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Vidal EIDO, Ribeiro LFA, Carvalho-Filho MAD, Fukushima FB. Mindfulness training in medical education as a means to improve resilience, empathy, and mental health in the medical profession. World J Psychiatry 2024; 14:489-493. [PMID: 38659597 PMCID: PMC11036457 DOI: 10.5498/wjp.v14.i4.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/17/2024] [Accepted: 03/13/2024] [Indexed: 04/17/2024] Open
Abstract
The high rates of depression, burnout, and increased risk of suicide among medical students, residents, and physicians in comparison with other careers signal a mental health crisis within our profession. We contend that this crisis coupled with the inadequate acquisition of interpersonal skills during medical education results from the interaction between a challenging environment and the mental capital of individuals. Additionally, we posit that mindfulness-based practices are instrumental for the development of major components of mental capital, such as resilience, flexibility of mind, and learning skills, while also serving as a pathway to enhance empathy, compassion, self-awareness, conflict resolution, and relational abilities. Importantly, the evidence base supporting the effectiveness of mindfulness-based interventions has been increasing over the years, and a growing number of medical schools have already integrated mindfulness into their curricula. While we acknowledge that mindfulness is not a panacea for all educational and mental health problems in this field, we argue that there is currently an unprecedented opportunity to gather momentum, spread and study mindfulness-based programs in medical schools around the world as a way to address some longstanding shortcomings of the medical profession and the health and educational systems upon which it is rooted.
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Affiliation(s)
- Edison Iglesias de Oliveira Vidal
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil
- Wenckebach Institute for Education and Training, LEARN - Lifelong Learning, Education and Assessment Research Network, University Medical Center Groningen, Groningen 9713AV, Groningen, Netherlands
| | | | - Marco Antonio de Carvalho-Filho
- Wenckebach Institute for Education and Training, LEARN - Lifelong Learning, Education and Assessment Research Network, University Medical Center Groningen, Groningen 9713AV, Groningen, Netherlands
| | - Fernanda Bono Fukushima
- Wenckebach Institute for Education and Training, LEARN - Lifelong Learning, Education and Assessment Research Network, University Medical Center Groningen, Groningen 9713AV, Groningen, Netherlands
- Surgical Specialties and Anesthesiology Department, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil
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Mamede S, Zandbergen A, de Carvalho-Filho MA, Choi G, Goeijenbier M, van Ginkel J, Zwaan L, Paas F, Schmidt HG. Role of knowledge and reasoning processes as predictors of resident physicians' susceptibility to anchoring bias in diagnostic reasoning: a randomised controlled experiment. BMJ Qual Saf 2024:bmjqs-2023-016621. [PMID: 38365449 DOI: 10.1136/bmjqs-2023-016621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/26/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Diagnostic errors have been attributed to reasoning flaws caused by cognitive biases. While experiments have shown bias to cause errors, physicians of similar expertise differed in susceptibility to bias. Resisting bias is often said to depend on engaging analytical reasoning, disregarding the influence of knowledge. We examined the role of knowledge and reasoning mode, indicated by diagnosis time and confidence, as predictors of susceptibility to anchoring bias. Anchoring bias occurs when physicians stick to an incorrect diagnosis triggered by early salient distracting features (SDF) despite subsequent conflicting information. METHODS Sixty-eight internal medicine residents from two Dutch university hospitals participated in a two-phase experiment. Phase 1: assessment of knowledge of discriminating features (ie, clinical findings that discriminate between lookalike diseases) for six diseases. Phase 2 (1 week later): diagnosis of six cases of these diseases. Each case had two versions differing exclusively in the presence/absence of SDF. Each participant diagnosed three cases with SDF (SDF+) and three without (SDF-). Participants were randomly allocated to case versions. Based on phase 1 assessment, participants were split into higher knowledge or lower knowledge groups. MAIN OUTCOME MEASUREMENTS frequency of diagnoses associated with SDF; time to diagnose; and confidence in diagnosis. RESULTS While both knowledge groups performed similarly on SDF- cases, higher knowledge physicians succumbed to anchoring bias less frequently than their lower knowledge counterparts on SDF+ cases (p=0.02). Overall, physicians spent more time (p<0.001) and had lower confidence (p=0.02) on SDF+ than SDF- cases (p<0.001). However, when diagnosing SDF+ cases, the groups did not differ in time (p=0.88) nor in confidence (p=0.96). CONCLUSIONS Physicians apparently adopted a more analytical reasoning approach when presented with distracting features, indicated by increased time and lower confidence, trying to combat bias. Yet, extended deliberation alone did not explain the observed performance differences between knowledge groups. Success in mitigating anchoring bias was primarily predicted by knowledge of discriminating features of diagnoses.
