Impact of a teaching attending physician on medical student, resident, and faculty perceptions and satisfaction

Interventions to improve the well-being of medical learners in Canada: a scoping review

BACKGROUND

Medical education affects learner well-being. We explored the breadth and depth of interventions to improve the well-being of medical learners in Canada.

METHODS

We searched MEDLINE, EMBASE, CINAHL and PsycINFO from inception to July 11, 2020, using the Arksey-O'Malley, 5-stage, scoping review method. We included interventions to improve well-being across 5 wellness domains (i.e., social, mental, physical, intellectual, occupational) for medical learners in Canada, grouped as undergraduate or graduate nonmedical (i.e., health sciences) students, undergraduate medical students or postgraduate medical students (i.e., residents). We categorized interventions as targeting the individual (learner), program (i.e., in which learners are enrolled) or system (i.e., higher education or health care) levels.

RESULTS

Of 1753 studies identified, we included 65 interventions that aimed to improve well-being in 10 202 medical learners, published from 1972 through 2020; 52 (80%) were uncontrolled trials. The median year for intervention implementation was 2010 (range 1971-2018) and the median length was 3 months (range 1 h-48 mo). Most (n = 34, 52%) interventions were implemented with undergraduate medical students. Two interventions included only undergraduate, nonmedical students; none included graduate nonmedical students. Most studies (n = 51, 78%) targeted intellectual well-being, followed by occupational (n = 32, 49%) and social (n = 17, 26%) well-being. Among 19 interventions implemented for individuals, 14 (74%) were for medical students; of the 27 program-level interventions, 17 (63%) were for resident physicians. Most (n = 58, 89%) interventions reported positive well-being outcomes.

INTERPRETATION

Many Canadian medical schools address intellectual, occupational and social well-being by targeting interventions at medical learners. Important emphasis on the mental and physical well-being of medical learners in Canada warrants further exploration.

Teaching Rapid Assessment Skills in Triage for the Emergency Medicine Clerkship

BACKGROUND

Rapidly assessing an undifferentiated patient and developing a gestalt for "sick vs. not sick" is a core component of emergency medicine (EM). Developing this skill requires clinical experience and pattern recognition, which can be difficult to attain during a typical EM clerkship.

OBJECTIVE

We developed a novel approach to teaching medical students rapid assessment skills in the emergency department (ED) by implementing a teaching shift in triage.

METHODS

Fourth-year medical students in our EM clerkship in fall 2019 were scheduled one shift in triage with a dedicated teaching attending. The students evaluated patients under direct supervision, discussed their immediate differential diagnosis, and proposed an initial workup. The attending gave real-time feedback using a standardized direct observation tool. Students completed an electronic pre and post survey (5-point Likert scale) to assess their comfort level in the following areas: performing a rapid triage assessment, determining "sick vs. not sick", performing a focused physical examination, developing a targeted differential diagnosis, and ordering an initial diagnostic workup.

RESULTS

Twenty-one students participated in the triage shifts. There was a significant improvement in self-assessed comfort with performing a rapid triage assessment, mean pre 2.76 and post 4.43 (p < 0.0001). There were also significant improvements in the four other survey areas (p < 0.004 or less).

CONCLUSIONS

A teaching shift in triage can increase medical students' self-assessed rapid assessment skills for patients in the ED. Benefits to the teaching attending included the opportunity to perform direct observation, give real-time feedback, and identify real-time teaching moments.

Medical student and resident perceptions when working together in resident continuity clinics

BACKGROUND

Resident continuity clinics (RCCs), where residents see patients largely independently, is a common requirement for residency programs in the USA. Students often participate in these clinics but it is unknown how this effects resident learning or student satisfaction.

OBJECTIVE

This study aims to describe effects on the learning environment when students and residents work together in an RCC.

DESIGN

Separate surveys were administered to residents and students working at St. Joseph Mercy Hospital (SJMH) in Ann Arbor, Michigan, from 2016-2018.

RESULTS

Response rates were 79/116 (68.1%) for students and 21/24 (87.5%) for residents. A one-sample Wilcoxon signed rank test was used to test whether most five-level Likert-type scale responses were 'agree' or 'strongly agree.' Of medical students, 88.6% enjoyed working with residents (p < 0.001) with 60.8% indicating residents were effective teachers (p < 0.001). The majority of residents (85.7%) were neutral, agreed, or strongly agreed that they enjoyed working with students (p < 0.001). However, 61.9% of residents believed they were too busy to be effective teachers (p < 0.001).

