Department of General Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461 Japan
| | - Yoshimi Harada
- />Department of Primary Care and General Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Yoji Hirayama
- />Department of Primary Care and General Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Miki Izumi
- />Department of Medical Education, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
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Vaughan EM, Moreno JP, Johnston CA. Utilizing the One-Minute Preceptor for Patient Education. Am J Lifestyle Med 2015. [DOI: 10.1177/1559827615570565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Providing thorough responses to patient questions is an important part of the provider–patient relationship and key to good communication. Failure to do so puts patients at risk of looking for alternative and possibly harmful answers. Mindfulness is a popular topic, but due to its vague definition and variable outcomes, it may be difficult for health care providers to know how to answer patient questions or to identify patient needs. Using the One-Minute Preceptor model as a template provides health care providers a thorough yet organized and time-efficient method while also giving patients answers to their questions.
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Affiliation(s)
- Elizabeth M. Vaughan
- Department of Family and Community Medicine (EMV), USDA/ARS Children’s Nutrition Research Center
- Department of Pediatrics-Nutrition (JPM, CAJ), Baylor College of Medicine, Houston, Texas
- Department of Medicine (CAJ), Baylor College of Medicine, Houston, Texas
| | - Jennette P. Moreno
- Department of Family and Community Medicine (EMV), USDA/ARS Children’s Nutrition Research Center
- Department of Pediatrics-Nutrition (JPM, CAJ), Baylor College of Medicine, Houston, Texas
- Department of Medicine (CAJ), Baylor College of Medicine, Houston, Texas
| | - Craig A. Johnston
- Department of Family and Community Medicine (EMV), USDA/ARS Children’s Nutrition Research Center
- Department of Pediatrics-Nutrition (JPM, CAJ), Baylor College of Medicine, Houston, Texas
- Department of Medicine (CAJ), Baylor College of Medicine, Houston, Texas
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Lockspeiser TM, Kaul P. Applying the one minute preceptor model to pediatric and adolescent gynecology education. J Pediatr Adolesc Gynecol 2015; 28:74-7. [PMID: 25850586 DOI: 10.1016/j.jpag.2014.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 10/25/2022]
Abstract
There are multiple challenges to teaching in the clinical setting. The One Minute Preceptor is a learner-centered model for effective and efficient teaching in a clinical setting that can help to overcome these challenges. It consists of 5 microskills: get a commitment; probe for supporting evidence; teach general rules; reinforce what was right; correct mistakes. This article illustrates with case vignettes the use of these microskills for the busy Pediatric and Adolescent Gynecology clinician.
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Affiliation(s)
- Tai M Lockspeiser
- Section of General Academic Pediatrics, Department of Pediatrics, University of Colorado, School of Medicine, Children's Hospital Colorado, Aurora, CO
| | - Paritosh Kaul
- Section of Adolescent Medicine, Department of Pediatrics, University of Colorado, School of Medicine, Children's Hospital Colorado, Aurora, CO.
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Pascoe JM, Nixon J, Lang VJ. Maximizing teaching on the wards: review and application of the One-Minute Preceptor and SNAPPS models. J Hosp Med 2015; 10:125-30. [PMID: 25627348 DOI: 10.1002/jhm.2302] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 10/29/2014] [Accepted: 11/10/2014] [Indexed: 11/07/2022]
Abstract
Hospitalist educators face a number of challenges in teaching clinical reasoning to residents and medical students. Helping to develop trainees' clinical acumen is an essential and highly nuanced process, yet complex patients, documentation requirements, and productivity goals compete with teaching time. Workplace-based assessment is particularly important for residents with the institution of the developmental milestones for meeting Accreditation Council for Graduate Medical Education competencies. Two frameworks for facilitating the clinical reasoning discussion-the One-Minute Preceptor preceptor and SNAPPS-have been well studied in the outpatient setting with positive results. Both models show promise for use in the inpatient teaching environment with little modification. This narrative review compares and contrasts these 2 teaching frameworks and discusses their application to the inpatient teaching environment. These models can provide opportunities for hospitalist educators to better assess trainees, integrate regular feedback, and encourage self-directed learning. These teaching frameworks can also allow hospitalists to provide more focused education to trainees without taking additional valuable time.
