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Suliman S, Allen M, Chivese T, de Rijk AE, Koopmans R, Könings KD. Is medical training solely to blame? Generational influences on the mental health of our medical trainees. MEDICAL EDUCATION ONLINE 2024; 29:2329404. [PMID: 38488138 PMCID: PMC10946265 DOI: 10.1080/10872981.2024.2329404] [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: 10/28/2023] [Accepted: 03/07/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The negative impact of medical training on trainee mental health continues to be a concern. Situated within a sociocultural milieu, Generation Z and Generation Y, defined by their highly involved parents and the widespread use of technology, currently dominate undergraduate and graduate medical education respectively. It is necessary to explore medical trainees' generational characteristics and job-related factors related to stress, burnout, depression, and resilience. This might provide different perspectives and potential solutions to medical trainees' mental health. METHODS A cross-sectional study was conducted among medical trainees (students and residents) from two institutions in Qatar. A self-administered online survey included measures for trainees' social media overuse, their parent's parenting style, the educational support by the clinical teacher, job (demands, control, and support), and work-life balance and their relation with their stress, burnout, depression, and resilience. Relationships were tested with multiple linear regression analyses. RESULTS Of the 326 medical trainees who responded, 142 (44%) trainees - 93 students and 49 residents - completed all items and were included in the analysis. Social media overuse and inability to maintain a work-life balance were associated with higher levels of stress, depression, and student burnout. Higher levels of job support were associated with lower levels of stress, depression, and resident burnout, and a higher level of resilience. Job control was associated with lower burnout levels. Parenting style was unrelated to trainees' mental health. DISCUSSION The two generations 'Y' and 'Z' dominating current medical training showed more stress-related complaints when there is evidence of social media overuse and failure to maintain a work-life balance, while job support counterbalances this, whereas parenting style showed no effect. Measures to enhance medical trainees' mental health may include education about the wise use of social media, encouraging spending more quality social time, and enhancing job support and job control.
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Affiliation(s)
- Shireen Suliman
- Medical Education, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Margaret Allen
- Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Tawanda Chivese
- Department of Population Medicine, Qatar University, Doha, Qatar
| | - Angelique E. de Rijk
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Richard Koopmans
- Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Karen D. Könings
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- School of Health Sciences, University of East Anglia, Norwich, UK
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Randall Armel S. Small programs, big challenges: Reimagining the evaluation of clinical teaching in genetic counseling. J Genet Couns 2024. [PMID: 38798095 DOI: 10.1002/jgc4.1924] [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: 01/03/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
Within the health professions education system, a significant proportion of teaching and learning occurs in the clinical setting. As such, the need to measure effective teaching for accreditation standards, faculty development, merit pay, academic promotion, and for monitoring the safety of the learning environment has led to numerous universities developing instruments to evaluate teaching effectiveness in this context. To date; however, these instruments typically focus on the student perspective, despite evidence demonstrating that student evaluations of teaching (SETs) lack correlation with learning outcomes and are not a true measure of teaching effectiveness. This issue is further exacerbated in small health professional training programs, such as genetic counseling, where clinical teachers may only supervise 1-3 students per year. As a result, not only are SETs more confounded due to small sample sizes, but a direct conflict exists between respecting learner anonymity and providing timely and relevant feedback to faculty. In such contexts, even using SETs to evaluate the nature of the learning environment may be unreliable due to student concerns about identifiability and fear of retaliation for unfavorable evaluation. This paper will review the literature regarding SETs, barriers to this process within the clinical setting, and the unintended downstream consequences. Options for addressing issues related to the use of SETs will be considered, with particular focus on the process of reflection and the use of teaching consultations or peer support groups as a means to improve teaching effectiveness in this learning environment.
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Affiliation(s)
- Susan Randall Armel
- Bhalwani Familial Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
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Tipwong A, Hall NC, Snell L, Chamnan P, Moreno M, Harley JM. Clinical teaching self-efficacy positively predicts professional fulfillment and negatively predicts burnout amongst Thai physicians: a cross-sectional survey. BMC MEDICAL EDUCATION 2024; 24:361. [PMID: 38566108 PMCID: PMC10988928 DOI: 10.1186/s12909-024-05325-1] [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: 09/29/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Clinician teachers (physicians who teach in clinical settings) experience considerable psychological challenges in providing both educational training and patient care. This study aimed to determine the prevalence of physician burnout and professional fulfillment, and to identify internal and external factors associated with mental health outcomes among Thai clinician teachers working in non-university teaching hospitals. METHOD A one-time online questionnaire was completed by physicians at 37 governmental, non-university teaching hospitals in Thailand, with 227 respondents being assessed in the main analyses. Four outcomes were evaluated including burnout, professional fulfillment, quality of life, and intentions to quit. RESULTS The observed prevalence of professional fulfillment was 20%, and burnout was 30.7%. Hierarchical regression analysis showed a significant internal, psychological predictor (clinical teaching self-efficacy) and external, structural predictors (multiple roles at work, teaching support), controlling for the background variables of gender, years of teaching experience, family roles, and active chronic disease, with clinical teaching self-efficacy positively predicting professional fulfillment (b = 0.29, p ≤.001) and negatively predicting burnout (b = - 0.21, p =.003). CONCLUSIONS Results highlight the importance of faculty development initiatives to enhance clinical teaching self-efficacy and promote mental health among Thai physicians.
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Affiliation(s)
- Arunee Tipwong
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
- Department of Social Medicine, Surat Thani Hospital, Surat Thani, SNI, Thailand
| | - Nathan C Hall
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Linda Snell
- Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
- Division of General Internal Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Parinya Chamnan
- Office of the Collaborative Project to Increase Production of Rural Doctor (CPIRD), Ministry of Public Health, Nonthaburi, NBI, Thailand
| | - Matthew Moreno
- Department of Surgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Jason M Harley
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada.
- Institute of Health Sciences Education, McGill University, Montreal, QC, Canada.
- Department of Surgery, Faculty of Medicine, McGill University, Montreal, QC, Canada.
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
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Salajegheh M, Rooholamini A, Norouzi A. Investigating the role of clinical exposure on motivational self-regulation skills in medical students based on cognitive apprenticeship model. BMC MEDICAL EDUCATION 2024; 24:257. [PMID: 38459546 PMCID: PMC10921607 DOI: 10.1186/s12909-024-05253-0] [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: 10/28/2023] [Accepted: 03/03/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND The importance of motivation regulation in medical students is highly significant due to their unique educational circumstances, such as clinical exposure. However, the role of clinical exposure in learning motivational self-regulation skills in students has not been explored thus far. This current study aims to investigate the role of clinical exposure on motivational self-regulation skills in medical students based on cognitive apprenticeship model. METHOD This study was descriptive-analytical research conducted in 2022 on medical students. Data collection involved two questionnaires including Meta motivational Strategies in Medical Students Questionnaire and Maastricht Clinical Teaching Questionnaire. The research comprised two stages including measuring motivational self-regulation strategies in students before entering the clinical exposure phase, and simultaneous measurement of clinical exposure based on the student's viewpoint and their motivational self-regulation strategies at the end of the first term of clinical exposure. RESULTS The results revealed a significant relationship between six dimensions of the cognitive apprenticeship model, including modeling, coaching, scaffolding, reflection, exploration, and learning environment, with motivational self-regulation strategies. However, there was no significant relationship between the articulation dimension of the cognitive apprenticeship model and motivational self-regulation strategies. CONCLUSION Clinical exposure indirectly enhances students' metacognitive skills. Observing the behavior of clinical faculty in the clinical exposure setting leads to the improvement of motivational self-regulation strategies in medical students.
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Affiliation(s)
- Mahla Salajegheh
- Department of Medical Education, Medical Education Development Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Azadeh Rooholamini
- Department of Medical Education, Medical Education Development Center, Kerman University of Medical Sciences, Kerman, Iran.
| | - Ali Norouzi
- Education Development Center, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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Nejadkoorki H, Norouzi A, Salajegheh F, Salajegheh M. Psychometric evaluation of Maastricht clinical teaching questionnaire based on the cognitive apprenticeship model. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 12:434. [PMID: 38464664 PMCID: PMC10920695 DOI: 10.4103/jehp.jehp_1528_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/22/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND The Maastricht Clinical Teaching Questionnaire is a valid and reliable instrument for measuring the quality of clinical teaching. This study was aimed at translation and psychometric evaluation of the Persian version of this questionnaire to evaluate clinical teaching based on the cognitive apprenticeship model. MATERIALS AND METHODS The translation of the questionnaire was performed according to Guillemins framework. Reliability was examined by calculating Cronbach's alpha coefficient. Confirmatory factor analysis was studied among 120 medical students. Content validity was assessed by calculating the content validity index and content validity ratio. Face validity was evaluated by conducting interviews with students using concurrent verbal probing and thinking aloud. RESULTS Cronbach's alpha coefficient for the whole scale was 0.95. The content validity index was 0.92, and the content validity ratio was 0.82. Confirmatory factor analysis resulted in a seven-factor model and demonstrated an adequate fit with the data. CONCLUSION The Persian version of the Maastricht Clinical Teaching Questionnaire with seven factors including modeling, coaching, scaffolding, articulation, reflection, exploration, and learning environment appears to be a valid and reliable instrument for the evaluation of clinical teaching in Iranian universities of medical sciences.
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Affiliation(s)
- Hamid Nejadkoorki
- Department of Medical Education, Medical Education Development Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Norouzi
- Education Development Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Faranak Salajegheh
- Clinical Research Development Unit, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahla Salajegheh
- Department of Medical Education, Medical Education Development Center, Kerman University of Medical Sciences, Kerman, Iran
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Hari R, Caprez R, Dolmans D, Huwendiek S, Robbiani S, Stalmeijer RE. Describing Ultrasound Skills Teaching by Near-Peer and Faculty Tutors Using Cognitive Apprenticeship. TEACHING AND LEARNING IN MEDICINE 2024; 36:33-42. [PMID: 36322510 DOI: 10.1080/10401334.2022.2140430] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Phenomenon: Ultrasound skills are becoming increasingly important in clinical practice but are resource-intensive to teach. Near-peer tutors often alleviate faculty teaching burden, but little is known about what teaching methods near-peer and faculty tutors use. Using the lens of cognitive apprenticeship, this study describes how much time faculty and near-peer tutors spend on different teaching methods during abdominal ultrasound skills training. Approach: Sixteen near-peer and 16 faculty tutors were videotaped during one 55-min practical ultrasound lesson with randomly assigned students. Videos were directly coded using Cognitive Apprenticeship teaching methods and activities. Segment durations were summed up and compared quantitatively. Findings: All 32 tutors spent most of the time on observing and helping students (Coaching, Median 29:14 minutes), followed by asking open and stimulating questions (Articulation, 12:04 minutes and demonstrating and giving explanations (Modeling, 04:50 minutes). Overall, distributions of teaching methods used were similar between faculty and near-peer tutors. However, faculty tutors spent more time on helping students manually, whereas near-peer tutors spent more time on exploring students' learning gaps and establishing a safe learning climate. Cognitive Apprenticeship was well suited as observational framework to describe ultrasound skills. Insights: Ultrasound train-the-tutor programs should particularly focus on coaching and articulation. Near-peers' similar use of teaching methods adds to the evidence that supports the use of near-peer teaching in ultrasound skills education.