CONCLUSIONS

Both residents and students positively viewed their interactions in RCCs. Although most students felt residents were effective teachers, most residents worried about their ability to balance clinical care and teaching responsibilities.

A Model for Undergraduate Medical Student Education in Otolaryngology During the Post–COVID-19 Era

The clinical learning environment is limited for undergraduate medical education in otolaryngology as the result of coronavirus disease 2019. In an effort to foster and rebuild the attending–medical student relationship, we have developed the R4 teaching model. This model encourages the student to read background information, respond to questions, and review online with faculty with the goal of realization of clinical decision making with gained knowledge. Within the R4 model, there are learning environment subtypes, including real patient cases, journal club, interactive quizzes, flipped classroom, and attending-lead discussions. In the absence of a multitude of “live” patients, our curricula reinstate the core of clinical teaching for medical students.

Impact of a Dedicated Teaching Attending Experience on a Required Emergency Medicine Clerkship

Introduction

One published strategy for improving educational experiences for medical students in the emergency department (ED) while maintaining patient care has been the implementation of dedicated teaching attending shifts. To leverage the advantages of the ED as an exceptional clinical educational environment and to address the challenges posed by the rapid pace and high volume of the ED, our institution developed a clerkship curriculum that incorporates a dedicated clinical educator role – the teaching attending – to deliver quality bedside teaching experiences for students in a required third-year clerkship. The purpose of this educational innovation was to determine whether a dedicated teaching attending experience on a third-year required emergency medicine (EM) clerkship would improve student-reported clinical teaching evaluations and student-reported satisfaction with the overall quality of the EM clerkship.

Methods

Using a five-point Likert-type scale (1 - poor to 5 - excellent), student-reported evaluation ratings and the numbers of graduating students matching into EM were trended for 10 years retrospectively from the inception of the clerkship for the graduating class of 2009 through and including the graduating class of 2019. We used multinomial logistic regression to evaluate whether the presence of a teaching attending during the EM clerkship improved student-reported evaluation ratings for the EM clerkship. We used sample proportion tests to assess the differences between top-box (4 or 5 rating) proportions between years when the teaching attending experience was present and when it was not.

Results

For clinical teaching quality, when the teaching attending is present the estimated odds of receiving a rating of 5 is 77.2 times greater (p <0.001) than when the teaching attending is not present and a rating of 4 is 27.5 times greater (p =0.0017). For overall clerkship quality, when the teaching attending is present, the estimated odds of receiving a rating of 5 is 13 times greater (p <0.001) and a rating of 4 is 5.2 times greater (p=0.0086) than when the teaching attending is not present.

Conclusion

The use of a dedicated teaching attending shift is a successful educational innovation for improving student self-reported evaluation items in a third-year required EM clerkship.

Validity of the scan of postgraduate educational environment domains (SPEED) questionnaire in a rural general practice training setting

BACKGROUND

The educational environment is critical to learning and is determined by social interactions. Trainee satisfaction translates to career commitment, retention and a positive professional attitude as well as being an important factor in assessing the impact of the training program. This study aimed to validate the Scan of Postgraduate Educational Environment Domain (SPEED) tool and assess its appropriateness in evaluating the quality of General Practice (GP) rural postgraduate educational environment.

METHODS

A questionnaire containing the 15-item SPEED tool was administered to GP registrars to examine their perceptions of the educational environment. Principal component analysis (PCA) and exploratory factor analysis (EFA) were used to gather evidences of the validity of the instrument based on its internal structure. Additional validity evidence and reliability estimates were obtained using many-facet Rasch model analysis (MFRM).

RESULTS

The survey was completed by 351 registrars with a response rate of 60%. Parallel analysis performed using principal component analysis and exploratory factor analysis suggests that the SPEED tool is unidimensional. The MFRM analysis demonstrated an excellent degree of infit and outfit for items and training sites, but not for persons. The MFRM analysis also estimated high reliability levels for items (0.98), training sites (0.95) and persons within training sites (ranging from 0.87 to 0.93 in each training sites). Overall, the registrars agreed that the educational environment had high quality, with most (13 out of 15) of the items rated above 4 out of 5.

CONCLUSIONS

This study demonstrated a high degree of validity and reliability of the SPEED tool for the measurement of the quality of the educational environment in a rural postgraduate GP training context. However, when applied in a new setting, the tool may not function as a multidimensional tool consistent with its theoretical grounding.

