1
|
Shrivastava SR, Shrivastava PS, Pise R, Joshi A. Practice makes perfect: The learner-doctor blueprint for proficient physicians. J Family Med Prim Care 2024; 13:1156-1159. [PMID: 38827667 PMCID: PMC11141965 DOI: 10.4103/jfmpc.jfmpc_1717_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/03/2023] [Accepted: 12/27/2023] [Indexed: 06/04/2024] Open
Abstract
In the process of producing competent and efficient medical graduates, clinical teaching is an integral component of undergraduate training. Even though clinical training has been linked with multiple benefits and plays a defining role in transforming a medical student into a competent doctor, it has some inherent challenges. The learner-doctor method emphasizes learning by doing and has the potential to counter the identified challenges in the traditional mode of clinical training. The learner-doctor method places emphasis on collaborative learning, wherein students learn by experiential learning and active participation in patient care. This method not only fosters the development of clinical skills but also cultivates critical thinking, teamwork, empathy, and effective communication. A number of activities or strategies must be planned and implemented to ensure that the set objectives of the learner-doctor method are accomplished by the medical institutions. In conclusion, as medical education continues to evolve, the learner-doctor method of clinical training is a dynamic approach to bridging the gap between theoretical knowledge and practical skills. As this method enables medical students to actively engage in patient care and improve their critical thinking, it becomes the need of the hour that every medical institution should explore the opportunity to effectively implement the same in their settings.
Collapse
Affiliation(s)
- Saurabh RamBihariLal Shrivastava
- Deputy Director (Research and Development), Off Campus, Datta Meghe Institute of Higher Education and Research, Department of Community Medicine, Datta Meghe Medical College, Off-campus Centre of Datta Meghe Institute of Higher Education and Research, Hingna Road, Wanadongri, Nagpur, Maharashtra, India
| | | | - Rainita Pise
- Department of Community Medicine, Datta Meghe Medical College, Off-campus Centre of Datta Meghe Institute of Higher Education and Research, Hingna Road, Wanadongri, Nagpur, Maharashtra, India
| | - Abhishek Joshi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India
| |
Collapse
|
2
|
Homberg A, Narciß E, Thiesbonenkamp-Maag J, Heindl F, Schüttpelz-Brauns K. Final-year information on didactic and organizational issues for students and supervising physicians - project report on the development and implementation of the cross-site website PJ-input. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc6. [PMID: 36923324 PMCID: PMC10010762 DOI: 10.3205/zma001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 07/12/2022] [Accepted: 10/31/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Final-year training is becoming increasingly important in medical studies and requires a high degree of personal responsibility from students. It is the task of supervising physicians to make informal learning opportunities available to students when working with and on patients and to gradually transfer responsibility to them. Both students and physicians have a great need for information regarding the contextual conditions and didactic realization of this transfer of responsibility. Up to now, the faculties have only provided information and support in a sporadic manner and with little standardization. With MERLIN, the joint project undertaken by the Competence Network for Teaching Medicine in Baden-Württemberg, a platform for the final year was developed and released on the web. The aim was to bundle information in order to support students and supervising physicians in their teaching-learning process and to improve the quality of teaching in the final year. PROJECT DESCRIPTION The development process of this platform took place in several steps across all faculties. Content and materials were compiled and structured based on a needs assessment. The first draft was evaluated by means of a simulation by students and then revised. A professional internet agency was involved for the technical implementation. The newly designed website PJ-input ("PJ" being the abbreviation for "Praktisches Jahr", the final year) contains areas for students and supervising physicians, as well as faculty-specific and general information about the final year. Faculty-specific content can be entered directly by the respective staff via an input mask and updated at any time. The provision of didactic materials can support competency-oriented teaching and learning in the final year. Here, for example, the concept of the Entrustable Professional Activities (EPA) was taken up, which gives students and supervising physicians orientation for the gradual assumption or transfer of responsibility. The platform was launched in spring 2021. Usage behavior is continuously recorded via the web application. RESULTS AND CONCLUSION The evaluation results show that the website is visited often and perceived as supportive. Increasing usage figures and the high frequency of use by students in the sections "im PJ" (during the final year) and "nach dem PJ" (after the final year) for the faculties involved in the MERLIN project confirm the target group-oriented design and use. The site should be promoted even more to pre-final-year students, as well as across state borders and to the target group of faculties. It is expected that nationwide faculty participation will make a significant contribution to the competency-based shift in teaching and the standardization of training during the final year of study under the new licensing regulations.