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Affiliation(s)
- Roman Hari
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Reto Caprez
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Diana Dolmans
- School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Sara Robbiani
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Renée E Stalmeijer
- School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Wurth S, Maisonneuve H, Moussa MA, Campion B, Caire Fon N, Peltier C, Audétat MC. Development of complex pedagogical competencies and reflexivity in clinical teachers via distance learning: a mixed methods study. MEDICAL EDUCATION ONLINE 2023; 28:2265163. [PMID: 37818594 PMCID: PMC10569352 DOI: 10.1080/10872981.2023.2265163] [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: 04/26/2023] [Accepted: 09/26/2023] [Indexed: 10/12/2023]
Abstract
Clinical reasoning is the cornerstone to healthcare practice and teaching it appropriately is of utmost importance. Yet there is little formal training for clinical supervisors in supervising this reasoning process. Distance education provides interesting opportunities for continuous professional development of healthcare professionals. This mixed methods study aimed at gaining in-depth understanding about whether and how clinical teachers can develop complex pedagogical competencies through participation in a Massive Open Online Course on the supervision of clinical reasoning (MOOC SCR). Participants self-assed their clinical supervision skills before and after partaking in the MOOC SCR through the Maastricht Clinical Teachers Questionnaire. Item scores and the distribution of response proportions before and after participation were compared using paired t-tests and McNemar's tests respectively. In parallel, the evolution of a subset of MOOC participants' pedagogical practice and posture was explored via semi-structured interviews throughout and beyond their MOOC participation using simulated and personal situational recalls. The verbatim were analysed with standard thematic analysis. Quantitative and qualitative findings converged and their integration demonstrated that partaking in the MOOC SCR promoted the development of complex pedagogical competencies and reflexivity with the participants. This was quantitatively evidenced by significantly higher self-assessed supervision skills and corresponding attitudes after completing the MOOC. The qualitative data provided rich descriptions of how this progression in pedagogical practice and posture occurred in the field and how it was shaped by participants' interaction with the MOOC's content and their motivations to progress. Our findings provide evidence for the development of pedagogical skills and corresponding attitudes for the supervision of clinical reasoning through participation in the MOOC SCR and contribute to the literature body on the opportunities that distance learning provides for the development of pedagogical competencies. The extent to which the pedagogical underpinnings of the MOOC contributed to these developments remains to be determined.
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Affiliation(s)
- Sophie Wurth
- Unit for Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Hubert Maisonneuve
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mohamed Amir Moussa
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Baptiste Campion
- Institute of Higher Studies in Social Communications, Brussels School of Journalism and Communication, Brussels, Belgium
| | - Nathalie Caire Fon
- Family Medicine and Emergency Medicine Department, Medicine, Université de Montréal, Montréal, Canada
| | - Claire Peltier
- Unit for Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Faculty of Educational Sciences, Université Laval, Quebec City, Canada
| | - Marie-Claude Audétat
- Unit for Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Jaconia G, Naus C, Lee A. Anesthesiology resident preferences regarding learning to perform epidural anesthesia procedures in obstetrics: a qualitative phenomenological study. Int J Obstet Anesth 2023; 56:103923. [PMID: 37708742 DOI: 10.1016/j.ijoa.2023.103923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/20/2023] [Accepted: 07/30/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Learning to perform neuraxial techniques in obstetrics is considered one of the most difficult skills for anesthesiology trainees to acquire and no consensus exists regarding the best practices for teaching these procedures. Utilizing a qualitative, phenomenological approach, we aimed to explore what trainees perceive as the best approaches to teaching epidural anesthesia techniques; identify how these perceptions align or differ from those of faculty anesthesiologists; and examine how these approaches fit into the cognitive apprenticeship framework, which describes a process of reflection on how learning occurs in the authentic environment. METHODS Semi-scripted interviews were conducted with 10 residents and three faculty members from the division of obstetric anesthesiology at an academic center. Interviews were transcribed, de-identified, fragmented, and coded. A thematic analysis was conducted, and codes re-organized into the cognitive apprenticeship framework of (1) content, (2) method (including subcategories modeling, coaching, scaffolding, articulation, reflection, and exploration), (3) sequence, and (4) sociology (including situated learning and culture of expert practice). RESULTS Trainees valued a staged approach to learning epidural techniques, independent trouble-shooting, graded independence, focused feedback, and a calm instructor. The challenges of learning and teaching epidural techniques identified by trainees and instructors included the tactile nature of the procedure, teaching on awake, non-sedated patients, limited teaching time, and creating an environment of psychological safety. CONCLUSION Trainee and instructor preferences for teaching epidural procedures in obstetrics aligned with the cognitive apprenticeship framework. These concepts may be applied to curriculum design, evaluation, feedback, self-assessment and faculty development.
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Affiliation(s)
- G Jaconia
- Columbia University Irving Medical Center, New York, NY, USA
| | - C Naus
- Columbia University Irving Medical Center, New York, NY, USA
| | - A Lee
- Columbia University Irving Medical Center, New York, NY, USA.
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O'Connor E, Doyle E. The lecturer-tutor in undergraduate medical education; navigating complexity as "a recruiter, a timetabler, an administrator, a counsellor". BMC MEDICAL EDUCATION 2023; 23:575. [PMID: 37582727 PMCID: PMC10428569 DOI: 10.1186/s12909-023-04560-2] [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: 04/17/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Tutors play an important role in the delivery of effective undergraduate medical education (UGME). These roles commonly involve competing clinical, educational and research commitments. We sought to obtain a rich description of these posts from doctors working in them. METHODS We used a pragmatist, sequential explanatory mixed-methods design with a sampling frame of clinical lecturer/tutors in 5 Irish medical schools. Purposive sampling was used for recruitment. Quantitative data collected from a validated online questionnaire were used to inform a semi-structured interview question guide. Thematic analysis was conducted independently by each of the study researchers, using a coding frame derived in part from the findings of the online questionnaire. Quantitative and qualitative mixing occurred during data collection, analysis and reporting. RESULTS 34 tutors completed the online survey with 7 volunteers for interview. Most respondents took the job to gain experience in either educational practice (79.4%) or in research (61.8%). Major themes to emerge were the diverse interactions with students, balancing multiple professional commitments, a high degree of role-autonomy, mis-perception of role by non-tutor colleagues, challenges around work-life balance and unpredictable work demands. Using a complexity theory lens, the tutor role was defined by its relational interactions with numerous stakeholders, all in the context of an environment that changed regularly and in an unpredictable manner. CONCLUSIONS The undergraduate tutor works in a demanding role balancing educational and non-educational commitments with suboptimal senior guidance and feedback. The role is notable for its position within a complex adaptive system. An understanding of the system's interactions recognises the non-linearity of the role. Using a complex systems lens, we propose improvements to undergraduate education centred around the tutor.
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Affiliation(s)
- Enda O'Connor
- Trinity College Dublin, Dublin, Ireland.
- Department of Anaesthesia and Intensive Care St.James's Hospital, Trinity College Dublin, Dublin, Ireland.
| | - Evin Doyle
- Trinity College Dublin, Dublin, Ireland
- Department of Anaesthesia and Intensive Care St.James's Hospital, Trinity College Dublin, Dublin, Ireland
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Jansen I, Silkens MEWM, Galema G, Vermeulen H, Geerlings SE, Lombarts KMJMH, Stalmeijer RE. Exploring nurses' role in guiding residents' workplace learning: A mixed-method study. MEDICAL EDUCATION 2023; 57:440-451. [PMID: 36226355 DOI: 10.1111/medu.14951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Understanding residents' workplace learning could be optimized by not only considering attending physicians' role but also the role of nurses. While previous studies described nurses' role during discrete activities (e.g. feedback), a more profound understanding of how nurses contribute to residents' learning remains warranted. Therefore, we used the educational concept of guidance and explored the extent to which residents' and nurses' perceptions align regarding nurses' guiding role and which reasons they provide for their perceptions. METHODS This mixed-method study was conducted at four Dutch university medical centres in 2021. We simultaneously collected quantitative and qualitative data from 103 residents and 401 nurses through a theory-informed questionnaire with a Likert-scale and open-ended questions. We analyzed quantitative data to explore respondents' perceptions of nurses' guiding role by using anova. The thematically analyzed qualitative open comments explored respondents' reasons for their perceptions. RESULTS Nurses indicated to provide significantly more support (p = .01) and guidance on learning from patient care (p < .01) than perceived by residents. Moreover, nurses indicated that attending physicians did not always involve them in guiding residents, whereas residents perceived nurses were being involved (p < .001). Themes suggest that nurses and residents could be divided into two groups: (i) respondents who felt that guiding was inextricably linked to good interprofessional collaboration and patient care and (ii) respondents who saw the guiding role as limited and emphasised the distinct fields of expertise between nurses and physicians. CONCLUSIONS Residents and nurses felt that nurses played an important role in guiding residents' workplace learning. However, some residents did not always perceive to be guided. To further capitalise on nurses' guiding role, we suggest that residents can be encouraged to engage in the learning opportunities nurses provide to achieve optimal team-based patient care.
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Affiliation(s)
- Iris Jansen
- Professional Performance and Compassionate Care Research Group, Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Milou E W M Silkens
- Centre for Healthcare Innovation Research, City University of London, London, UK
| | - Gerbrich Galema
- University Medical Center Groningen, Department of Anesthesiology, University of Groningen, Groningen, The Netherlands
| | - Hester Vermeulen
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- School of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Suzanne E Geerlings
- Internal Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Kiki M J M H Lombarts
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Renée E Stalmeijer
- School of Health Professions Education, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Kay HG, Mahoney MR, Edwards RA. The Objective Structured Teaching Encounter (OSTE) in health professions education: A systematic review. MEDICAL TEACHER 2023:1-13. [PMID: 36940135 DOI: 10.1080/0142159x.2023.2189539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE New emphasis on the assessment of health professions educators' teaching competence has led to greater use of the Objective Structured Teaching Encounter (OSTE). The purpose of this study is to review and further describe the current uses and learning outcomes of the OSTE in health professions education. MATERIALS AND METHODS PubMed, MEDLINE, and CINAHL (March 2010 to February 2022) were searched for English-language studies describing the use of an OSTE for any educational purpose within health professions education. RESULTS Of the 29 articles that met inclusion criteria, over half of the studies (17 of 29, 58.6%) were published during or after 2017. Seven studies described OSTE use outside of the traditional medical education context. These new contexts included basic sciences, dental, pharmacy, and Health Professions Education program graduates. Eleven articles described novel OSTE content, which included leadership skills, emotional intelligence, medical ethics, inter-professional conduct, and a procedural OSTE. There is increasing evidence supporting the use of OSTEs for the assessment of clinical educators' teaching skills. CONCLUSIONS The OSTE is a valuable tool for the improvement and assessment of teaching within a variety of health professions education contexts. Further study is required to determine the impact of OSTEs on teaching behaviors in real-life contexts.
