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McDaniel LM, Molloy MJ, Blanck J, Beck JB, Shilkofski NA. The Chief Residency in U.S. and Canadian Graduate Medical Education: A Scoping Review. TEACHING AND LEARNING IN MEDICINE 2024:1-10. [PMID: 38247430 DOI: 10.1080/10401334.2023.2298870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
PHENOMENON Despite the nearly universal presence of chief residents within U.S. and Canadian residency programs and their critical importance in graduate medical education, to our knowledge, a comprehensive synthesis of publications about chief residency does not exist. An understanding of the current state of the literature can be helpful to program leadership to make evidence-based improvements to the chief residency and for medical education researchers to recognize and fill gaps in the literature. APPROACH We performed a scoping review of the literature about chief residency. We searched OVID Medline, PsycINFO, ERIC, and Web of Science databases through January 2023 for publications about chief residency. We included publications addressing chief residency in ACGME specialties in the U.S. and Canada and only those using the term "chief resident" to refer to additional responsibilities beyond the typical residency training. We excluded publications using chief residents as a convenience sample. We performed a topic analysis to identify common topics among studies. FINDINGS We identified 2,064 publications. We performed title and abstract screening on 1,306 and full text review on 208, resulting in 146 included studies. Roughly half of the publications represented the specialties of Internal Medicine (n = 37, 25.3%) and Psychiatry (n = 30, 20.5%). Topic analysis revealed six major topics: (1) selection of chief residents (2) qualities of chief residents (3) training of chief residents (4) roles of chief residents (5) benefits/challenges of chief residency (6) outcomes after chief residency. INSIGHTS After reviewing our topic analysis, we identified three key areas warranting increased attention with opportunity for future study: (1) addressing equity and bias in chief resident selection (2) establishment of structured expectations, mentorship, and training of chief residents and (3) increased attention to chief resident experience and career development, including potential downsides of the role.
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Affiliation(s)
- Lauren M McDaniel
- Department of Pediatrics, Division of Hospital Medicine, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Matthew J Molloy
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jaime Blanck
- Informationist Services, Welch Medical Library, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jimmy B Beck
- Department of Pediatrics, Division of Hospital Medicine, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Nicole A Shilkofski
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA
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Younas A, Khan RA, Yasmin R. Entrustment in physician-patient communication: a modified Delphi study using the EPA approach. BMC MEDICAL EDUCATION 2021; 21:497. [PMID: 34544394 PMCID: PMC8454034 DOI: 10.1186/s12909-021-02931-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Competency based curricula across the globe stress on the importance of effective physician patient communication. A variety of courses have been used to train physicians for this purpose. However, few of them link competencies with practice resulting in confusions in implementation and assessment. This issue can be resolved by treating certain specific patient communication related tasks as acts of entrustment or entrustable professional activities (EPAs). In this study, we aimed to define a competency-based framework for assessing patient physician communication using the language of EPAs. METHODS A modified Delphi study was conducted in three stages. The first stage was an extensive literature review to identify and elaborate communication related tasks which could be treated as EPAs. The second stage was content validation by medical education experts for clarity and representativeness. The third stage was three iterative rounds of modified Delphi with predefined consensus levels. The McNemar test was used to check response stability in the Delphi Rounds. RESULTS Expert consensus resulted in development of 4 specific EPAs focused on physician-patient communication with their competencies and respective assessment strategies all aiming for level 5 of unsupervised practice. These include Providing information to the patient or their family about diagnosis or prognosis; Breaking Bad news to the patient or their family; Counseling a patient regarding their disease or illness; Resolving conflicts with patients or their families. CONCLUSIONS The EPAs for Physician-patient communication are a step toward an integrative, all-inclusive competency-based assessment framework for patient-centered care. They are meant to improve the quality of physician patient interaction by standardizing communication as a decision of entrustment. The EPAs can be linked to competency frameworks around the world and provide a useful assessment framework for effective training in patient communication. They can be integrated into any post graduate curriculum and can also serve as a self-assessment tool for postgraduate training programs across the globe to improve their patient communication curricula.