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Affiliation(s)
- Sílvia Mamede
- Institute of Medical Education Research Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Adrienne Zandbergen
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Goda Choi
- Department of Hematology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marco Goeijenbier
- Department of Intensive Care, Spaarne Gasthuis, Haarlem, The Netherlands
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
| | - Joost van Ginkel
- Department of Psychology, Methodology and Statistics, Leiden University, Leiden, The Netherlands
| | - Laura Zwaan
- Institute of Medical Education Research Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Fred Paas
- Department of Psychology, Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Henk G Schmidt
- Department of Psychology, Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
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Spruijt A, Prins-Aardema CC, Antonio de Carvalho-Filho M, Jaarsma D, Martin A. Co-constructive Veterinary Simulation: A Novel Approach to Enhancing Clinical Communication and Reflection Skills. J Vet Med Educ 2023; 50:134-139. [PMID: 35452374 DOI: 10.3138/jvme-2021-0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Interpersonal communication is critical in training, licensing, and post-graduate maintenance of certification in veterinary medicine. Simulation has a vital role in advancing these skills, but even sophisticated simulation models have pedagogic limitations. Specifically, with learning goals and case scenarios designed by instructors, interaction with simulated participants (SPs) can become performative or circumscribed to evaluative assessments. This article describes co-constructive veterinary simulation (CCVS), an adaptation of a novel approach to participatory simulation that centers on learner-driven goals and individually tailored scenarios. CCVS involves a first phase of scriptwriting, in which a learner collaborates with a facilitator and a professional actor in developing a client-patient case scenario. In a second phase, fellow learners have a blinded interaction with the SP-in-role, unaware of the underlying clinical situation. In the final part, all learners come together for a debriefing session centered on reflective practice. The authors provide guidelines for learners to gain maximal benefit from their participation in CCVS sessions and describe thematic possibilities to incorporate into the model, with specific case examples drawn from routine veterinary practice. Finally, the authors outline challenges and future directions toward implementing CCVS in veterinary medical education toward the ultimate goal of professional growth and co-evolution as veterinary practitioners.
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Affiliation(s)
- Annemarie Spruijt
- Faculty of Veterinary Medicine, Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, the Netherlands
| | - Cecil C Prins-Aardema
- GGZ Drenthe (Geestelijke Gezondheids Zorg: Mental Health Care), Beilen, the Netherlands
| | - Marco Antonio de Carvalho-Filho
- Faculty of Veterinary Medicine, Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, the Netherlands, and Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Debbie Jaarsma
- Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, the Netherlands, and Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Andrés Martin
- Yale School of Medicine; and Director, Simulated Participant Program, Teaching and Learning Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06510 USA. He is also a doctoral candidate at the Research Institute SHARE and the Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
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Lima Ribeiro D, Pompei Sacardo D, Jaarsma D, de Carvalho-Filho MA. "Every day that I stay at home, it's another day blaming myself for not being at #Frontline"-Understanding medical students' sacrifices during COVID-19 Pandemic. Adv Health Sci Educ Theory Pract 2022:1-21. [PMID: 36508137 PMCID: PMC9744057 DOI: 10.1007/s10459-022-10192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
COVID-19 struck the world and stretched the healthcare system and professionals. Medical students engaged in the pandemic effort, making personal and professional sacrifices. However, the impact of these sacrifices on students` professional development is still unknown. We applied constructivist grounded theory to individual audio diaries (total time = 5h38 min) and interviews (total time = 11h57min) performed with 18 last-year medical students during the first wave of COVID-19 pandemic in Brazil. The perspective of making sacrifices caused initial emotional distress in medical students, followed by a negotiation process revolving around three themes: predisposition to sacrifice, sense of competence, and sense of belonging. This negotiation process led to three response patterns: Pattern A: "No sense of duty"-the sacrifice was perceived as meaningless, and students showed intense anger and a desire to flee; Pattern B: "Sense of duty with hesitation to act"-the sacrifice was acknowledged as legitime, but students felt unprepared to contribute, leading to feelings of frustration and shame; and, Pattern C: "Sense of duty with readiness to act"-the engagement with the sacrifice was perceived as an opportunity to grow as a doctor, leading to fulfillment and proudness. Students ready to engage with the COVID-19 effort experienced identity consonance, reinforcing their professional identities. Students who felt incompetent or found the sacrifice meaningless experienced identity dissonance, which led to emotional suffering and the consideration of abandoning the course. Monitoring students' emotional reactions when facing professional challenges creates opportunities to problematize the role of sacrifice in the medical profession and scaffold professional identity development.