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Affiliation(s)
- Jennifer M Pascoe
- Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York
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Dougherty PJ. CORR curriculum - orthopaedic education: Faculty development begins at home. Clin Orthop Relat Res 2014; 472:3637-43. [PMID: 25298280 PMCID: PMC4397787 DOI: 10.1007/s11999-014-3986-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/26/2014] [Indexed: 01/31/2023]
Affiliation(s)
- Paul J. Dougherty
- Detroit Medical Center, 4201 St. Antoine, Suite 4G, Detroit, MI 48201 USA
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Yang YM, Kim CH, Briones MA, Hilinski JA, Greenwald M. Instinctive Clinical Teaching: Erasing the Mental Boundary Between Clinical Education and Patient Care to Promote Natural Learning. J Grad Med Educ 2014; 6:415-8. [PMID: 26279765 PMCID: PMC4535203 DOI: 10.4300/jgme-d-13-00277.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 02/05/2014] [Accepted: 05/13/2014] [Indexed: 11/06/2022] Open
Abstract
Effective clinical teaching is essential in physician education, yet faculty members rarely receive formal training in clinical teaching. Formal models for training clinical educators are often tedious and require significant time and effort. Instinctive clinical teaching allows clinicians to seamlessly integrate and promote effective teaching into their clinical practice. The approach is guided by similarities between the components of Kolb's experiential learning cycle-concrete experience, reflective observation, abstract conceptualization, and active experimentation-and the elements of the patient care process-history and physical, initial assessment, differential, hypothesis, final diagnosis, management, and follow-up. Externalization of these clinical thought processes allows for inclusion of learners and promotes effective clinical teaching.
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Rabinowitz PM, Kock R, Kachani M, Kunkel R, Thomas J, Gilbert J, Wallace R, Blackmore C, Wong D, Karesh W, Natterson B, Dugas R, Rubin C. Toward proof of concept of a one health approach to disease prediction and control. Emerg Infect Dis 2014; 19. [PMID: 24295136 PMCID: PMC3840882 DOI: 10.3201/eid1912.130265] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A One Health approach considers the role of changing environments with regard to infectious and chronic disease risks affecting humans and nonhuman animals. Recent disease emergence events have lent support to a One Health approach. In 2010, the Stone Mountain Working Group on One Health Proof of Concept assembled and evaluated the evidence regarding proof of concept of the One Health approach to disease prediction and control. Aspects examined included the feasibility of integrating human, animal, and environmental health and whether such integration could improve disease prediction and control efforts. They found evidence to support each of these concepts but also identified the need for greater incorporation of environmental and ecosystem factors into disease assessments and interventions. The findings of the Working Group argue for larger controlled studies to evaluate the comparative effectiveness of the One Health approach.
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Irby DM. Excellence in clinical teaching: knowledge transformation and development required. MEDICAL EDUCATION 2014; 48:776-84. [PMID: 25039734 DOI: 10.1111/medu.12507] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 01/20/2014] [Accepted: 04/14/2014] [Indexed: 05/27/2023]
Abstract
CONTEXT Clinical teachers in medicine face the daunting task of mastering the many domains of knowledge needed for practice and teaching. The breadth and complexity of this knowledge continue to increase, as does the difficulty of transforming the knowledge into concepts that are understandable to learners. Properly targeted faculty development has the potential to expedite the knowledge transformation process for clinical teachers. METHODS Based on my own research in clinical teaching and faculty development, as well as the work of others, I describe the unique forms of clinical teacher knowledge, the transformation of that knowledge for teaching purposes and implications for faculty development. RESULTS The following forms of knowledge for clinical teaching in medicine need to be mastered and transformed: (i) knowledge of medicine and patients; (ii) knowledge of context; (iii) knowledge of pedagogy and learners, and (iv) knowledge integrated into teaching scripts. This knowledge is employed and conveyed through the parallel processes of clinical reasoning and clinical instructional reasoning. Faculty development can facilitate this knowledge transformation process by: (i) examining, deconstructing and practising new teaching scripts; (ii) focusing on foundational concepts; (iii) demonstrating knowledge-in-use, and (iv) creating a supportive organisational climate for clinical teaching. CONCLUSIONS To become an excellent clinical teacher in medicine requires the transformation of multiple forms of knowledge for teaching purposes. These domains of knowledge allow clinical teachers to provide tailored instruction to learners at varying levels in the context of fast-paced and demanding clinical practice. Faculty development can facilitate this knowledge transformation process.
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Affiliation(s)
- David M Irby
- Office of Medical Education, University of California San Francisco, San Francisco, California, USA
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Chan LK, Sharma N. Effects of training experienced teachers in the use of the one-minute preceptor technique in the gross anatomy laboratory. ANATOMICAL SCIENCES EDUCATION 2014; 7:124-129. [PMID: 23864286 DOI: 10.1002/ase.1381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/29/2013] [Indexed: 06/02/2023]
Abstract
The one-minute preceptor (OMP) is a time-efficient, learner-centered teaching method used in a busy ambulatory care setting. This project evaluated the effects of training experienced anatomy teachers in the use of the OMP in the gross anatomy laboratory on students' perceived learning. Second-year medical students from a five-year, undergraduate-entry, system- and problem-based medical program were divided randomly into two groups of 76 students each. The groups took part in the same gross anatomy laboratory session on different dates, supervised by the same two teachers (both with over 25 years of teaching experience). The teachers attended a workshop on the use of the OMP between the two sessions. Students were given a questionnaire at the end of the two sessions to indicate their agreements to statements regarding their learning experiences. Semistructured interviews were conducted with the two teachers after the second session. Results showed that training experienced anatomy teachers in the use of the OMP did not result in improvement of student learning perception in the gross anatomy laboratory. The experienced teachers have developed their own approaches with elements similar to those in the OMP: being learner centered and adaptable to individual student's needs, providing feedback, and enhancing teacher immediacy. They do not have an explicit structure such as the OMP, and are thus flexible and adaptive. Confining the teachers' teaching behaviors to the OMP structure could limit their performance. Although there are theoretical advantages for novice teachers in adopting the OMP technique, these advantages still need to be supported by further studies.