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Affiliation(s)
- Ayesha Younas
- Department of Medical and Dental Education, Shifa College of Dentistry, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
| | - Rehan Ahmed Khan
- Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan
| | - Raheela Yasmin
- RARE Department, Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan
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Mlika M, Ben Amor A, Mezni F. Improving the communicational skills in medicine using role play: a study about 28 students in the second cycle of medical studies. LA TUNISIE MEDICALE 2021; 99:201-206. [PMID: 33899187 PMCID: PMC8636956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
BACKGROUND Medical teaching is usually centred on an objective-based approach and influenced by a flexnerian approach inducing an emphasis on abilities and skills more than the know-how. The know-how is usually under taught and assessed. AIM To assess the competencies in announcing bad news of students in medicine in addition to their satisfaction about the methods used which were serious games. METHODS Students in the third-pregraduate year of medicine who performed their externship in a Department of Pathology of a university Hopsital were included during the year 2018-2019. Seven groups including 4 externs performing a 3-week-period were included. The training started with a pre-test, which consisted in an Objective-Structured-Clinical situation with a simulated patient and a evaluator with a checklist. The students were asked to perform a serious game, then they assisted to a lecture-based learning about the rules of announce of bad news. The serious game was screened then watched by all the students. After a debriefing session, the students were asked to fulfill a post test and a questionnaire-test. RESULTS Twenty-eight students were included. The mean score accounted for 6,76 +/- 2,78 over 20 for the pre-test and 13,17 +/- 1,99 over 20 for the post-test. A significant difference was observed between the pre and post test (p<0.0001). All the students expressed their satisfaction. 27 students wished to repeat the experience. All the students put emphasis on the importance of the peer and auto-evaluation phase using videos. 14 students suggested to integrate this teaching method to the curriculum of the Faculty before their internship. CONCLUSION Inspite of some limits, this study highlighted the improvement of the students' relational competences in addition to their satisfaction related to the use of role play in the acquisition of relational competences related to particular situation such as the announce of bad news.
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Acceptability and efficacy of a communication skills training for nursing students: Building empathy and discussing complex situations. Nurse Educ Pract 2020; 50:102928. [PMID: 33310509 DOI: 10.1016/j.nepr.2020.102928] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 11/21/2022]
Abstract
Nurses must demonstrate effective communication across complex interpersonal domains, as emphasized by numerous professional healthcare organizations. However, formal communication skills training has been only modestly integrated into baccalaureate nursing programs, and of those studied systematically, there are notable methodological concerns. The current study focused on application of a well-researched communication program (Comskil) to student nurses completing summer internships at a comprehensive cancer center as part of their clinical education. The Comskil training program for student nurses is an in-person, day-long training that includes three sections: responding empathically to patients; discussing death, dying, and end-of-life goals of care; and responding to challenging family interactions. Student nurse participants provided strongly favorable perceptions of the program, with 90% indicating that they agreed or strongly agreed with all perception items. A significant pre-to post-training improvement in self-reported confidence was observed (p < .01). Additionally, pre- and post-training observational coding of standardized patient assessments indicated significant improvements in usage of the following skill categories: total skill use, information organization, and empathic communication (p < .001). Overall, these results suggest that communication skills training for student nurses is a feasible, acceptable, and effective way of increasing confidence and skills usage in complex clinical scenarios.