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Affiliation(s)
- Diego Lima Ribeiro
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Department Public Health, Medical Sciences College, University of Campinas, Campinas, Brazil.
| | - Daniele Pompei Sacardo
- Department Public Health, Medical Sciences College, University of Campinas, Campinas, Brazil
| | - Debbie Jaarsma
- Dean at the Faculty of the Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Marco Antonio de Carvalho-Filho
- LEARN (Lifelong Learning, Education & Assessment Research Network), University Medical Center Groningen, Groningen, The Netherlands
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de Souza LAM, Paredes RG, Giraldi T, Franco MH, de Carvalho-Filho MA, Cecilio-Fernandes D, de Figueiredo LC, Santos TM. Implementation and Assessment of Lung Ultrasound Training Curriculum for Physiotherapists With a Focus on Image Acquisition and Calculation of an Aeration Score. Ultrasound Med Biol 2022; 48:2119-2127. [PMID: 35948457 DOI: 10.1016/j.ultrasmedbio.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
Described here is the implementation of a lung ultrasound course for physiotherapists focused on the acquisition and retention of knowledge and skills. Initially, we provided online lectures in a virtual learning environment (VLE), in which we taught the semiquantification of edema through a lung ultrasound score (LUS). Afterward, the physiotherapists participated in face-to-face lectures (which resumed the online lectures), followed by hands-on training and simulation with ultrasound. We assessed knowledge acquisition through a multiple-choice test with 30 questions (totaling 10 points). The test was applied before accessing the VLE (pre-VLE), before the face-to-face course and at its end (pre- and post-course). Physiotherapists collected actual patients' ultrasound scans, which were uploaded to the VLE and assessed by three supervisors, who performed a consensus LUS calculation and gave virtual written feedback. Thirteen physiotherapists collected 59 exams. The test results were 3.60 ± 1.58 (pre-VLE), 5.94 ± 1.45 (pre-course) and 8.50 ± 0.71 (post-course), with p < 0.001 for all. The intraclass correlation coefficient for LUS between physiotherapists and supervisors was 0.814 (p < 0.001), with moderate-to-weak agreement for LUS of the lung apical, median and basal zones, with κ = 0.455.334, and 0.417 (p < 0.001 for all). Trainees were found to have increased short-term acquisition and retention of knowledge and skills, with a good intraclass correlation coefficient between them and the consensus of supervisors for the LUS of actual patients.
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Affiliation(s)
| | - Ramon Gonzalez Paredes
- Postgraduate Department in Clinical Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Tiago Giraldi
- Discipline of Emergency Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Mário Henrique Franco
- Discipline of Emergency Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Dario Cecilio-Fernandes
- Postgraduate Department in Clinical Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Thiago Martins Santos
- Discipline of Emergency Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Gryschek G, Cecilio-Fernandes D, Barros GAMD, Mason S, de Carvalho-Filho MA. Examining the effect of non-specialised clinical rotations upon medical students' Thanatophobia and Self-efficacy in Palliative Care: a prospective observational study in two medical schools. BMJ Open 2020; 10:e041144. [PMID: 33208334 PMCID: PMC7677329 DOI: 10.1136/bmjopen-2020-041144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/30/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Including palliative care (PC) in overloaded medical curricula is a challenge, especially where there is a lack of PC specialists. We hypothesised that non-specialised rotations could provide meaningful PC learning when there are enough clinical experiences, with adequate feedback. OBJECTIVE Observe the effects of including PC topics in non-specialised placements for undergraduate medical students in two different medical schools. DESIGN Observational prospective study. SETTING Medical schools in Brazil. PARTICIPANTS 134 sixth-year medical students of two medical schools. METHODS This was a longitudinal study that observed the development of Self-efficacy in Palliative Care (SEPC) and Thanatophobia (TS) in sixth-year medical students in different non-specialised clinical rotations in two Brazilian medical schools (MS1 and MS2). We enrolled 78 students in MS1 during the Emergency and Critical Care rotation and 56 students in MS2 during the rotation in Anaesthesiology. Both schools provide PC discussions with different learning environment and approaches. PRIMARY OUTCOMES SEPC and TS Scales were used to assess students at the beginning and the end of the rotations. RESULTS In both schools' students had an increase in SEPC and a decrease in TS scores. CONCLUSION Non-specialised rotations that consider PC competencies as core aspects of being a doctor can be effective to develop SEPC and decrease TS levels.