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Affiliation(s)
- Hannah G Kay
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Roger A Edwards
- Center for Interprofessional Studies and Innovation, MGH Institute of Health Professions, Boston, MA, USA
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Stalmeijer RE, Whittingham JRD, Bendermacher GWG, Wolfhagen IHAP, Dolmans DHJM, Sehlbach C. Continuous enhancement of educational quality - fostering a quality culture: AMEE Guide No. 147. MEDICAL TEACHER 2023; 45:6-16. [PMID: 35469546 DOI: 10.1080/0142159x.2022.2057285] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Internal quality assurance (IQA) is one of the core support systems on which schools in the health professions rely to ensure the quality of their educational processes. Through IQA they demonstrate being in control of their educational quality to accrediting bodies and continuously improve and enhance their educational programmes. Although its need is acknowledged by all stakeholders, creating a system of quality assurance has often led to establishing a 'tick-box' exercise overly focusing on quality control while neglecting quality improvement and enhancement. This AMEE Guide uses the concept of quality culture to describe the various dimensions that need to be addressed to move beyond the tick-box exercise. Quality culture can be defined as an organisational culture which consists of a structural/managerial aspect and a cultural/psychological aspect. As such this AMEE Guide addresses tools and processes to further an educational quality culture while also addressing ways in which individual and collective awareness of and commitment to educational quality can be fostered. By using cases within health professions education of both formal and informal learning settings, examples will be provided of how the diverse dimensions of a quality culture can be addressed in practice.
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Affiliation(s)
- Renée E Stalmeijer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Jill R D Whittingham
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Guy W G Bendermacher
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Ineke H A P Wolfhagen
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Diana H J M Dolmans
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Carolin Sehlbach
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Elster MJ, O'Sullivan PS, Muller-Juge V, Sheu L, Kaiser SV, Hauer KE. Does being a coach benefit clinician-educators? A mixed methods study of faculty self-efficacy, job satisfaction and burnout. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:45-52. [PMID: 34406613 PMCID: PMC8371581 DOI: 10.1007/s40037-021-00676-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Coaching is a growing clinician-educator role. Self-efficacy is a powerful faculty motivator that is associated positively with job satisfaction and negatively with burnout. This study examines self-efficacy, job satisfaction, and burnout in coaches and other clinician-educators. METHODS We conducted a mixed methods study using a quantitative survey followed by qualitative interviews of faculty at the University of California, San Francisco. Coaches (funded 20% full-time equivalents), faculty with other funded education positions ("funded"), and faculty without funded education positions ("unfunded") completed a 48-item survey addressing self-efficacy (teaching, professional development, and scholarship), job satisfaction, and burnout. Data were analyzed using analysis of variance followed by post-hoc tests and chi-square tests. To elaborate quantitative results, we conducted qualitative interviews of 15 faculty and analyzed data using framework analysis. RESULTS 202 of 384 faculty (52.6%) responded to the survey; 187 complete surveys were analyzed. Teaching self-efficacy was similar across groups. Coaches and funded educators had significantly higher professional development self-efficacy and job satisfaction than unfunded educators. Burnout was more prevalent in coaches and unfunded educators. Qualitative analysis yielded three themes: sources of reward, academic identity, and strategies to mitigate burnout. Educator roles provide reward that enhances self-efficacy and job satisfaction but also generate competing demands. Coaches cited challenges in forming professional identities and working with struggling learners. DISCUSSION The coaching role provides faculty with benefits similar to other funded educator roles, but the particular demands of the coach role may contribute to burnout.
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Affiliation(s)
- Martha J Elster
- Department of Pediatrics, University of California, San Francisco, CA, USA.
| | - Patricia S O'Sullivan
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Department of Surgery, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Leslie Sheu
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Sunitha V Kaiser
- Departments of Pediatrics and Clinical Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Karen E Hauer
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
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Al-Yousuf N, Kassab SE, Alsetri H, Hamdy H. Psychometric Properties of Visual Indicators of Teaching and Learning Success "VITALS" Instrument for Evaluation of Clinical Teachers. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:905-911. [PMID: 34429680 PMCID: PMC8380291 DOI: 10.2147/amep.s318798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE We have previously developed an instrument for students' evaluation of clinical teachers that we called Visual Indicators of Clinical Teaching and Learning Success (VITALS). This study measures the reliability of VITALS as an instrument for student evaluation of clinical tutors. Additionally, the study explores the minimum number of student raters necessary for an acceptable reliability, and provides evidence of construct validity of the evaluation scores. MATERIALS AND METHODS This retrospective study included 1825 evaluation forms completed by medical students evaluating clinical tutors using the VITALS instrument. Reliability was measured by applying generalizability theory (G-theory) analysis using a two-facet design (raters and items). A D-study was used to determine the minimum number of raters required to achieve a reliability ≥0.80. Face validity was tested by measuring tutors' degree of agreement with the items of the study instrument. RESULTS The overall G-coefficient was 0.89. The subject of measurement (clinical tutors' scores) represented 15.8% of the variance across all tutors and items. The variance due to the interaction between raters (students) and tutors contributed to 43.5%, while the variance due to items was negligible. The remaining 40% of the variance was due to unexplained sources of error. The D-study demonstrated that a minimum of 12 raters (students) are required to achieve a reliability of 0.80. Finally, most of the clinical tutors agreed that all items in the instrument were appropriate. CONCLUSION We demonstrate that VITALS exhibits good psychometric properties. There should be at least 12 students rating each clinical tutor to have an acceptable level of reliability for the study instrument. Face validity of the study instrument was evidenced by its high level of approval among clinical tutors.
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Affiliation(s)
- Nada Al-Yousuf
- Department of Opthalmology, King Abdullah Medical City, Manama, Kingdom of Bahrain
| | - Salah Eldin Kassab
- Department of Physiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Department of Basic Medical Sciences, College of Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - Hasan Alsetri
- Department of Chemistry and Biochemistry, University of California, Los Angeles, CA, USA
| | - Hossam Hamdy
- Department of Surgery, Gulf Medical University, Ajman, United Arab Emirates
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15
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Stalmeijer RE, Varpio L. The wolf you feed: Challenging intraprofessional workplace-based education norms. MEDICAL EDUCATION 2021; 55:894-902. [PMID: 33651450 PMCID: PMC8359828 DOI: 10.1111/medu.14520] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/29/2021] [Accepted: 02/26/2021] [Indexed: 05/26/2023]
Abstract
CONTEXT The trajectory towards becoming a medical professional is strongly situated within the clinical workplace. Through participatory engagement, medical trainees learn to address complex health care issues through collaboration with the interprofessional health care team. To help explain learning and teaching dynamics within the clinical workplace, many scholars have relied on socio-cultural learning theories. In the field of medical education, this research has largely adopted a limited interpretation of a crucial dimension within socio-cultural learning theory: the expert who guides the trainee into the community is almost exclusively from the same profession. We contend that this narrow interpretation is not necessary. This limited focus is one we choose to maintain-be that choice intentional or implicit. In this cross-cutting edge paper, we argue that choosing an interprofessional orientation towards workplace learning and guidance may better prepare medical trainees for their future role in health care practice. METHODS By applying Communities of Practice and Landscapes of Practice , and supported by empirical examples, we demonstrate how medical trainees are not solely on a trajectory towards the Community of Physician Practice (CoPP) but also on a trajectory towards various Landscapes of Healthcare Practice (LoHCP). We discuss some of the barriers present within health care organisations and professions that have likely inhibited adoption of the broader LoHCP perspective. We suggest three perspectives that might help to deliberately and meaningfully incorporate the interprofessional learning and teaching dynamic within the medical education continuum. CONCLUSION Systematically incorporating Landscapes of Competence, Assessment, and Guidance in workplace-based education-in addition to our current intraprofessional approach-can better prepare medical trainees for their roles within the LoHCP. By advocating and researching this interprofessional perspective, we can embark on a journey towards fully harnessing and empowering the health care team within workplace-based education.
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Affiliation(s)
- Renée E. Stalmeijer
- School of Health Professions EducationFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Lara Varpio
- Center for Health Professions EducationDepartment of MedicineUniformed Services University of the Health SciencesBethesdaMDUSA
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16
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Hayden C, Raidan J, Rees J, Oswal A. Understanding junior doctors' experiences of teaching on the acute take: a qualitative study. BMC MEDICAL EDUCATION 2021; 21:383. [PMID: 34256755 PMCID: PMC8278645 DOI: 10.1186/s12909-021-02815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND New medical graduates are significantly unprepared to manage acutely unwell patients due to limited first-hand clinical exposure in the undergraduate curriculum. Supporting undergraduate learning in the acute setting can be challenging for junior doctors when balancing teaching and clinical responsibilities. Our aim was to explore junior doctors' first-hand experiences of supporting undergraduate education in the acute admissions environment(take). METHODS Fourteen junior doctors in one teaching hospital in South West England took part in semi-structured focus groups (4-6 participants in each) which were audio-recorded, transcribed, and thematically analysed. RESULTS Junior doctors described their educational role as comprising: teaching, demonstrating, coaching, and supervising. They perceived the acute take as a highly variable, unpredictable setting that offered a broad scope for learning. Tensions between doctors' clinical and educational roles were described, influenced by internal and external factors. Clinical work was prioritised over teaching and participants lacked confidence in supervisory and clinical skills. Doctors felt pressured to meet students' expectations and lacked understanding of their educational needs. Senior colleagues were highly influential in establishing an educational culture and were often a source of pressure to deliver timely clinical care. Organisations were perceived not to value teaching due to the lack of provision of dedicated teaching time and prioritisation of limited resources towards patient care. Participants managed tensions by attempting to formally separate roles, demoting students to passive observers, and they sought greater continuity in placements to better understand students' abilities and expectations. CONCLUSIONS Educational opportunities for undergraduate students on the acute take are varied and highly valuable. This study provides insight into the provision of workplace education and its challenges from junior doctors' perspectives. We highlight areas for improvement of relevance to educational providers.