Collapse
Affiliation(s)
- Angelika Homberg
- Medical Faculty Mannheim, Heidelberg University, Division for Study and Teaching Development, Department of Medical Education Research, Mannheim, Germany
| | - Elisabeth Narciß
- Medical Faculty Mannheim, Heidelberg University, Competence Center for final-year education Baden-Württemberg, Mannheim, Germany
| | - Julia Thiesbonenkamp-Maag
- Medical Faculty Mannheim, Heidelberg University, Division for Study and Teaching Development, Mannheim, Germany
| | - Felix Heindl
- Medical Faculty Ulm, Competence Center eEducation Baden-Württemberg, Ulm, Germany
| | - Katrin Schüttpelz-Brauns
- Medical Faculty Mannheim, Heidelberg University, Division for Study and Teaching Development, Department of Medical Education Research, Mannheim, Germany
| |
Collapse
|
3
|
Hmoud AlSheikh M, Zaini RG, Iqbal MZ. Developing and Mapping Entrustable Professional Activities with Saudi Meds Competency Framework: A Consensus Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:1367-1374. [PMID: 36330463 PMCID: PMC9624166 DOI: 10.2147/amep.s379184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE This study aimed at developing a national consensus on entrustable professional activities (EPAs) for Saudi undergraduate medical education and mapping them with the "Saudi Meds" competency framework. METHODS A three phased approach was used. Phase 1 consisted of identifying and developing EPAs; Phase 2 consisted of building a national consensus on developed EPAs (validation process); and Phase 3 consisted of mapping the validated EPAs with the Saudi Meds competency framework. Nominal group and modified Delphi techniques were used to develop consensus on EPAs. Classical test theory-based item analysis was conducted to establish validity and reliability of finalized EPAs. RESULTS Fifteen expert medical educationists and 109 academic leaders from 23 medical schools participated in the validation process. The study achieved a consensus on 10 core EPAs with an overall reliability (Cronbach's Alpha) of 0.814. The item-total correlation ranged from 0.341 to 0.642. CONCLUSION This study results in a national consensus on generic, comprehensive and region-specific EPAs that have been mapped with Saudi Meds competency framework. Our study is the first step in the direction of facilitating EPA-based curricular reforms in Saudi medical schools.
Collapse
Affiliation(s)
- Mona Hmoud AlSheikh
- Medical Education Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rania G Zaini
- Medical Education Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Muhammad Zafar Iqbal
- Medical Education Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
4
|
Brätz J, Bußenius L, Brätz I, Grahn H, Prediger S, Harendza S. Assessment of final-year medical students' entrustable professional activities after education on an interprofessional training ward: A case-control study. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:266-272. [PMID: 35864296 PMCID: PMC9302559 DOI: 10.1007/s40037-022-00720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/12/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Interprofessional training wards (ITWs) are implemented to provide medical students with a holistic and authentic health care experience to improve their clinical competencies. Controlled outcome studies assessing students' competencies after ITW-training are uncommon. In this case-control study, we assessed final-year medical students who received ITW-training regarding entrustable professional activities (EPAs) and communicative as well as social competencies. METHODS In March 2021, 32 final-year students, 16 with (ITW group) and 16 without (control group) a previous four-week placement on an ITW participated in a training simulating the first day of residency. The simulated patients assessed students' communication and interpersonal skills for history taking with the ComCare index after every consultation. Twelve prospective EPAs were assessed by three senior physicians after watching videos of the students' case presentations. RESULTS While baseline characteristics and ComCare index ratings were not significantly different between the two groups, the overall mean entrustment level for the 12 EPAs was significantly higher (p < 0.001) in the ITW group compared to the control group (median = 3.15 versus 2.22). The interrater reliability for all EPAs was high and entrustment in students from the ITW group was significantly higher in 10 out of 12 EPAs. DISCUSSION ITW training seems to prepare medical students well to practice competencies which are relevant for prospective entrustment decisions and can be deduced by senior physicians from case presentations. Further studies with larger student cohorts are needed to corroborate this finding and observable EPAs could also be defined to assess students' competencies after ITW training.