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Affiliation(s)
- Guilherme Gryschek
- Internal Medicine, University of Campinas School of Medical Sciences, Campinas, SP, Brazil
| | - Dario Cecilio-Fernandes
- Department of Medical Psychology and Psychiatry, University of Campinas School of Medical Sciences, Campinas, SP, Brazil
| | - Guilherme Antonio Moreira de Barros
- Department of Anesthesiology, Universidade Estadual Paulista Júlio de Mesquita Filho Câmpus de Botucatu Faculdade de Medicina, Botucatu, SP, Brazil
| | - Stephen Mason
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - Marco Antonio de Carvalho-Filho
- CEDAR-Center for Educational Development and Research in Health Sciences, University Medical Centre Groningen, Groningen, Netherlands
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
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Ament Giuliani Franco C, Franco RS, Cecilio-Fernandes D, Severo M, Ferreira MA, de Carvalho-Filho MA. Added value of assessing medical students' reflective writings in communication skills training: a longitudinal study in four academic centres. BMJ Open 2020; 10:e038898. [PMID: 33158823 PMCID: PMC7651724 DOI: 10.1136/bmjopen-2020-038898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/13/2020] [Accepted: 10/16/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study describes the development and implementation of a model to assess students' communication skills highlighting the use of reflective writing. We aimed to evaluate the usefulness of the students' reflections in the assessment of communication skills. DESIGN Third-year and fourth-year medical students enrolled in an elective course on clinical communication skills development were assessed using different assessment methods. SETTING AND PARTICIPANTS The communication skills course was offered at four universities (three in Brazil and one in Portugal) and included 69 students. OUTCOME MEASURES The students were assessed by a Multiple-Choice Questionnaire (MCQ), an objective structured clinical examination (OSCE) and reflective writing narratives. The Cronbach's alpha, dimensionality and the person's correlation were applied to evaluate the reliability of the assessment methods and their correlations. Reflective witting was assessed by applying the Reflection Evaluation for Enhanced Competencies Tool Rubric (Reflect Score (RS)) to measure reflections' depth, and the Thematic Score (TS) to map and grade reflections' themes. RESULTS The Cronbach alpha for the MCQ, OSCE global score, TS and RS were, respectively, 0.697, 0.633, 0.784 and 0.850. The interobserver correlation for the TS and RS were, respectively, 0.907 and 0.816. The assessment of reflection using the TS was significantly correlated with the MCQ (r=0.412; p=0.019), OSCE (0.439; p=0.012) and RS (0.410; p=0.020). The RS did not correlate with the MCQ and OSCE. CONCLUSIONS Assessing reflection through mapping the themes and analysing the depth of reflective writing expands the assessment of communication skills. While the assessment of reflective themes is related to the cognitive and behavioural domains of learning, the reflective depth seems to be a specific competence, not correlated with other assessment methods-possibly a metacognitive domain.
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Affiliation(s)
| | - Renato Soleiman Franco
- Medicine School and Post-Graduate Program in Bioethics, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Dario Cecilio-Fernandes
- Department of Medical Psychology and Psychiatry, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Milton Severo
- Department of Clinical Epidemiology, Predictive Medicine and Public Health and Public Health and Forensic Sciences, and Medical Education Department, University of Porto Medical School, Porto, Portugal
| | - Maria Amélia Ferreira
- Public Health and Forensic Sciences, and Medical Education Department, University of Porto Faculty of Medicine, Porto, Portugal
| | - Marco Antonio de Carvalho-Filho
- Internal Medicine, University of Minho School of Medicine, Braga, Portugal
- CEDAR - Center for Educational Development and Research in Health Sciences, University Medical Center Groningen, Groningen, The Netherlands
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Gryschek G, Cecilio-Fernandes D, Mason S, de Carvalho-Filho MA. Assessing palliative care education in undergraduate medical students: translation and validation of the Self-Efficacy in Palliative Care and Thanatophobia Scales for Brazilian Portuguese. BMJ Open 2020; 10:e034567. [PMID: 32601112 PMCID: PMC7328756 DOI: 10.1136/bmjopen-2019-034567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/10/2020] [Accepted: 04/28/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As the global population ages, palliative care is ever more essential to provide care for patients with incurable chronic conditions. However, in many countries, doctors are not prepared to care for dying patients. Palliative care education should be an urgent concern for all medical schools all around the world, including Latin America and Brazil. Advances in palliative care education require robust assessment tools for constant evaluation and improvement of educational programmes. Bandura's social cognitive theory proposes that active learning processes are mediated by self-efficacy and associated outcome expectancies, both crucial elements of developing new behaviour. The Self-Efficacy in Palliative Care (SEPC) and Thanatophobia Scales were developed using Bandura's theory to assess the outcomes of palliative care training. OBJECTIVES We aimed to translate and validate these scales for Brazilian Portuguese to generate data on how well doctors are being prepared to meet the needs of their patients. DESIGN Cross-sectional study. SETTING One Brazilian medical school. PARTICIPANTS Third-year medical students. METHODS The authors translated the scales following the European Organisation for Research and Treatment of Cancer's recommendations and examined their psychometric properties using data collected from a sample of 111 students in a Brazilian medical school in 2017. RESULTS The Brazilian versions of SEPC and Thanatophobia Scales showed good psychometric properties, including confirmatory factor analysis, replicating the original factors (factor range: 0.51-0.90), and acceptable values of reliability (Cronbach's alpha: 0.82-0.97 and composite reliability: 0.82-0.96). Additionally, the Brazilian versions of the scales showed concurrent validity, demonstrated through a significant negative correlation. CONCLUSIONS The Brazilian version of the scales may be used to assess the impact of current undergraduate training and identify areas for improvement within palliative care educational programmes. The data generated allow Brazilian researchers to join international conversations on this topic and educators to develop tailored pedagogical approaches.