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Affiliation(s)
- Charlotte Hayden
- Bristol Royal Infirmary, South Bristol Academy, University Hospitals of Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, BS2 8HW, Bristol, UK.
| | - Jedd Raidan
- Bristol Royal Infirmary, South Bristol Academy, University Hospitals of Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, BS2 8HW, Bristol, UK
- University of Bristol Medical School, 5 Tyndall Avenue, BS8 1UD, Bristol, UK
| | - Jonathan Rees
- Bristol Royal Infirmary, South Bristol Academy, University Hospitals of Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, BS2 8HW, Bristol, UK
| | - Abhishek Oswal
- Bristol Royal Infirmary, South Bristol Academy, University Hospitals of Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, BS2 8HW, Bristol, UK
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17
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Costa ACAC, da Silva Campos Costa NM, Pereira ERS. Educational Environment Assessment by Multiprofessional Residency Students: New Horizons Based on Evidence from the DREEM. MEDICAL SCIENCE EDUCATOR 2021; 31:429-437. [PMID: 34457901 PMCID: PMC8368835 DOI: 10.1007/s40670-020-01169-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The multiprofessional residency in health (MRH) is in its initial stage situated in the long history of the Brazilian and worldwide health system. There are few published analytical data on the teaching environment as perceived by residents. Roff et al. developed a questionnaire to assess the educational environment known as the Dundee Ready Education Environment Measure (DREEM), which is widely used in international literature. AIM To analyse perceptions of the educational environment among residents in various undergraduate health courses at a university hospital in the Midwest Region of Brazil using the DREEM. METHODS The DREEM was administered to MRH students in a postgraduate health course consisting of 2 years of in-service training at a university hospital in Brazil in 2017. The results were analysed using the Statistical Package of Social Sciences (SPSS 24.0). RESULTS Cronbach's alpha reliability coefficient for all the items in this study was 0.76, which indicates good internal consistency. The average (95% CI) total DREEM score was 85.23 (ranging from 79.2 to 91.26), which suggests problems in the educational environment as perceived by health residents and a more negative than positive environment. CONCLUSIONS Several problem areas were identified in all domains of the educational environment that was assessed.
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18
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Park Y, Chun K, Kwon M. Mediation effects of clinical practice stress between clinical education environment and satisfaction with clinical practice. KOREAN JOURNAL OF MEDICAL EDUCATION 2021; 33:27-36. [PMID: 33735554 PMCID: PMC7973074 DOI: 10.3946/kjme.2021.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to identify the possible correlations of 'satisfaction with clinical practice (SA)' with 'clinical learning environment (EN)' and 'clinical practice stress (ST).' We searched for the mediating effect of 'clinical practice stress' on 'satisfaction with clinical practice' when the clinical learning environment influences 'satisfaction with clinical practice.' METHODS This research investigated 208 medical and nursing students attending the school of medicine and nursing in Korea. The total number of nursing students was 135 (64.9%); 73 medical students participated (35.1%). We used the Korean-Undergraduate Clinical Education Environment in 24 questions for EN, ST scale in 24 questions, and SA scale in 10 questions. We performed measurement structural equation model analysis to identify a path of the model. RESULTS Medical students had significantly higher levels of ST. EN had a significant negative correlation with ST and a significant positive correlation with SA. The ST had a significant negative correlation with SA. The results of the goodness of fit index have fulfilled the criteria of goodness of fit. There was a significant mediating effect of ST on SA when EN influences SA. CONCLUSION The clinical learning environment affected satisfaction with the clinical practice directly or indirectly mediated by clinical practice stress. Therefore, educational institutes should try to increase satisfaction with clinical practice by continuously monitoring and improving the clinical learning environment in addition to taking measures for decreasing the clinical practice stress.
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Affiliation(s)
- Youngsoon Park
- Department of Medical Education, Konyang University College of Medicine, Daejeon, Korea
| | - Kyunghee Chun
- Department of Medical Education, Konyang University College of Medicine, Daejeon, Korea
| | - Mihye Kwon
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
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W. Wolford G, L. Wolford L, Fissel Brannick S, Scott M, Smith R. “Shouldn’t you be collaborative by now?”: Supervisory needs, expectations, and satisfaction across the educational trajectory in speech-language pathology. CLINICAL SUPERVISOR 2020. [DOI: 10.1080/07325223.2020.1833268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | | | - Megan Scott
- Department of Speech-Language Pathology, Midwestern University
| | - Rebekah Smith
- Department of Speech-Language Pathology, Midwestern University
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20
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Bajwa NM, De Grasset J, Audétat MC, Jastrow N, Richard-Lepouriel H, Dominicé Dao M, Nendaz MR, Junod Perron N. Training junior faculty to become clinical teachers: The value of personalized coaching. MEDICAL TEACHER 2020; 42:663-672. [PMID: 32130055 DOI: 10.1080/0142159x.2020.1732316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Junior clinical faculty require institutional support in the acquisition of feedback and clinical supervision skills of trainees. We tested the effectiveness of a personalized coaching versus guided self-reflection format of a faculty development program at improving faculty skills and self-efficacy.Methods: Participants were evaluated both before and after the program using a four-station Objective Structured Teaching Exercise (OSTE). A gain-score analysis, one-way ANOVA, and paired t-tests were used to evaluate both groups. The impact on the learning environment was measured by resident ratings of the Maastricht Clinical Teaching Questionnaire.Results: One hundred and twenty-seven participants completed the study over a three-year period. Both groups had significant improvements in self-efficacy. Participants in the coaching group demonstrated superior performance in encouraging learner self-reflection, teaching effectiveness, verifying learner understanding, exploring feelings/needs, and defining learning objectives. Over a 5-year period, the overall institutional learning climate significantly improved concerning faculty role-modeling, coaching, articulation, and explorations skills.Conclusion: Offering a contextualized faculty-development program using OSTEs that provides multiple opportunities for feedback and is focused on creating a community of practice is an effective method to facilitate the transfer of skills to the clinical environment, supports teacher identity development, and favorably impacts the learning climate.
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Affiliation(s)
- Nadia M Bajwa
- Department of General Pediatrics at the Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Jehanne De Grasset
- Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Marie-Claude Audétat
- Faculty of Medicine, Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Nicole Jastrow
- Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | | | - Melissa Dominicé Dao
- Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu R Nendaz
- Faculty of Medicine, Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Noëlle Junod Perron
- Department of community medicine and primary care, Geneva University Hospitals, Geneva, Switzerland
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21
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Shimizu I, Kikukawa M, Tada T, Kimura T, Duvivier R, van der Vleuten C. Measuring social interdependence in collaborative learning: instrument development and validation. BMC MEDICAL EDUCATION 2020; 20:177. [PMID: 32487067 PMCID: PMC7268626 DOI: 10.1186/s12909-020-02088-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In health professions education, several collaborative learning approaches have been used. As collaborative learning has a theoretical background of social interdependence theory, a theory informed and valid instrument to measure social interdependence is required to evaluate and compare several learning approaches. The aim of this study was to develop an instrument (the SOcial interdependence in Collaborative learning Scale; SOCS) to measure students' perceived social interdependence in collaborative learning and validate it. METHODS We conducted a modified Delphi procedure among stakeholders to develop the content validity of the instrument. To establish construct validity, we performed a confirmatory factor analysis, and we estimated reliability. RESULTS Two rounds of Delphi were conducted to develop the instrument. Confirmatory factor analysis yielded a three-factor model with 15 items, which provided an excellent fit with CMIN/df = 1.838, GFI = 0.924, CFI = 0.951, RMSEA = 0.061, and PCLOSE = 0.121. Alpha-coefficients for all factors indicated high internal consistency of all the factors. CONCLUSION This study describes the development and construct validation of the SOCS for measuring social interdependence in collaborative learning. This instrument will provide teachers and schools with feedback about their classroom environment.
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Affiliation(s)
- Ikuo Shimizu
- Center for Medical Education and Clinical Training, Shinshu University, 3-1-1 Asahi, Matsumoto, 3908621 Japan
| | - Makoto Kikukawa
- Department of Medical Education, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 8128582 Japan
| | - Tsuyoshi Tada
- Center for Medical Education and Clinical Training, Shinshu University, 3-1-1 Asahi, Matsumoto, 3908621 Japan
| | - Teiji Kimura
- Department of Fundamental Physical Therapy, Shinshu University, 3-1-1 Asahi, Matsumoto, 3908621 Japan
| | - Robbert Duvivier
- Center for Educational Development and Research in Health Sciences (CEDAR), University Medical Center Groningen, Groningen, The Netherlands
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Cees van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229 ER Maastricht, The Netherlands
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22
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Konishi E, Saiki T, Kamiyama H, Nishiya K, Tsunekawa K, Imafuku R, Fujisaki K, Suzuki Y. Improved cognitive apprenticeship clinical teaching after a faculty development program. Pediatr Int 2020; 62:542-548. [PMID: 31834972 DOI: 10.1111/ped.14095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/15/2019] [Accepted: 12/10/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND While it is well known that the cognitive apprenticeship is an effective workplace-based teaching approach for clinical teachers, the effects of faculty development (FD) have not been analyzed from that perspective. The purpose of this study was to investigate self-assessment by clinical teachers of their educational perceptions and behaviors after a FD program using the cognitive apprenticeship model. METHODS Board-certified pediatricians who participated in a 3-day FD program on practical clinical teaching were asked to complete questionnaires. Fifty participants completed two questionnaires prior to and 3 and 6 months after the FD program: the first was on the participants' general perceptions and behaviors in relation to their own clinical education and the second was a self-assessment using the Maastricht Clinical Teaching Questionnaire (MCTQ) that was developed based on the cognitive apprenticeship model. RESULTS The general survey demonstrated that 78% of the participants experienced positive changes in their educational perceptions 6 months after FD. Self-assessment using the MCTQ showed that the scores in the categories of "articulation," "exploration," and "safe learning environment" remained significantly improved 6 months after the FD program. CONCLUSIONS The participants' self-perceived improvement in behaviors was sustainable for 6 months after participation the FD program. The results of the MCTQ show that through their experiences in the FD program, the participants seemingly transformed their clinical teaching to become interactive facilitators, encouraging self-directed learning. Our results also suggest that the MCTQ can be used for self-assessment of clinical teachers and to enhance the effectiveness of the FD program.
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Affiliation(s)
- Eri Konishi
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Pediatrics, Matsue Red Cross Hospital, Matsue, Japan.,Committee of Education, Japan Pediatric Society, Tokyo, Japan
| | - Takuya Saiki
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroshi Kamiyama
- Committee of Education, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Katsumi Nishiya
- Committee of Education, Japan Pediatric Society, Tokyo, Japan.,Center for Medical Education, Kansai Medical University, Osaka, Japan
| | - Koji Tsunekawa
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Rintaro Imafuku
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazuhiko Fujisaki
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yasuyuki Suzuki
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan.,Committee of Education, Japan Pediatric Society, Tokyo, Japan
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Isba R, Rousseva C, Woolf K, Byrne-Davis L. Development of a brief learning environment measure for use in healthcare professions education: the Healthcare Education Micro Learning Environment Measure (HEMLEM). BMC MEDICAL EDUCATION 2020; 20:110. [PMID: 32272934 PMCID: PMC7146917 DOI: 10.1186/s12909-020-01996-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 03/06/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND The learning environment impacts many aspects of healthcare education, including student outcomes. Rather than being a single and fixed phenomenon, it is made up of multiple micro learning environments. The standard clinical learning environment measurement tools do not consider such diversity and may fail to adequately capture micro learning environments. Moreover, the existing tools are often long and may take a prohibitive amount of time to complete properly. This may have a negative impact on their usefulness in educational improvement strategies. In addition, there is no universal tool available which could be utilised across several healthcare student groups and placement settings. AIM To create an evidence-based measurement tool for assessing clinical micro learning environments across several healthcare profession student groups. METHODS The measurement tool was developed through a step-wise approach: 1) literature review with iterative analysis of existing tools; 2) generation of new items via thematic analysis of student experiences; 3) a Delphi process involving healthcare educators; 4) piloting of the prototype; and 5) item reduction. RESULTS The literature review and experiential data from healthcare students resulted in 115 and 43 items respectively. These items were refined, leaving 75 items for the Delphi process, which produced a prototype with 57 items. This prototype was then completed by 257 students across the range of healthcare professions, with item reduction resulting in a 12-item tool. CONCLUSION This paper describes a mixed methods approach to developing a brief micro learning environment measurement tool. The generated tool can be used for measuring student perceptions of clinical environments across several healthcare professions. Further cross-cultural and cross-professional validation studies are needed to support widespread use, possibly through mobile application.