Medical students' perceptions of bedside teaching

BACKGROUND

Bedside teaching is recognised as a valuable tool in medical education by both students and faculty members. Bedside teaching is frequently delivered by consultants; however, junior doctors are increasingly engaging in this form of clinical teaching, and their value in this respect is becoming more widely recognised. The aim of this study was to supplement work completed by previous authors who have begun to explore students' satisfaction with bedside teaching, and their perceptions of the relationship with the clinical teachers. Specifically, we aimed to identify how students perceive bedside teaching delivered by junior doctors compared with consultants. We aimed to identify how students perceived bedside teaching delivered by junior doctors compared with consultants METHODS: A questionnaire was distributed to all third-year medical students at Keele University via e-mail. Responses were submitted anonymously.

RESULTS

Forty-six students responded (37.4%), 73.3 per cent of whom said that they felt more comfortable having bedside teaching delivered by junior doctors than by consultants. Consultants were perceived as more challenging by 60 per cent of respondents. Students appeared to value feedback on their performance, trust the validity of taught information, and to value the overall educational experience equally, regardless of the clinical grade of the teacher.

DISCUSSION

Student preference does not equate to the value that they place on their bedside teaching. Junior doctors are perceived as being more in touch with students and the curriculum, whereas consultants are perceived as having higher expectations and as being both stricter and more knowledgeable. The clinical teacher's approachable manner and enthusiasm for teaching are more important than clinical grade, as is the ability to deliver well-structured constructive feedback.

Impact of a Dedicated Emergency Medicine Teaching Resident Rotation at a Large Urban Academic Center

Introduction

In the face of declining bedside teaching and increasing emergency department (ED) crowding, balancing education and patient care is a challenge. Dedicated shifts by teaching residents (TRs) in the ED represent an educational intervention to mitigate these difficulties. We aimed to measure the perceived learning and departmental impact created by having TR.

Methods

TRs were present in the ED from 12pm–10pm daily, and their primary roles were to provide the following: assist in teaching procedures, give brief “chalk talks,” instruct junior trainees on interesting cases, and answer clinical questions in an evidence-based manner. This observational study included a survey of fourth-year medical students (MSs), residents and faculty at an academic ED. Surveys measured the perceived effect of the TR on teaching, patient flow, ease of procedures, and clinical care.

Results

Survey response rates for medical students, residents, and faculty are 56%, 77%, and 75%, respectively. MSs perceived improved procedure performance with TR presence and the majority agreed that the TR was a valuable educational experience. Residents perceived increased patient flow, procedure performance, and MS learning with TR presence. The majority agreed that the TR improved patient care. Faculty agreed that the TR increased resident and MS learning, as well as improved patient care and procedure performance.

Conclusion

The presence of a TR increased MS and resident learning, improved patient care and procedure performance as perceived by MSs, residents and faculty. A dedicated TR program can provide a valuable resource in achieving a balance of clinical education and high quality healthcare.

Critical appraisal of emergency medicine educational research: the best publications of 2011

OBJECTIVES

The objective was to critically appraise and highlight medical education research studies published in 2011 that were methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine (EM).

METHODS

A search of the English language literature in 2011 querying PubMed, Scopus, Education Resources Information Center (ERIC), and PsychInfo identified EM studies that used hypothesis-testing or observational investigations of educational interventions. Six reviewers independently ranked all publications based on 10 criteria, including four related to methodology, that were chosen a priori to standardize evaluation by reviewers. This method was used previously to appraise medical education published in 2008, 2009, and 2010.

RESULTS

Forty-eight educational research papers were identified. Comparing the literature of 2011 to that of 2008 through 2010, the number of published educational research papers meeting the criteria increased over time from 30, to 36, to 41, and now to 48. Five medical education research studies met the a priori criteria for inclusion as exemplary and are reviewed and summarized in this article. The number of funded studies remained fairly stable over the past 3 years, at 13 (2008), 16 (2009), 9 (2010), and 13 (2011). As in past years, research involving the use of technology accounted for almost half (n = 22) of the publications. Observational study designs accounted for 28 of the papers, while nine studies featured an experimental design.

CONCLUSIONS

Forty-eight EM educational studies published in 2011 and meeting the criteria were identified. This critical appraisal reviews and highlights five studies that met a priori quality indicators. Current trends and common methodologic pitfalls in the 2011 papers are noted.