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Affiliation(s)
- Guilherme Gryschek
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | - Dario Cecilio-Fernandes
- Department of Medical Psychology and Psychiatry, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | - Stephen Mason
- Research and Development Division, Marie Curie Palliative Care Institute Liverpool, Liverpool, UK
| | - Marco Antonio de Carvalho-Filho
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
- Department of Health Sciences, Center for Educational Development and Research in Health Professions, University of Groningen, Groningen, The Netherlands
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Abstract
Teaching and learning practices often fail to incorporate new concepts in the ever-evolving field of medical education. Although medical education research provides new insights into curricular development, learners' engagement, assessment methods, professional development, interprofessional education, and so forth, faculty members often struggle to modernize their teaching practices. Communities of practice (CoP) for faculty development offer an effective and sustainable approach for knowledge management and implementation of best practices. A successful CoP creates and shares knowledge in the context of a specific practice toward the development of expertise. CoPs' collaborative nature, based on the co-creation of practical solutions to daily problems, aligns well with the goals of applying best practices in health professions education and training new faculty members. In our article, we share 12 tips for implementing a community of practice for faculty development. The tips were based on a comprehensive literature review and the authors' experiences.
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Affiliation(s)
- Marco Antonio de Carvalho-Filho
- Emergency Medicine Department School of Medical Sciences, University of Campinas, São Paulo, Brazil
- Faculty Development Task Group - Center for Education Development and Research in Health Professions, University Medical Center Groningen, Groningen, The Netherlands
| | - René A Tio
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
- Department of Educational Development and Research in the Faculty of Health Medicine and Life Sciences, Maastricht University, The Netherlands
| | - Yvonne Steinert
- Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Canada
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Mamede S, de Carvalho-Filho MA, de Faria RMD, Franci D, Nunes MDPT, Ribeiro LMC, Biegelmeyer J, Zwaan L, Schmidt HG. 'Immunising' physicians against availability bias in diagnostic reasoning: a randomised controlled experiment. BMJ Qual Saf 2020; 29:550-559. [PMID: 31988257 PMCID: PMC7362774 DOI: 10.1136/bmjqs-2019-010079] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/24/2019] [Accepted: 01/16/2020] [Indexed: 12/14/2022]
Abstract
Background Diagnostic errors have often been attributed to biases in physicians’ reasoning. Interventions to ‘immunise’ physicians against bias have focused on improving reasoning processes and have largely failed. Objective To investigate the effect of increasing physicians’ relevant knowledge on their susceptibility to availability bias. Design, settings and participants Three-phase multicentre randomised experiment with second-year internal medicine residents from eight teaching hospitals in Brazil. Interventions Immunisation: Physicians diagnosed one of two sets of vignettes (either diseases associated with chronic diarrhoea or with jaundice) and compared/contrasted alternative diagnoses with feedback. Biasing phase (1 week later): Physicians were biased towards either inflammatory bowel disease or viral hepatitis. Diagnostic performance test: All physicians diagnosed three vignettes resembling inflammatory bowel disease, three resembling hepatitis (however, all with different diagnoses). Physicians who increased their knowledge of either chronic diarrhoea or jaundice 1 week earlier were expected to resist the bias attempt. Main outcome measurements Diagnostic accuracy, measured by test score (range 0–1), computed for subjected-to-bias and not-subjected-to-bias vignettes diagnosed by immunised and not-immunised physicians. Results Ninety-one residents participated in the experiment. Diagnostic accuracy differed on subjected-to-bias vignettes, with immunised physicians performing better than non-immunised physicians (0.40 vs 0.24; difference in accuracy 0.16 (95% CI 0.05 to 0.27); p=0.004), but not on not-subjected-to-bias vignettes (0.36 vs 0.41; difference −0.05 (95% CI −0.17 to 0.08); p=0.45). Bias only hampered non-immunised physicians, who performed worse on subjected-to-bias than not-subjected-to-bias vignettes (difference −0.17 (95% CI −0.28 to −0.05); p=0.005); immunised physicians’ accuracy did not differ (p=0.56). Conclusions An intervention directed at increasing knowledge of clinical findings that discriminate between similar-looking diseases decreased physicians’ susceptibility to availability bias, reducing diagnostic errors, in a simulated setting. Future research needs to examine the degree to which the intervention benefits other disease clusters and performance in clinical practice. Trial registration number 68745917.1.1001.0068.