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Affiliation(s)
- R. Isba
- Lancaster Medical School, Lancaster University, Bailrigg, Lancaster LA1 4YW England
- Emergency Department, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester, M8 5RB England
| | - C. Rousseva
- Royal Liverpool Hospital, Prescot Street, Liverpool, L7 8XP England
| | - K. Woolf
- Research Department of Medical Education, UCL Medical School, Gower Street, London, WC1E 6BT England
| | - L. Byrne-Davis
- Division of Medical Education, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT UK
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Sellberg M, Skavberg Roaldsen K, Nygren-Bonnier M, Halvarsson A. Clinical supervisors' experience of giving feedback to students during clinical integrated learning. Physiother Theory Pract 2020; 38:122-131. [PMID: 32149555 DOI: 10.1080/09593985.2020.1737996] [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] [Indexed: 10/24/2022]
Abstract
Background: For students within health-care education, clinical integrated learning has an important role in combining theory and practice. Constructive feedback is a cornerstone of effective clinical teaching, even though it can be a challenging task for both students and supervisors. There are limited studies on clinical physiotherapists' experience of giving feedback to students.Purpose: To explore clinical physiotherapy supervisors' experience of giving feedback to students during clinical integrated learning.Method: Twelve physiotherapists were interviewed in focus groups about their experiences of giving feedback to students. The interviews were analyzed using qualitative content analysis. Results: One latent, overarching theme was identified, which was continuous development and support within the social network at the workplace facilitates the work of giving feedback to students and three manifest main themes: (1) constructive dialog; (2) professionalism; and (3) enabling strategies.Conclusion: The current study focuses on supervisors' experiences of giving feedback to students in a clinical setting. The findings showed that giving feedback to students was a part of continuous development, facilitated by the social network at the workplace, and that the supervisors aimed to be professional while handling emotions in social interactions between supervisors and students.
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Affiliation(s)
- Malin Sellberg
- Karolinska University Hospital, Allied Health Professionals Function, Medical Unit Occupational Therapy and Physiotherapy, Huddinge, Sweden.,Department of Clinical Sciences, Intervention and Technology, CLINTEC Karolinska Institutet, Huddinge, Sweden
| | - Kirsti Skavberg Roaldsen
- Departments of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Malin Nygren-Bonnier
- Karolinska University Hospital, Allied Health Professionals Function, Medical Unit Occupational Therapy and Physiotherapy, Huddinge, Sweden.,Departments of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Alexandra Halvarsson
- Karolinska University Hospital, Allied Health Professionals Function, Medical Unit Occupational Therapy and Physiotherapy, Huddinge, Sweden.,Departments of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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25
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Jeong YN, Natto ZS, Marks ME, Karimbux N. Development and Implementation of a Clinical Dental Faculty Evaluation Instrument. J Dent Educ 2020; 84:323-328. [PMID: 32176350 DOI: 10.21815/jde.019.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/04/2019] [Indexed: 11/20/2022]
Abstract
The aim of this study was to develop and test the reliability of an instrument to evaluate the quality of clinical teaching among dental school faculty. Fourth-year dental students' perspectives on effective clinical teaching were first collected in focus group meetings. An 11-item questionnaire to assess seven domains of clinical teaching was developed based on the collected student perspectives and a medical model. All 374 third- and fourth-year dental students at one U.S. dental school in 2015 were invited to evaluate four clinical instructors whom they felt were strong role models and four clinical instructors whom they felt would benefit from constructive criticism. The survey was completed by 139 students (37.2% response rate); they evaluated 96 dental instructors. The results showed that the survey demonstrated strong internal reliability, with Cronbach's alpha values of >0.95 for each of the seven domains. In addition, there was significant agreement between groups: the interclass correlation (ICC) ranged from 0.97 to 0.99. These results suggest that the clinical faculty evaluation instrument developed in this study is a reliable method that can be used to evaluate dental faculty members. This system can be a valuable guide for clinical faculty members and administrators in assessing and improving clinical teaching effectiveness.
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Affiliation(s)
- Y Natalie Jeong
- Associate Professor of Periodontology, Tufts University School of Dental Medicine
| | - Zuhair S Natto
- Assistant Professor of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Saudi Arabia
- Visiting Assistant Professor of Periodontology, Tufts University School of Dental Medicine
| | - Mary-Ellen Marks
- Academic Affairs Administrator, Tufts University School of Dental Medicine
| | - Nadeem Karimbux
- Dean and Professor of Periodontology, Tufts University School of Dental Medicine
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Jansen I, Silkens MEWM, Stalmeijer RE, Lombarts KMJMH. Team up! Linking teamwork effectiveness of clinical teaching teams to residents' experienced learning climate. MEDICAL TEACHER 2019; 41:1392-1398. [PMID: 31366271 DOI: 10.1080/0142159x.2019.1641591] [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: Supportive learning climates are key to ensure high-quality residency training. Clinical teachers, collaborating as teaching team, have an important role in maintaining such climates since they are responsible for residency training. Successful residency training is dependent on effective teamwork within teaching teams. Still, it remains unclear whether this team effort benefits residents' perceptions of the learning climate. We, therefore, investigated to what extent teamwork effectiveness within teaching teams is associated with (1) the overall learning climate, and (2) its affective, cognitive and instrumental facets?Methods: This study used a web-based platform to collect data in clinical departments in the Netherlands from January 2014 to May 2017. Teamwork effectiveness was measured with the TeamQ questionnaire, administered amongst clinical teachers. The learning climate was measured with the D-RECT, applied amongst residents. Associations were analyzed using multilevel models and multivariate general linear models.Results: Teamwork effectiveness was positively associated with the overall learning climate as well as with the affective and the instrumental facets of the learning climate. No significant associations were found with the cognitive facet.Conclusion: Effective teamwork within teaching teams benefits learning climates in postgraduate medical education. Therefore, departments aiming to improve their learning climate should target teamwork within teaching teams.
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Affiliation(s)
- Iris Jansen
- Professional Performance and Compassionate Care Research Group, Department of Medical Psychology, Amsterdam UMC/University of Amsterdam, Amsterdam, the Netherlands
| | - Milou E W M Silkens
- Professional Performance and Compassionate Care Research Group, Department of Medical Psychology, Amsterdam UMC/University of Amsterdam, Amsterdam, the Netherlands
| | - Renée E Stalmeijer
- Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Kiki M J M H Lombarts
- Professional Performance and Compassionate Care Research Group, Department of Medical Psychology, Amsterdam UMC/University of Amsterdam, Amsterdam, the Netherlands
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Rodino AM, Wolcott MD. Assessing Preceptor Use of Cognitive Apprenticeship: Is the Maastricht Clinical Teaching Questionnaire (MCTQ) a Useful Approach? TEACHING AND LEARNING IN MEDICINE 2019; 31:506-518. [PMID: 31064222 DOI: 10.1080/10401334.2019.1604356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Construct: The authors investigated the utility of the Maastricht Clinical Teaching Questionnaire (MCTQ) to assess preceptor use of cognitive apprenticeship teaching methods. Background: The MCTQ is an instrument first studied in medical and veterinary education; it was shown to produce valid and reliable data when evaluating how well preceptors engage in cognitive apprenticeship. Additional validity evidence, however, is needed to determine if the MCTQ is useful and applicable in other healthcare professions, such as pharmacy. Approach: Student pharmacists and pharmacy residents at a large academic medical center completed the MCTQ to evaluate pharmacist preceptors. A confirmatory factor analysis (CFA) was used to determine how consistent the data were with the 5-factor structure of the cognitive apprenticeship teaching methods (e.g., modeling, coaching, articulation, exploration, and safe learning environment). A structural equation model (SEM) was used to evaluate the relationship between the 5 factors. Preceptor and student perceptions were also collected to evaluate the response process and potential consequences of using the instrument. Results: Thirty-eight learners (2nd-year and 4th-year student pharmacists and pharmacy residents) submitted 157 evaluations. The CFA showed appreciable fit with the 5-factor structure of the cognitive apprenticeship framework after 2 modifications (removal of 1 item and moving 1 item to a different factor). The SEM had poor model fit compared to previous studies, and an exploratory analysis suggests that there is a complex relationship between the various teaching methods. Preceptors and students highly agreed that the instrument was valuable for providing feedback. Conclusion: The MCTQ has additional validity evidence that supports it as a viable instrument to assess preceptor engagement in teaching methods consistent with the cognitive apprenticeship framework. Additional research is warranted to explore the relationship between components in the cognitive apprenticeship framework to determine how preceptors can best focus their efforts to improve clinical teaching.
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Affiliation(s)
- Anne M Rodino
- Department of Pharmacy, University of North Carolina Hospital, Chapel Hill, North Carolina, USA
| | - Michael D Wolcott
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
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Al Ansari A, Tabbara KS. Evaluating the Reliability and Validity of the Maastricht Clinical Teaching Questionnaire in Bahrain. Oman Med J 2019; 34:427-433. [PMID: 31555419 PMCID: PMC6745430 DOI: 10.5001/omj.2019.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives The Maastricht Clinical Teaching Questionnaire (MCTQ) was developed to evaluate clinical teachers’ supervisory skills during undergraduate clinical rotations. Evidence exists supporting the reliability and validity of this questionnaire. Our study sought to examine the reliability and validity of the MCTQ in a Middle Eastern context. Methods Between 2016 and 2017, we evaluated a total of 549 medical students in their final year who were undergoing clinical rotations using the MCTQ. The construct validity was assessed using exploratory and confirmatory factor analysis. Internal consistency reliability was measured using Cronbach’s alpha. Factor scores were compared with other outcomes to explore the relationship with other relevant variables. Results A four-factor model demonstrated an adequate fit with the data. The findings showed good internal consistency reliability. The following results were obtained for the four-factor model: chi-square divided by degrees of freedom was 5.026, and the comparative index, goodness of fit index, normalized fit index, and non-normalized fit index were all above 0.800 (0.955, 0.858, 0.950, and 0.952, respectively). The standardized root mean square residual was 0.016, and the root mean square error of approximation score was 0.086. Acceptable reliability was achieved with 10 evaluations per teacher. We observed a strong correlation between factors and overall judgment. Conclusions Our study suggests that the MCTQ is a valid and reliable instrument to evaluate teachers’ performance during clinical rotations in Bahrain.