Collapse
Affiliation(s)
- Julian Brätz
- Heart Center, Cardiology Division, Albertinen Hospital, Hamburg, Germany.
| | - Lisa Bußenius
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Irina Brätz
- Heart Center, Cardiology Division, Albertinen Hospital, Hamburg, Germany
| | - Hanno Grahn
- Department for Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Sarah Prediger
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrid Harendza
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
5
|
Weissenbacher A, Bolz R, Stehr SN, Hempel G. Development and consensus of entrustable professional activities for final-year medical students in anaesthesiology. BMC Anesthesiol 2022; 22:128. [PMID: 35488205 PMCID: PMC9052481 DOI: 10.1186/s12871-022-01668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background The transfer of classic concepts of competency-based medical education into clinical practice has been proven to be difficult in the past, being described as partially fragmented, misleading and inadequate. At the beginning of training, novice doctors commonly feel overwhelmed, overloaded and exposed to extreme time pressure. The discrepancy between expected and actual clinical competence of doctors at the start of their speciality training jeopardizes patient safety. The framework of Entrustable Professional Activities (EPAs) is a promising instrument to effectively integrate competency-based training into clinical practice and may help to close this gap and consequently to improve patient safety. Methods For anaesthesiology, we developed 5 EPAs for final-year medical students. The EPAs comprised the following seven categories: 1. Title, 2. Specifications, 3. Limitations, 4. Competency domains, 5. Knowledge, abilities and skills, professional attitudes, 6. Assessment and 7. Entrustment. Based on a modified, online-based Delphi study, we further developed and refined these EPAs. Education experts were recruited from the alumni network of the Master of Medical Education (MME) degree course from the University of Heidelberg, Germany. Results 28 data sets were evaluated in three Delphi rounds. 82% of study participants had previous experience with EPAs. Qualitative and quantitative data formed the basis during the iterative process and resulted in complete descriptions of 5 EPAs for final-year medical students in anaesthesiology. Conclusions Our study including the associated description of 5 EPAs represent a further step and starting point for EPA-based curricula in medical training in Germany linking undergraduate training, to residency training and continuous medical education. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01668-8.
Collapse
Affiliation(s)
- Andreas Weissenbacher
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Centre, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Robert Bolz
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Centre, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Sebastian N Stehr
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Centre, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Gunther Hempel
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Centre, Liebigstrasse 20, 04103, Leipzig, Germany.
| |
Collapse
|
6
|
|
7
|
Jud SM, Cupisti S, Frobenius W, Benn S, Winkler A, Antoniadis S, Beckmann MW, Heindl F. Logbooks alone are not enough: initial experience with implementing a logbook for medical students in a clinical internship in gynecology and obstetrics. Eur J Med Res 2020; 25:15. [PMID: 32384922 PMCID: PMC7206670 DOI: 10.1186/s40001-020-00413-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Logbooks are being increasingly widely used as a means of improving medical education and further training. They will in all probability continue to be mandatory in the Practical Year (PJ) in Germany even after the upcoming amendment of the Medical Licensing Regulations (ÄAppO). However, there are different approaches to their design and use, and these are also currently undergoing considerable change. This study for the first time examines and discusses the influence of logbooks on students' evaluation of a gynecology internship. METHODS The study was based on a well-established two-part 1-week internship course, with initially unstructured morning classes on wards and duty areas, along with precisely planned afternoon classes with skills training by peer teachers and seminars supervised by duty-exempted physicians. The postgraduate lecturers were prepared for the introduction of the logbook in a special course, and the aim was to optimize morning classes by introducing learning objectives adapted to the respective locations. The effects over 38 weeks of practical training were examined in evaluations by 235 prospectively group-randomized students with and without logbooks (n = 166 and n = 66, respectively; three datasets were not evaluable). RESULTS In the cohort comparison, the logbook group responded significantly more positively toward the internship at the start of the course (P = 0.046). In the final evaluation, however, medical supervision during the entire internship was rated significantly more poorly (P = 0.007). The logbook cohort also considered that guidance based on learning objectives was significantly worse, as was the extent to which wards and duty areas were prepared for the students (P = 0.001 and P = 0.029). CONCLUSIONS Introducing a logbook to optimize clinical teaching in internships may raise expectations that cannot always be met. In addition to adapting the learning objectives to a general framework that is less favorable in comparison with the Practical Year, the least that is required appears to be simultaneous and continuous mentoring of the lecturers, as well as an increase in staffing resources.
Collapse
Affiliation(s)
- Sebastian M Jud
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Susanne Cupisti
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Wolfgang Frobenius
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Sigrid Benn
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Andrea Winkler
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Sophia Antoniadis
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| |
Collapse
|