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For a Healthy (and) Higher Education: Evidences from Learning Outcomes in Health Sciences. EDUCATION SCIENCES 2020. [DOI: 10.3390/educsci10060168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Increased recognition of outcomes, or competency-based education, has evolved across higher education on health sciences. However, there is significant diversity in the current study of Portuguese programmes. Considering learning outcomes (LO) as indicators of knowledge, skills, abilities, attitudes and the understanding that the student will gain as a result of an educational experience, this study aims to explore which LO are emphasised on the study programmes of health sciences in Portugal. Through a qualitative methodology, carried out through MAXQDA software, all LO of all Portuguese health sciences study programmes submitted to quality accreditation to the Portuguese Agency for Assessment and Accreditation of Higher Education (A3ES) since 2009 until 2016 were analysed. Although specific knowledge was the most referenced LO, transversal skills were also emphasized, such as critical and reflexive analysis/critical thinking, research, ability to organize and plan and professional ethics. Significant differences were found between LO selection when the analysis was made by comparing the diverse study programmes. This required assortment of knowledge and skills seems to reflect not only the specificities of each health science programme but also the challenging demands on professionals in the 21st century, along with the necessary changes imposed by society, fostering intercultural understanding, tolerance, mutual respect and an ethic of global citizenship and shared responsibility, crucial enablers of educational development for all in the scope of the 2030 Agenda for Sustainable Development.
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Bylund CL, Adams KA, Sinha T, Afana A, Yassin MA, El Geziry A, Nauman A, Al-Romaihi S, Anand A. The Impact of a Communication Skills Workshop on Doctors' Behavior Over Time. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:289-294. [PMID: 32346319 PMCID: PMC7167260 DOI: 10.2147/amep.s216642] [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: 05/22/2019] [Accepted: 03/10/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Communication skills education is still relatively new in some non-Western countries. Further, most evaluation research on communication skills education examines only short-term results. In our communication skills program in Qatar, we aimed to: 1) assess the impact of the communication skills course on participant skills application; 2) assess the length of time since course completion associated with participant skills application; and 3) assess participant gender or clinical position associated with participant skills application. METHODS Seven hundred and thirty-eight physicians completed a seven-module communication skills course. Participants reflected on what they learned in the course and how the course had impacted their behavior through a nine-item online survey that included a four-item Communication Workshop Impact Scale (CWIS), three open questions, and two demographic questions. To assess the effect of time since workshop on outcomes, we stratified the respondents into five groups based on how long ago they had completed the course. RESULTS Three hundred and thirty-two physicians completed the survey. Participants reported agreement with the items on the CWIS: X=4.45 (range 1-5; SD=0.70). When asked which skill(s) they had been able to implement in their clinical practice, 235 gave a specific response, either a specific communication skill (eg, ask open questions), a higher-order category of skills (eg, questioning skills), or the name of one of the seven modules of the course. Only 28 participants listed the name of a skill or module name that they had not been able to implement. There was no evidence of difference in CWIS score based on time since course completion. There was no gender difference; however, residents had significantly lower CWIS scores than fellows (4.70 vs. 4.29, p<0.05). CONCLUSION Participants reported agreement with response items about the impact of the course on their skills application. Participant gender did not play a significant role, but residents had lower scores than did fellows. Furthermore, most physicians (92%) were able to name something specific that they had learned from the course and were currently implementing in their practice. Positive outcomes of the course did not seem to diminish over time. Future research should identify whether observable communication behavior matches the self-reported behavior.
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Affiliation(s)
- Carma L Bylund
- College of Journalism and Communications, College of Medicine, UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
- Department of Anesthesia, Sidra Medicine, Doha, Qatar
| | - Kelsy-Ann Adams
- College of Journalism and Communications, College of Medicine, UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
| | - Tripiti Sinha
- Department of Anesthesia, Sidra Medicine, Doha, Qatar
| | - Abdelhamid Afana
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Yassin
- Department of Hematology/Oncology, Hamad Medical Corporation, Doha, Qatar
| | | | - Awais Nauman
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Ambika Anand
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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Bylund CL, Banerjee SC, Bialer PA, Manna R, Levin TT, Parker PA, Schofield E, Li Y, Bartell A, Chou A, Hichenberg SA, Dickler M, Kissane DW. A rigorous evaluation of an institutionally-based communication skills program for post-graduate oncology trainees. PATIENT EDUCATION AND COUNSELING 2018; 101:1924-1933. [PMID: 29880404 PMCID: PMC6755908 DOI: 10.1016/j.pec.2018.05.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Integrating education about physician-patient communication into oncology specialists' education is important to improve quality of care. Our aim was to rigorously evaluate a 4-year institutionally-based patient communication skills program for oncology post-graduate trainees. METHODS Trainees from 10 specialties in the U.S. participated in patient communication skills modules tailored to sub-specialties. The program was evaluated by comparing pre-post scores on hierarchical outcomes: course evaluation, self-confidence, skills uptake in standardized and real patient encounters, and patient evaluations of satisfaction with communication. We examined breadth of skill usage as key outcome. Generalized estimating equations were used in data analysis. RESULTS Two hundred and sixty-two trainees' data were analyzed, resulting in 984 standardized and 753 real patient encounters. Participants reported high satisfaction and demonstrated significant skill growth with standardized patients, but transfer of these skills into real patient encounters was incomplete. Participants with lower baseline scores had larger improvements with both standardized and real patients. CONCLUSION The program was well received and increased participant skills in the simulated setting without effective transfer to real patient encounters. PRACTICE IMPLICATIONS Future work should allocate proportionally greater resources to trainees with lower baseline scores and measure breadth of participant skill usage as an outcome.