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Affiliation(s)
- Ahmed Al Ansari
- Training and Education Department, Bahrain Defense Force Hospital, Riffa, Bahrain.,Medical Education Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Khaled Saeed Tabbara
- Department of Microbiology, Immunology and Infection Diseases, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
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van der Meulen MW, Smirnova A, Heeneman S, Oude Egbrink MGA, van der Vleuten CPM, Lombarts KMJMH. Exploring Validity Evidence Associated With Questionnaire-Based Tools for Assessing the Professional Performance of Physicians: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1384-1397. [PMID: 31460937 DOI: 10.1097/acm.0000000000002767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To collect and examine-using an argument-based validity approach-validity evidence of questionnaire-based tools used to assess physicians' clinical, teaching, and research performance. METHOD In October 2016, the authors conducted a systematic search of the literature seeking articles about questionnaire-based tools for assessing physicians' professional performance published from inception to October 2016. They included studies reporting on the validity evidence of tools used to assess physicians' clinical, teaching, and research performance. Using Kane's validity framework, they conducted data extraction based on four inferences in the validity argument: scoring, generalization, extrapolation, and implications. RESULTS They included 46 articles on 15 tools assessing clinical performance and 72 articles on 38 tools assessing teaching performance. They found no studies on research performance tools. Only 12 of the tools (23%) gathered evidence on all four components of Kane's validity argument. Validity evidence focused mostly on generalization and extrapolation inferences. Scoring evidence showed mixed results. Evidence on implications was generally missing. CONCLUSIONS Based on the argument-based approach to validity, not all questionnaire-based tools seem to support their intended use. Evidence concerning implications of questionnaire-based tools is mostly lacking, thus weakening the argument to use these tools for formative and, especially, for summative assessments of physicians' clinical and teaching performance. More research on implications is needed to strengthen the argument and to provide support for decisions based on these tools, particularly for high-stakes, summative decisions. To meaningfully assess academic physicians in their tripartite role as doctor, teacher, and researcher, additional assessment tools are needed.
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Affiliation(s)
- Mirja W van der Meulen
- M.W. van der Meulen is PhD candidate, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands, and member, Professional Performance Research Group, Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; ORCID: https://orcid.org/0000-0003-3636-5469. A. Smirnova is PhD graduate and researcher, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands, and member, Professional Performance Research Group, Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; ORCID: https://orcid.org/0000-0003-4491-3007. S. Heeneman is professor, Department of Pathology, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands; ORCID: https://orcid.org/0000-0002-6103-8075. M.G.A. oude Egbrink is professor, Department of Physiology, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands; ORCID: https://orcid.org/0000-0002-5530-6598. C.P.M. van der Vleuten is professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands; ORCID: https://orcid.org/0000-0001-6802-3119. K.M.J.M.H. Lombarts is professor, Professional Performance Research Group, Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; ORCID: https://orcid.org/0000-0001-6167-0620
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Butler BA, Butler CM, Peabody TD. Cognitive Apprenticeship in Orthopaedic Surgery: Updating a Classic Educational Model. JOURNAL OF SURGICAL EDUCATION 2019; 76:931-935. [PMID: 30738729 DOI: 10.1016/j.jsurg.2019.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/24/2018] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To define cognitive apprenticeship and describe how it can be applied to orthopedic education. DESIGN Traditional apprenticeships have been used through history as a teaching model for wide variety of skills. These apprenticeships are characterized by practical, on-the-job training in which the apprentice observes and assists a master in the completion of a task, and thereby learns the skills needed to complete that task on his or her own. RESULTS Cognitive apprenticeship is differentiated from the traditional apprenticeship model primarily by its educational goals. Cognitive apprenticeships are used to teach skills which require internal though processes which cannot be readily observed externally by the teacher or the student. CONCLUSION Here, we review the history of the cognitive apprenticeship concept, its basic principles, its applications to a wide variety of educational circumstances, and its potential use a framework for developing orthopedic curricula.
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Affiliation(s)
- Bennet A Butler
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
| | - Cameron M Butler
- University of Maryland College of Education, College Park, Maryland
| | - Terrance D Peabody
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Chicago, Illinois
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Díaz LA, Sepúlveda P, Abbott E, Fuentes-López E, Letelier LM, Riquelme A, Aizman A. “Residents get no… satisfaction” a problem to face during internal medicine rotations: development and psychometric properties of the IMPRINT-15. Postgrad Med J 2019; 95:96-101. [PMID: 30787196 DOI: 10.1136/postgradmedj-2018-136187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/24/2018] [Accepted: 01/06/2019] [Indexed: 11/04/2022]
Abstract
Clinical rotations are an essential part of Internal Medicine (IM) residency programmes, where curricular objectives are carried out. To our knowledge, there are no validated instruments to assess IM clinical rotations. Our objective was to develop an instrument for residents to assess the quality of clinical rotations in an IM residency programme, and to test the psychometric properties of the instrument. A mixed methodology was used, including qualitative and quantitative phases. Items were proposed by a group of experts based on previously identified residency needs, followed by a quantitative phase to generate consensus among educators and residents to define which items would be included in the instrument (Delphi panel). After generating the instrument, psychometric tests were performed to assess construct validity (factor analysis) and reliability (Raykov’s reliability coefficient). We obtained a 15-item instrument after two Delphi rounds: Internal Medicine Program Instrument 15-items (IMPRINT-15). Sixty-two residents answered 428 surveys using a Likert scale during 7 months (response rate 98.9%). The median score was 4.3 (IQR 3.9–4.7) (scale from 1 to 5). The factor analysis showed two domains in the clinical rotation assessment: (1) teaching and care activities; (2) evaluation and feedback. The instrument is reliable with Raykov’s reliability coefficient of 0.86. Also, Raykov’s reliability coefficient for the domains were 0.89 and 0.83, respectively. The IMPRINT-15 instrument is a bi-dimensional, valid and reliable questionnaire to evaluate the perceived quality by residents of the IM clinical rotations. Also, it constitutes the first validated instrument in this field worldwide.
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Potisek NM, Page L, Narayan A, McNeal-Trice K, Steiner MJ. The Association Between Pediatric Faculty Factors and Resident Physician Ratings of Teaching Effectiveness. Glob Pediatr Health 2019; 6:2333794X18822996. [PMID: 30719494 PMCID: PMC6348494 DOI: 10.1177/2333794x18822996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 11/16/2022] Open
Abstract
Background. Faculty factors not inherently related to teaching effectiveness can influence teaching ratings. No studies have focused on pediatric faculty who possess unique differences from general medical faculty. Methods. We designed a retrospective observational study to compare faculty teaching ratings with measured factors across 3 academic pediatric institutions. Results. Our study included 196 faculty members. The majority (76%) of variation in teaching effectiveness ratings was not accounted for by any measured variable, but 24% was attributed to measurable factors. Increased resident exposure (sequential r 2 = .10, P < .0001) significantly affected teaching effectiveness. Variation between resident ratings of pediatric faculty teaching can be partially explained by measured factors not necessarily related to teaching effectiveness. Conclusions. The identification of faculty factors that significantly contribute to rating variation can enhance interpretation of these rating.
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Affiliation(s)
| | - Laura Page
- Duke University Hospital, Durham, NC, USA
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Lui VH, Toner P, Matthews H. Reflection and redesign of a residency program for the hospital pharmacist. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Viki H. Lui
- The Royal Melbourne Hospital Melbourne Australia
| | - Paul Toner
- The Royal Melbourne Hospital Melbourne Australia
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Reflective learning with complex problems in a visualization-based learning environment with expert support. COMPUTERS IN HUMAN BEHAVIOR 2018. [DOI: 10.1016/j.chb.2018.01.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Vaughan B. Exploring the measurement properties of the osteopathy clinical teaching questionnaire using Rasch analysis. Chiropr Man Therap 2018; 26:13. [PMID: 29744031 PMCID: PMC5932865 DOI: 10.1186/s12998-018-0182-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 03/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Clinical teaching evaluations are common in health profession education programs to ensure students are receiving a quality clinical education experience. Questionnaires students use to evaluate their clinical teachers have been developed in professions such as medicine and nursing. The development of a questionnaire that is specifically for the osteopathy on-campus, student-led clinic environment is warranted. Previous work developed the 30-item Osteopathy Clinical Teaching Questionnaire. The current study utilised Rasch analysis to investigate the construct validity of the Osteopathy Clinical Teaching Questionnaire and provide evidence for the validity argument through fit to the Rasch model. Methods Senior osteopathy students at four institutions in Australia, New Zealand and the United Kingdom rated their clinical teachers using the Osteopathy Clinical Teaching Questionnaire. Three hundred and ninety-nine valid responses were received and the data were evaluated for fit to the Rasch model. Reliability estimations (Cronbach's alpha and McDonald's omega) were also evaluated for the final model. Results The initial analysis demonstrated the data did not fit the Rasch model. Accordingly, modifications to the questionnaire were made including removing items, removing person responses, and rescoring one item. The final model contained 12 items and fit to the Rasch model was adequate. Support for unidimensionality was demonstrated through both the Principal Components Analysis/t-test, and the Cronbach's alpha and McDonald's omega reliability estimates. Analysis of the questionnaire using McDonald's omega hierarchical supported a general factor (quality of clinical teaching in osteopathy). Conclusion The evidence for unidimensionality and the presence of a general factor support the calculation of a total score for the questionnaire as a sufficient statistic. Further work is now required to investigate the reliability of the 12-item Osteopathy Clinical Teaching Questionnaire to provide evidence for the validity argument.
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Affiliation(s)
- Brett Vaughan
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
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Bush MA, Rushton S, Conklin JL, Oermann MH. Considerations for Developing a Student Evaluation of Teaching Form. TEACHING AND LEARNING IN NURSING 2018. [DOI: 10.1016/j.teln.2017.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schriver M, Cubaka VK, Vedsted P, Besigye I, Kallestrup P. Development and validation of the ExPRESS instrument for primary health care providers' evaluation of external supervision. Glob Health Action 2018; 11:1445466. [PMID: 29547066 PMCID: PMC5945230 DOI: 10.1080/16549716.2018.1445466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: External supervision of primary health care facilities to monitor and improve services is common in low-income countries. Currently there are no tools to measure the quality of support in external supervision in these countries. Aim: To develop a provider-reported instrument to assess the support delivered through external supervision in Rwanda and other countries. Methods: “External supervision: Provider Evaluation of Supervisor Support” (ExPRESS) was developed in 18 steps, primarily in Rwanda. Content validity was optimised using systematic search for related instruments, interviews, translations, and relevance assessments by international supervision experts as well as local experts in Nigeria, Kenya, Uganda and Rwanda. Construct validity and reliability were examined in two separate field tests, the first using exploratory factor analysis and a test–retest design, the second for confirmatory factor analysis. Results: We included 16 items in section A (‘The most recent experience with an external supervisor’), and 13 items in section B (‘The overall experience with external supervisors’). Item-content validity index was acceptable. In field test I, test–retest had acceptable kappa values and exploratory factor analysis suggested relevant factors in sections A and B used for model hypotheses. In field test II, models were tested by confirmatory factor analysis fitting a 4-factor model for section A, and a 3-factor model for section B. Conclusions: ExPRESS is a promising tool for evaluation of the quality of support of primary health care providers in external supervision of primary health care facilities in resource-constrained settings. ExPRESS may be used as specific feedback to external supervisors to help identify and address gaps in the supervision they provide. Further studies should determine optimal interpretation of scores and the number of respondents needed per supervisor to obtain precise results, as well as test the functionality of section B.