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Affiliation(s)
- Sílvia Mamede
- Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands .,Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Marco Antonio de Carvalho-Filho
- Internal Medicine, State University of Campinas, Campinas, Brazil.,Center for Education Development and Research in the Health Professions, University of Groningen, Groningen, The Netherlands
| | - Rosa Malena Delbone de Faria
- Propeudeutics, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Education and Research Center, Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil
| | - Daniel Franci
- Internal Medicine, State University of Campinas, Campinas, Brazil
| | | | | | | | - Laura Zwaan
- Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Henk G Schmidt
- Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands.,Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
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Martin A, Weller I, Amsalem D, Adigun A, Jaarsma D, Duvivier R, de Carvalho-Filho MA. From Learning Psychiatry to Becoming Psychiatrists: A Qualitative Study of Co-constructive Patient Simulation. Front Psychiatry 2020; 11:616239. [PMID: 33488433 PMCID: PMC7820173 DOI: 10.3389/fpsyt.2020.616239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives: Co-constructive patient simulation (CCPS) is a novel medical education approach that provides a participatory and emotionally supportive alternative to traditional supervision and training. CCPS can adapt iteratively and in real time to emergent vicissitudes and challenges faced by clinicians. We describe the first implementation of CCPS in psychiatry. Methods: We co-developed clinical scripts together with child and adolescent psychiatry senior fellows and professional actors with experience performing as simulated patients (SPs). We conducted the simulation sessions with interviewers blind to the content of case scenarios enacted by the SPs. Each hour-long simulation was followed by an hour-long debriefing session with all participants. We recorded and transcribed case preparation, simulation interactions, and debriefing sessions, and analyzed anonymized transcripts through qualitative analysis within a constructivist framework, aided by NVivo software. Results: Each of six CCPS sessions was attended by a median of 13 participants (range, 11-14). The first three sessions were conducted in person; the last three, which took place during the COVID-19 pandemic, via synchronized videoconferencing. Each of the sessions centered on clinically challenging and affectively charged situations informed by trainees' prior experiences. Through iterative thematic analysis we derived an alliterating "9R" model centered on three types of Reflection: (a) in action/"while doing" (Regulate, Relate, and Reason); (b) on action/"having done" (Realities, Restraints, and Relationships); and (c) for action/"will be doing" (with opportunities for Repair and Reaffirmation). Conclusions: CCPS is an experiential approach that fosters autonomous, meaningful, and individually tailored learning opportunities. CCPS and the 9R model for reflective practice can be effectively applied to psychiatry and have the potential to contribute uniquely to the educational needs of its trainees and practitioners.
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Affiliation(s)
- Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Standardized Patient Program, Teaching and Learning Center, Yale School of Medicine, New Haven, CT, United States
- Center for Educational Development and Research in Health Sciences (CEDAR), LEARN, University Medical Center Groningen, Groningen, Netherlands
- *Correspondence: Andrés Martin
| | - Indigo Weller
- Bioethics Program, Harvard University, Cambridge, MA, United States
| | - Doron Amsalem
- Tel-Aviv University Faculty of Medicine, Ramat-Aviv, Israel
- Mental Health Services, Columbia University Irving Medical Center, New York, NY, United States
| | - Ayodola Adigun
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Mental Health Services, Columbia University Irving Medical Center, New York, NY, United States
| | - Debbie Jaarsma
- Center for Educational Development and Research in Health Sciences (CEDAR), LEARN, University Medical Center Groningen, Groningen, Netherlands
| | - Robbert Duvivier
- Center for Educational Development and Research in Health Sciences (CEDAR), LEARN, University Medical Center Groningen, Groningen, Netherlands
- Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Marco Antonio de Carvalho-Filho
- Center for Educational Development and Research in Health Sciences (CEDAR), LEARN, University Medical Center Groningen, Groningen, Netherlands
- School of Medical Sciences, University of Minho, Braga, Portugal
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Grangeia TDAG, de Jorge B, Cecílio-Fernandes D, Tio RA, de Carvalho-Filho MA. Learn+Fun! Social Media and Gamification sum up to Foster a Community of Practice during an Emergency Medicine Rotation. Health Professions Education 2019. [DOI: 10.1016/j.hpe.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Silveira GL, Campos LK, Schweller M, Turato ER, Helmich E, de Carvalho-Filho MA. “Speed up”! The Influences of the Hidden Curriculum on the Professional Identity Development of Medical Students. Health Professions Education 2019. [DOI: 10.1016/j.hpe.2018.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Bernardo MO, Cecilio-Fernandes D, Lima ARDA, Silva JF, Ceccato HD, Costa MJ, de Carvalho-Filho MA. Investigating the relation between self-assessment and patients' assessments of physicians-in-training empathy: a multicentric, observational, cross-sectional study in three teaching hospitals in Brazil. BMJ Open 2019; 9:e029356. [PMID: 31243037 PMCID: PMC6597646 DOI: 10.1136/bmjopen-2019-029356] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES This study investigated the associations between self-assessed empathy levels by physicians in training and empathy levels as perceived by their patients after clinical encounters. The authors also examined whether patient assessments were valid and reliable tools to measure empathy in physicians in training. DESIGN A multicentric, observational, cross-sectional study. SETTING This study was conducted in three public teaching hospitals in Brazil. PARTICIPANTS From the 668 patients invited to participate in this research, 566 (84.7%) agreed. Of these, 238 (42%) were male and 328 (58%) were female. From the invited 112 physicians in training, 86 (76.8%) agreed. Of the 86 physicians in training, 35 (41%) were final-year medical students and 51 (59%) were residents from clinical and surgical specialties. The gender distribution was 39 (45%) males and 47 (51%) females. PRIMARY AND SECONDARY OUTCOME MEASURES Physicians in training filled the Jefferson Scale of Physician Empathy (JSE) and the Interpersonal Reactivity Index. Patients answered the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy Scale (CARE). RESULTS This study found non-significant correlations between patient and physicians-in-training self-assessments, except for a weak correlation (0.241, p<0.01) between the JSPPPE score and the JSE compassionate care subscore. CARE and JSPPPE scales proved to be valid and reliable instruments. CONCLUSIONS Physicians-in-training self-assessments of empathy differ from patient assessments. Knowledge about empathy derived from self-assessment studies probably does not capture the perspective of the patients, who are key stakeholders in patient-centred care. Future research on the development of physician empathy or on outcomes of educational interventions to foster empathy should include patient perspectives.