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Affiliation(s)
- Carma L Bylund
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States.
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Philip A Bialer
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Ruth Manna
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Tomer T Levin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Abraham Bartell
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Alexander Chou
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
| | - Shira A Hichenberg
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Maura Dickler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue New York, NY 10065, United States
| | - David W Kissane
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
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Møller JE, van Weel-Baumgarten E. Cross cultural training in primary mental health care consultations in Moldova - The tEACH perspective. PATIENT EDUCATION AND COUNSELING 2017; 100:1758-1761. [PMID: 28438364 DOI: 10.1016/j.pec.2017.04.007] [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: 12/15/2016] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This article reports experiences and challenges encountered in a cross-cultural training project in Moldova that was undertaken by tEACH, the teaching subcommittee of EACH: International Association for Communication in Healthcare, in cooperation with local and international stakeholders. As part of a major health policy reform, the aim was to equip a group of trainers with the skills to train Moldovan professionals in skills for primary mental health care, including communication skills. METHODS The project consisted of 3 weeks of training using mainly experiential teaching methods to allow participants to practice content and methods, including interactive lecturing, roleplay, feedback and video. RESULTS A majority of the participants reported that they acquired key facilitation skills. They valued the opportunity to practice and receive feedback. However, some reported that there was too much focus on communication skills, which was thought to be less relevant in a Moldovan context. Furthermore our learner-centered approach was occasionally experienced as a lack of structure CONCLUSION: The tEACH expertise plays an important role in supporting trainers in cross-cultural contexts with effective communication skills methods. PRACTICE IMPLICATIONS Teaching in a cross-cultural context is only successful through continuous dialogue with stakeholders and demands attention to cultural differences.
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Affiliation(s)
- Jane Ege Møller
- Center for Health Sciences Education, Aarhus University, Denmark.
| | - Evelyn van Weel-Baumgarten
- Radboud University Medical Center, & EACH, International Association for Communication in Healthcare, Nijmegen, The Netherlands
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Liu Y, Huang Y, Gao H, Cheng X. Communication skills training: Adapting to the trends and moving forward. Biosci Trends 2017; 11:142-147. [PMID: 28458335 DOI: 10.5582/bst.2017.01095] [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] [Indexed: 11/05/2022]
Abstract
Communication ability is one of the core requirements of doctors' competency. Teaching communication to medical students and junior doctors has attracted much attention. With the challenge of escalating demands, the status of training communication skills has been promoted in the past several decades. The training content was integrated with other courses and various pedagogic approaches have been applied and proved to be effective. Practical strategies and mixed types were highly recommended. However, there are still many problems, including the fragmentation of the training, insufficient practice, inadequate qualified teachers, case adaptation, course localization and impediment from the environment. This paper proposes some suggestions to solve the problems.
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Affiliation(s)
- Ye Liu
- School of Basic Medical Sciences, Fudan University
| | | | - Hong Gao
- Zhongshan Hospital, Fudan University
| | - Xunjia Cheng
- School of Basic Medical Sciences, Fudan University
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