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Affiliation(s)
- Lap Ki Chan
- Department of Anatomy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Abstract
Teaching in the fast-paced, high-pressure environment of the ICU can be very demanding. Thus, the educator-intensivist must learn teaching strategies that are time-efficient, simple, and successful. In this article, we provide an overview of the current and relevant teaching theories and highlight potential obstacles and limitations to teaching in the ICU. In the second part, we discuss a sample of simple approaches to optimize the ICU-rotation curriculum as well as effective techniques to improve teaching, while not compromising quality of care.
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Affiliation(s)
- Meghan Bhave
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
| | - Marek Brzezinski
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
- Veterans Affairs Medical Center, San Francisco, California
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Tolsgaard MG, Bjørck S, Rasmussen MB, Gustafsson A, Ringsted C. Improving efficiency of clinical skills training: a randomized trial. J Gen Intern Med 2013; 28:1072-7. [PMID: 23595928 PMCID: PMC3710384 DOI: 10.1007/s11606-013-2378-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The rising number of medical students and the impact this has on students' learning of clinical skills is a matter of concern. Cooperative learning in pairs, called dyad training, might help address this situation. OBJECTIVE The aim of this study was to evaluate the effect of dyad training on students' patient encounter skills. DESIGN Experimental, randomized, observer-blinded trial. PARTICIPANTS Forty-nine pre-clerkship medical students without prior clinical experience. INTERVENTION All students underwent a 4-h course on how to manage patient encounters. Subsequently, the students were randomized into a dyad practice group (n = 24) or a single practice group (n = 25). Both groups practiced for 4 h on four different case scenarios, using simulated patients. Students in the dyad group practiced together and took turns as the active participant, whereas students in the single group practiced alone. MAIN MEASURE Performance tests of patient encounter skills were conducted 2 weeks after the training by two blinded raters. Students had no clinical training during those weeks. A questionnaire-based evaluation surveyed students' confidence in their patient management skills. KEY RESULTS The dyad group scored significantly higher on the performance test, mean 40.7 % (SD 6.6), than the single group, mean 36.9 % (SD 5.8), P = 0.04, effect size 0.61. Inter-rater reliability was 0.69. The dyad group expressed significantly higher confidence in managing future clinical patient encounters than the single group, mean 7.6 (SD 0.9) vs. mean 6.5 (SD 1.1), respectively, P < 0.001, effect size 1.16. CONCLUSION Dyad training of pre-clerkship medical students' patient encounter skills is effective, efficient, and prompts higher confidence in managing future patient encounters compared to training alone. This training format may help maintain high-quality medical training in the face of an increasing number of students in medical schools.
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Affiliation(s)
- Martin G Tolsgaard
- Centre for Clinical Education, University of Copenhagen, Department 5404, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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Williams CK, Hui Y, Borschel D, Carnahan H. A scoping review of undergraduate ambulatory care education. MEDICAL TEACHER 2013; 35:444-53. [PMID: 23228083 DOI: 10.3109/0142159x.2012.737968] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Since a disproportionate amount of medical education still occurs in hospitals, there are concerns that medical school graduates are not fully prepared to deliver efficient and effective care in ambulatory settings to increasingly complex patients. AIMS To understand the current extent of scholarship in this area. METHOD A scoping review was conducted by searching electronic databases and grey literature sources for articles published between 2001 and 2011 that identified key challenges and models of practice for undergraduate teaching of ambulatory care. Relevant articles were charted and assigned key descriptors, which were mapped onto Canadian recommendations for the future of undergraduate medical education. RESULTS Most of the relevant articles originated in the United States, Australia, or the United Kingdom. Recommendations related to faculty development, learning contexts and addressing community needs had numerous areas of scholarly activity while scholarly activity was lacking for recommendations related to inter-professional practice, the use of technology, preventive medicine, and medical leadership. CONCLUSIONS Systems should be established to support education and research collaboration between medical schools to develop best practices and build capacity for change. This method of scoping the field can be applied using best practices and recommendations in other countries.
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Affiliation(s)
- Camille K Williams
- Graduate Department of Rehabilitation Science, University of Toronto, 200 Elizabeth Street, Toronto,Ontario, Canada.
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