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Affiliation(s)
- Mônica Oliveira Bernardo
- Radiology, Pontificia Universidade Catolica de Sao Paulo Faculdade de Ciencias Medicas e da Saude, Sorocaba, São Paulo, Brazil
| | - Dario Cecilio-Fernandes
- CEDAR - Center for Education Development and Research in Health Professions, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Julian Furtado Silva
- Internal Medicine, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, São Paulo, Brazil
| | - Hugo Dugolin Ceccato
- Internal Medicine, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, São Paulo, Brazil
| | - Manuel João Costa
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
| | - Marco Antonio de Carvalho-Filho
- CEDAR - Center for Education Development and Research in Health Professions, University Medical Center Groningen, Groningen, The Netherlands
- Internal Medicine, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, São Paulo, Brazil
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Schweller M, Ribeiro DL, Celeri EV, de Carvalho-Filho MA. Nurturing virtues of the medical profession: does it enhance medical students' empathy? Int J Med Educ 2017; 8:262-267. [PMID: 28704203 PMCID: PMC5511746 DOI: 10.5116/ijme.5951.6044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 06/26/2017] [Indexed: 05/19/2023]
Abstract
OBJECTIVES To examine if the empathy levels of first-year medical students are amenable to didactic interventions idealized to promote values inherent to medical professional identity. METHODS This is a pretest-posttest study designed to assess the empathy levels of first-year medical students (n=166) comprising two consecutive classes of a Brazilian medical school, performed before and after a didactic intervention. Students attended a course based on values and virtues related to medical professional identity once a week over four months. Every didactic approach (interviews with patients and physicians, supervised visits to the hospital, and discussion of videotaped simulated consultations) was based on "real-world" situations and designed to promote awareness of the process of socialization. Students filled out the Jefferson Scale of Physician Empathy (JSPE) on the first and last days of this course, and the pretest-posttest analysis was performed using the Wilcoxon Signed Rank Test. RESULTS The mean pretest JSPE score was 117.9 (minimum 92, maximum 135) and increased to 121.3 after the intervention (minimum 101, maximum 137). The difference was significant (z=-5.2, p<.001.), with an effect size of 0.40. The observed increase was greater among students with lower initial JSPE scores. CONCLUSIONS Empathy is a fundamental tool used to achieve a successful physician-patient relationship, and it seems to permeate other virtues of a good physician. This study's results suggest that medical students' empathy may be amenable to early curricular interventions designed to promote a positive development of their professional identity, even when empathy is not central in discussion.
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Affiliation(s)
- Marcelo Schweller
- Department of Emergency Medicine, Faculty of Medical Sciences, University of Campinas, Brazil
| | - Diego Lima Ribeiro
- Department of Emergency Medicine, Faculty of Medical Sciences, University of Campinas, Brazil
| | - Eloisa Valer Celeri
- Department of Psychiatry, Faculty of Medical Sciences, University of Campinas, Brazil
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Costa P, de Carvalho-Filho MA, Schweller M, Thiemann P, Salgueira A, Benson J, Costa MJ, Quince T. Measuring Medical Students' Empathy: Exploring the Underlying Constructs of and Associations Between Two Widely Used Self-Report Instruments in Five Countries. Acad Med 2017; 92:860-867. [PMID: 28557952 DOI: 10.1097/acm.0000000000001449] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE Understanding medical student empathy is important to future patient care; however, the definition and development of clinical empathy remain unclear. The authors sought to examine the underlying constructs of two of the most widely used self-report instruments-Davis's Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Empathy version for medical students (JSE-S)-plus, the distinctions and associations between these instruments. METHOD Between 2007 and 2014, the authors administered the IRI and JSE-S in three separate studies in five countries, (Brazil, Ireland, New Zealand, Portugal, and the United Kingdom). They collected data from 3,069 undergraduate medical students and performed exploratory factor analyses, correlation analyses, and multiple linear regression analyses. RESULTS Exploratory factor analysis yielded identical results in each country, confirming the subscale structures of each instrument. Results of correlation analyses indicated significant but weak correlations (r = 0.313) between the total IRI and JSE-S scores. All intercorrelations of IRI and JSE-S subscale scores were statistically significant but weak (range r = -0.040 to 0.306). Multiple linear regression models revealed that the IRI subscales were weak predictors of all JSE-S subscale and total scores. The IRI subscales explained between 9.0% and 15.3% of variance for JSE-S subscales and 19.5% for JSE-S total score. CONCLUSIONS The IRI and JSE-S are only weakly related, suggesting that they may measure different constructs. To better understand this distinction, more studies using both instruments and involving students at different stages in their medical education, as well as more longitudinal and qualitative studies, are needed.