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Affiliation(s)
- Michael Schriver
- a Center for Global Health, Department of Public Health , Aarhus University , Aarhus , Denmark
| | - Vincent Kalumire Cubaka
- a Center for Global Health, Department of Public Health , Aarhus University , Aarhus , Denmark.,b School of Medicine and Pharmacy, College of Medicine and Health Sciences , University of Rwanda , Kigali , Rwanda
| | - Peter Vedsted
- c Research Unit for General Practice, Department of Public Health , Aarhus University , Aarhus , Denmark
| | - Innocent Besigye
- d Department of Family Medicine, School of Medicine , Makerere University , Kampala , Uganda
| | - Per Kallestrup
- a Center for Global Health, Department of Public Health , Aarhus University , Aarhus , Denmark
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Bearman M, Tai J, Kent F, Edouard V, Nestel D, Molloy E. What should we teach the teachers? Identifying the learning priorities of clinical supervisors. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:29-41. [PMID: 28315114 DOI: 10.1007/s10459-017-9772-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/09/2017] [Indexed: 06/06/2023]
Abstract
Clinicians who teach are essential for the health workforce but require faculty development to improve their educational skills. Curricula for faculty development programs are often based on expert frameworks without consideration of the learning priorities as defined by clinical supervisors themselves. We sought to inform these curricula by highlighting clinical supervisors own requirements through answering the research question: what do clinical supervisors identify as relative strengths and areas for improvement in their teaching practice? This mixed methods study employed a modified version of the Maastricht Clinical Teaching Questionnaire (mMCTQ) which included free-text reflections. Descriptive statistics were calculated and content analysis was conducted on textual comments. 481 (49%) of 978 clinical supervisors submitted their mMCTQs and associated reflections for the research study. Clinical supervisors self-identified relatively strong capability with interpersonal skills or attributes and indicated least capability with assisting learners to explore strengths, weaknesses and learning goals. The qualitative category 'establishing relationships' was the most reported strength with 224 responses. The qualitative category 'feedback' was the most reported area for improvement, with 151 responses. Key areas for curricular focus include: improving feedback practices; stimulating reflective and agentic learning; and managing the logistics of a clinical education environment. Clinical supervisors' self-identified needs provide a foundation for designing engaging and relevant faculty development programs.
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Affiliation(s)
- Margaret Bearman
- Centre for Research into Assessment and Digital Learning (CRADLE), Deakin University, Geelong, Australia.
| | - Joanna Tai
- Centre for Research into Assessment and Digital Learning (CRADLE), Deakin University, Geelong, Australia
| | - Fiona Kent
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- WISER Unit, Monash Health, Melbourne, Australia
| | - Vicki Edouard
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Debra Nestel
- Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Monash Institute of Health and Clinical Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Elizabeth Molloy
- Department of Medical Education, University of Melbourne, Melbourne, Australia
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Effects of a Short Video–Based Resident-as-Teacher Training Toolkit on Resident Teaching. Obstet Gynecol 2017; 130 Suppl 1:36S-41S. [DOI: 10.1097/aog.0000000000002203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dreiling K, Montano D, Poinstingl H, Müller T, Schiekirka-Schwake S, Anders S, von Steinbüchel N, Raupach T. Evaluation in undergraduate medical education: Conceptualizing and validating a novel questionnaire for assessing the quality of bedside teaching. MEDICAL TEACHER 2017; 39:820-827. [PMID: 28532203 DOI: 10.1080/0142159x.2017.1324136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Evaluation is an integral part of curriculum development in medical education. Given the peculiarities of bedside teaching, specific evaluation tools for this instructional format are needed. Development of these tools should be informed by appropriate frameworks. The purpose of this study was to develop a specific evaluation tool for bedside teaching based on the Stanford Faculty Development Program's clinical teaching framework. METHODS Based on a literature review yielding 47 evaluation items, an 18-item questionnaire was compiled and subsequently completed by undergraduate medical students at two German universities. Reliability and validity were assessed in an exploratory full information item factor analysis (study one) and a confirmatory factor analysis as well as a measurement invariance analysis (study two). RESULTS The exploratory analysis involving 824 students revealed a three-factor structure. Reliability estimates of the subscales were satisfactory (α = 0.71-0.84). The model yielded satisfactory fit indices in the confirmatory factor analysis involving 1043 students. DISCUSSION The new questionnaire is short and yet based on a widely-used framework for clinical teaching. The analyses presented here indicate good reliability and validity of the instrument. Future research needs to investigate whether feedback generated from this tool helps to improve teaching quality and student learning outcome.
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Affiliation(s)
- Katharina Dreiling
- a Department of Cardiology and Pneumology , University Hospital Göttingen , Göttingen , Germany
| | - Diego Montano
- b Institute of Medical Psychology and Medical Sociology , Georg-August-University Göttingen , Göttingen , Germany
| | - Herbert Poinstingl
- b Institute of Medical Psychology and Medical Sociology , Georg-August-University Göttingen , Göttingen , Germany
| | - Tjark Müller
- c Department of Legal Medicine , University Medical Centre Hamburg-Eppendorf , Hamburg , Germany
| | - Sarah Schiekirka-Schwake
- d Division of Medical Education Research and Curriculum Development , Study Deanery of Göttingen Medical School , Göttingen , Germany
| | - Sven Anders
- c Department of Legal Medicine , University Medical Centre Hamburg-Eppendorf , Hamburg , Germany
| | - Nicole von Steinbüchel
- b Institute of Medical Psychology and Medical Sociology , Georg-August-University Göttingen , Göttingen , Germany
| | - Tobias Raupach
- a Department of Cardiology and Pneumology , University Hospital Göttingen , Göttingen , Germany
- d Division of Medical Education Research and Curriculum Development , Study Deanery of Göttingen Medical School , Göttingen , Germany
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Lyons K, McLaughlin JE, Khanova J, Roth MT. Cognitive apprenticeship in health sciences education: a qualitative review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:723-739. [PMID: 27544386 DOI: 10.1007/s10459-016-9707-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 08/11/2016] [Indexed: 05/23/2023]
Abstract
Cognitive apprenticeship theory emphasizes the process of making expert thinking "visible" to students and fostering the cognitive and meta-cognitive processes required for expertise. The purpose of this review was to evaluate the use of cognitive apprenticeship theory with the primary aim of understanding how and to what extent the theory has been applied to the design, implementation, and analysis of education in the health sciences. The initial search yielded 149 articles, with 45 excluded because they contained the term "cognitive apprenticeship" only in reference list. The remaining 104 articles were categorized using a theory talk coding scheme. An in depth qualitative synthesis and review was conducted for the 26 articles falling into the major theory talk category. Application of cognitive apprenticeship theory tended to focus on the methods dimension (e.g., coaching, mentoring, scaffolding), with some consideration for the content and sociology dimensions. Cognitive apprenticeship was applied in various disciplines (e.g., nursing, medicine, veterinary) and educational settings (e.g., clinical, simulations, online). Health sciences education researchers often used cognitive apprenticeship to inform instructional design and instrument development. Major recommendations from the literature included consideration for contextual influences, providing faculty development, and expanding application of the theory to improve instructional design and student outcomes. This body of research provides critical insight into cognitive apprenticeship theory and extends our understanding of how to develop expert thinking in health sciences students. New research directions should apply the theory into additional aspects of health sciences educational research, such as classroom learning and interprofessional education.
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Affiliation(s)
- Kayley Lyons
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jacqueline E McLaughlin
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Julia Khanova
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary T Roth
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kikukawa M, Stalmeijer RE, Okubo T, Taketomi K, Emura S, Miyata Y, Yoshida M, Schuwirth L, Scherpbier AJJA. Development of culture-sensitive clinical teacher evaluation sheet in the Japanese context. MEDICAL TEACHER 2017; 39:844-850. [PMID: 28509610 DOI: 10.1080/0142159x.2017.1324138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM Many instruments for evaluating clinical teaching have been developed, albeit most in Western countries. This study aims to develop a validated cultural and local context sensitive instrument for clinical teachers in an East Asian setting (Japan), Japanese Clinical Teacher Evaluation Sheet (JaCTES). METHODS A multicenter, cross-sectional evaluation study was conducted. We collected a total of 1368 questionnaires on 304 clinical teachers, completed by residents in 16 teaching hospitals. The construct validity was examined by conducting a factor analysis and using structural equation modeling (SEM). We also assessed the reliability using generalizability analysis and decision study. RESULTS Exploratory factor analysis resulted in three-factor (role model, teaching activities, and accessibility) model including 18 items. Confirmatory factor analysis was performed, using SEM. The comparative fit index was 0.931 and the root mean square error of approximation was 0.087, meaning an acceptable goodness of fit for this model. To obtain a reliable dependability-coefficient of at least 0.70 or higher, 5-8 resident responses are necessary. DISCUSSION AND CONCLUSION JaCTES is the first reported instrument with validity evidence of content and internal structure and high feasibility in Japan, an East Asian setting. Medical educators should be aware of the local context and cultural aspects in evaluating clinical teachers.
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Affiliation(s)
- Makoto Kikukawa
- a Department of Medical Education , Kyushu University , Fukuoka, Japan
| | - Renee E Stalmeijer
- b Faculty of Health, Medicine, and Life Sciences, Department of Educational Development and Research , Maastricht University , Maastricht , The Netherlands
| | - Tomoya Okubo
- c The National Center for University Entrance Examinations , Research Division , Tokyo , Japan
| | - Kikuko Taketomi
- d Center for Medical Education , Hokkaido University , Sapporo , Japan
| | - Sei Emura
- e The Center for Graduate Medical Education Development and Research, Saga University Hospital , Saga , Japan
| | - Yasushi Miyata
- f Department of Primary Care and Community Health , Aichi Medical University School of Medicine , Nagakute , Japan
| | - Motofumi Yoshida
- g Office of Medical Education , International University of Health and Welfare , Narita , Japan
| | - Lambert Schuwirth
- h Prideaux Centre for Research in Health Professions Education, Flinders University , Adelaide, Australia
| | - Albert J J A Scherpbier
- b Faculty of Health, Medicine, and Life Sciences, Department of Educational Development and Research , Maastricht University , Maastricht , The Netherlands
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Olmos-Vega FM, Dolmans DHJM, Vargas-Castro N, Stalmeijer RE. Dealing with the tension: how residents seek autonomy and participation in the workplace. MEDICAL EDUCATION 2017; 51:699-707. [PMID: 28436048 DOI: 10.1111/medu.13326] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/07/2016] [Accepted: 02/10/2017] [Indexed: 05/14/2023]
Abstract
CONTEXT The workplace can be a strenuous setting for residents: although it offers a wealth of learning opportunities, residents find themselves juggling their responsibilities. Even though supervisors regulate what is afforded to residents, the former find it difficult to strike the proper balance between residents' independence and support, which could create tensions. But what tensions do residents experience during clinical supervision and how do they cope with them to maximise their learning opportunities? Understanding how residents act on different affordances in the workplace is of paramount importance, as it influences their learning. METHOD Residents from different levels of training and disciplines participated in three focus groups (n = 19) and 10 semi-structured interviews (n = 10). The authors recruited these trainees using purposive and convenience sampling. Audio-recordings were transcribed verbatim and the ensuing scripts were analysed using a constructivist grounded theory methodology. RESULTS Residents reported that the autonomy and practice opportunities given by their supervisors were either excessive or too limited, and both were perceived as tensions. When in excess, trainees enlisted the help of their supervisor or peers, depending on how safe they recognised the learning environment to be. When practice opportunities were curtailed, trainees tried to negotiate more if they felt the learning environment was safe. When they did not, trainees became passive observers. Learning from each engagement was subject to the extent of intersubjectivity achieved between the actors involved. CONCLUSIONS Tensions arose when supervisors did not give trainees the desired degree of autonomy and opportunities to participate. Trainees responded in various ways to maximise their learning opportunities. For these different engagement-related responses to enhance workplace learning in specialty training, achieving intersubjectivity between trainee and supervisor seems foundational.
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Affiliation(s)
- Francisco M Olmos-Vega
- Department of Anaesthesiology, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Diana H J M Dolmans
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Nicolas Vargas-Castro
- Department of Anaesthesiology, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Renée E Stalmeijer
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
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Dybowski C, Sehner S, Harendza S. Influence of motivation, self-efficacy and situational factors on the teaching quality of clinical educators. BMC MEDICAL EDUCATION 2017; 17:84. [PMID: 28482895 PMCID: PMC5423026 DOI: 10.1186/s12909-017-0923-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 04/27/2017] [Indexed: 05/15/2023]
Abstract
BACKGROUND Being exposed to good teachers has been shown to enhance students' knowledge and their clinical performance, but little is known about the underlying psychological mechanisms that provide the basis for being an excellent medical teacher. Self-Determination Theory (SDT) postulates that more self-regulated types of motivation are associated with higher performance. Social Cognitive Theory (SCT) focuses on self-efficacy that has been shown to be positively associated with performance. To investigate the influences of different types of teaching motivation, teaching self-efficacy, and teachers' perceptions of students' skills, competencies and motivation on teaching quality. METHODS Before the winter semester 2014, physicians involved in bedside teaching in internal medicine at the University Medical Center Hamburg-Eppendorf completed a questionnaire with sociodemographic items and instruments measuring different dimensions of teaching motivation as well as teaching self-efficacy. During the semester, physicians rated their perceptions of the participating students who rated the teaching quality after each lesson. We performed a random intercept mixed-effects linear regression with students' ratings of teaching quality as the dependent variable and students' general interest in a subject as covariate. We explored potential associations between teachers' dispositions and their perceptions of students' competencies in a mixed-effects random intercept logistic regression. RESULTS 94 lessons given by 55 teachers with 500 student ratings were analyzed. Neither teaching motivation nor teaching self-efficacy were directly associated with students' rating of teaching quality. Teachers' perceptions of students' competencies and students' general interest in the lesson's subject were positively associated with students' rating of teaching quality. Physicians' perceptions of their students' competencies were significantly positively predicted by their teaching self-efficacy. CONCLUSIONS Teaching quality might profit from teachers who are self-efficacious and able to detect their students' competencies. Students' general interest in a lesson's subject needs to be taken into account when they are asked to evaluate teaching quality.
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Affiliation(s)
- Christoph Dybowski
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246 Germany
| | - Susanne Sehner
- Institute for Biometrics and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246 Germany
| | - Sigrid Harendza
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246 Germany
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Stephan A, Cheung G. Clinical teaching and supervision in postgraduate psychiatry training: the trainee perspective. Australas Psychiatry 2017; 25:191-197. [PMID: 27879425 DOI: 10.1177/1039856216679539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to explore psychiatry trainees' perspectives on clinical teaching and supervision as well as how this might be improved. METHOD New Zealand trainees ( n=51) completed online the Maastricht Clinical Teaching Questionnaire (MCQT) and three open-ended questions. RESULTS The majority rated 'agree' or 'strongly agree' to all items of the MCQT. Weaknesses in the feedback process including observation, feedback provision, and formulating learning goals were highlighted. College training requirements and workplace environment were identified as factors impacting on clinical teaching and supervision. CONCLUSIONS A model was proposed to enhance awareness of the various factors involved in the feedback process.
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Affiliation(s)
- Alice Stephan
- Director of Training (Psychiatry), Upper Central North Island, Waikato District Health Board, Hamilton, New Zealand
| | - Gary Cheung
- Senior Lecturer, Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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Leppink J. Evaluating the strength of evidence in research and education: The theory of anchored narratives. J Taibah Univ Med Sci 2017; 12:284-290. [PMID: 31435253 PMCID: PMC6695088 DOI: 10.1016/j.jtumed.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/12/2017] [Accepted: 01/15/2017] [Indexed: 11/29/2022] Open
Abstract
Empirical research based on groups of participants and assessment of the competence of individual students, trainees, and professionals in a given context have at least one thing in common: evidence in favour or against a hypothesis should be established by carefully considering and integrating various pieces of evidence to create a coherent story that has no contradictions, loose ends or missing elements. To provide a coherent framework for this process, this article introduces a modified version of a theory that has been used as a model of legal decision making in criminal cases: the theory of anchored narratives. In this theory, judges in a case judge the quality of pieces of evidence and whether these pieces of evidence can be anchored as narratives to form a chain of evidence that enables a decision beyond reasonable doubt regarding a suspect's guilt. This article provides examples from the domain of medicine to elaborate how a modified version of this theory can provide researchers and educators with a framework in which the assessment of both empirical research and competence is a qualitative professional judgement based on an integration of various sources of qualitative and quantitative information.
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Affiliation(s)
- Jimmie Leppink
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Eggleton K, Goodyear-Smith F, Henning M, Jones R, Shulruf B. A psychometric evaluation of the University of Auckland General Practice Report of Educational Environment: UAGREE. EDUCATION FOR PRIMARY CARE 2016; 28:86-93. [DOI: 10.1080/14739879.2016.1268934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kyle Eggleton
- Faculty of Medical & Health Science, Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Felicity Goodyear-Smith
- Faculty of Medical & Health Science, Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Marcus Henning
- Faculty of Medical & Health Science, Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Rhys Jones
- Faculty of Medical & Health Science, Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | - Boaz Shulruf
- Faculty of Medicine, Medical Education, University of New South Wales, Sydney, Australia
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Huete Á, Julio R, Rojas V, Herrera C, Padilla O, Solís N, Pizarro M, Etcheberry L, Sarfatis A, Pérez G, Díaz LA, Delfino A, Muñoz E, Rivera H, Parra DA, Bitran M, Riquelme A. Evaluation of Radiology Teachers' Performance and Identification of the "Best Teachers" in a Residency Program: Mixed Methodology and Pilot Study of the MEDUC-RX32 Questionnaire. Acad Radiol 2016; 23:779-88. [PMID: 27060856 DOI: 10.1016/j.acra.2016.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 02/20/2016] [Accepted: 02/21/2016] [Indexed: 10/22/2022]
Abstract
RATIONALE AND OBJECTIVES Radiology teachers are well trained in their specialty; however, when working in academic institutions, faculty development and promotion through the education pathway tends to be based on their teaching knowledge and skills. The aim of this study is to assess psychometric properties of the Medicina Universidad Católica-Radiology 32 items (MEDUC-RX32), an instrument designed to evaluate the performance of postgraduate radiology teachers and to identify the best teachers. MATERIALS AND METHODS Mixed methodology was used, including qualitative and quantitative phases. The psychometric properties of the MEDUC-RX32 survey were performed by factor analysis (validity), Cronbach alpha coefficient, and G coefficient (reliability). The residents assessed their teachers and simultaneously voted for the "best teacher," which was used as a gold standard for the receiver operating characteristic curves construction comparing their votes with the global score. RESULTS A total of 28 residents answered 164 surveys. The global score was 6.23 ± 0.8 (scale from 1 to 7). The factor analysis showed six domains of the resident's perception: (1) tutorial teaching, feedback, and independent learning; (2) communication and teamwork; (3) learning objectives; (4) respectful behavior; (5) radiological report; and (6) teaching and care support. The tutor's strengths were related with respectful behavior and teamwork. The instrument is highly reliable with a Cronbach alpha of 0.937 and a G coefficient of 0.831 (with a minimum of 8 residents). The MEDUC-RX32 instrument has a sensitivity of 91.7% and specificity of 83.3% to identify tutors as best teachers with at least one vote with an area under the receiver operating characteristic curve of 0.931 with a cutoff of 5.94. CONCLUSIONS The MEDC-RX32 instrument is a multidimensional, valid, and highly reliable method to evaluate radiology teachers, identifying teachers with excellence in tutorial teaching in a postgraduate radiology program.
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Mack HG, Sandhu SS, Filipe HP. Developing educators for continuing professional development. CANADIAN JOURNAL OF OPHTHALMOLOGY 2016; 51:196-200. [PMID: 27316269 DOI: 10.1016/j.jcjo.2016.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 02/27/2016] [Accepted: 03/12/2016] [Indexed: 10/21/2022]
Abstract
Continuing professional development (CPD) is part of the medical education continuum, has been shown to produce improved physician practice and good patient outcomes, and is increasingly required for revalidation of medical licensure. CPD can be considered a discipline in its own right but is the least formally organized stage in medical education. CPD educators play a central role, but there has been remarkably little published work specifically describing CPD educators. This narrative review, using ophthalmology as exemplar medical specialty, describes trends affecting CPD educators and their sources, attributes, and development needs, mainly extrapolated from information regarding other medical educators in the medical education continuum spectrum. Future research needs are discussed.
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Holdsworth C, Skinner EH, Delany CM. Using simulation pedagogy to teach clinical education skills: A randomized trial. Physiother Theory Pract 2016; 32:284-95. [DOI: 10.3109/09593985.2016.1139645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Clare Holdsworth
- Department of Physiotherapy, Western Health, Footscray, Victoria, Australia
| | - Elizabeth H. Skinner
- Department of Physiotherapy, Western Health, Footscray, Victoria, Australia
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, Victoria, Australia
| | - Clare M. Delany
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
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