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Affiliation(s)
- Patrício Costa
- P. Costa is assistant professor, School of Health Sciences, and researcher in medical education, Life and Health Sciences Research Institute, University of Minho, Braga, Portugal. M.A. de Carvalho-Filho is professor of medicine, Department of Emergency Medicine, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil. M. Schweller is emergency medicine physician and preceptor, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil. P. Thiemann is research assistant, Palliative Care Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. A. Salgueira is a PhD student, School of Health Sciences, and researcher in medical education, Life and Health Sciences Research Institute, University of Minho, Braga, Portugal. J. Benson is senior lecturer, General Practice, and director, General Practice Education Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. M.J. Costa is associate professor, School of Health Sciences, and researcher in medical education, Life and Health Sciences Research Institute, University of Minho, Braga, Portugal. T. Quince is medical educational research associate, Primary Care Unit, Department of Public Health and Primary Care and School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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de Araujo Guerra Grangeia T, de Jorge B, Franci D, Martins Santos T, Vellutini Setubal MS, Schweller M, de Carvalho-Filho MA. Cognitive Load and Self-Determination Theories Applied to E-Learning: Impact on Students' Participation and Academic Performance. PLoS One 2016; 11:e0152462. [PMID: 27031859 PMCID: PMC4816554 DOI: 10.1371/journal.pone.0152462] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 03/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Emergency clerkships expose students to a stressful environment that require multiple tasks, which may have a direct impact on cognitive load and motivation for learning. To address this challenge, Cognitive Load Theory and Self Determination Theory provided the conceptual frameworks to the development of a Moodle-based online Emergency Medicine course, inspired by real clinical cases. METHODS Three consecutive classes (2013-2015) of sixth-year medical students (n = 304) participated in the course, during a curricular and essentially practical emergency rotation. "Virtual Rounds" provided weekly virtual patients in narrative format and meaningful schemata to chief complaints, in order to simulate real rounds at Emergency Unit. Additional activities such as Extreme Decisions, Emergency Quiz and Electrocardiographic challenge offered different views of emergency care. Authors assessed student´s participation and its correlation with their academic performance. A survey evaluated students´ opinions. Students graduating in 2015 answered an online questionnaire to investigate cognitive load and motivation. RESULTS Each student produced 1965 pageviews and spent 72 hours logged on. Although Clinical Emergency rotation has two months long, students accessed the online course during an average of 5.3 months. Virtual Rounds was the most accessed activity, and there was positive correlations between the number of hours logged on the platform and final grades on Emergency Medicine. Over 90% of students felt an improvement in their clinical reasoning and considered themselves better prepared for rendering Emergency care. Considering a Likert scale from 1 (minimum load) to 7 (maximum load), the scores for total cognitive load were 4.79±2.2 for Virtual Rounds and 5.56±1.96 for real medical rounds(p<0,01). CONCLUSIONS A real-world inspired online course, based on cognitive and motivational conceptual frameworks, seems to be a strong tool to engage students in learning. It may support them to manage the cognitive challenges involved in clinical care and increase their motivation for learning.
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Affiliation(s)
- Tiago de Araujo Guerra Grangeia
- Department of Internal Medicine, Division of Emergency Medicine, Faculty of Medical Sciences at State University of Campinas (Unicamp), São Paulo, Brazil
| | - Bruno de Jorge
- Faculty of Medical Sciences at State University of Campinas (Unicamp), São Paulo, Brazil
| | - Daniel Franci
- Department of Internal Medicine, Division of Emergency Medicine, Faculty of Medical Sciences at State University of Campinas (Unicamp), São Paulo, Brazil
| | - Thiago Martins Santos
- Department of Internal Medicine, Division of Emergency Medicine, Faculty of Medical Sciences at State University of Campinas (Unicamp), São Paulo, Brazil
| | | | - Marcelo Schweller
- Department of Internal Medicine, Division of Emergency Medicine, Faculty of Medical Sciences at State University of Campinas (Unicamp), São Paulo, Brazil
| | - Marco Antonio de Carvalho-Filho
- Department of Internal Medicine, Division of Emergency Medicine, Faculty of Medical Sciences at State University of Campinas (Unicamp), São Paulo, Brazil
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Schweller M, Costa FO, Antônio MÂRGM, Amaral EM, de Carvalho-Filho MA. The impact of simulated medical consultations on the empathy levels of students at one medical school. Acad Med 2014; 89:632-7. [PMID: 24556779 PMCID: PMC4885552 DOI: 10.1097/acm.0000000000000175] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE To examine the impact of simulated medical consultations using standardized patients (SPs) on the empathy levels of fourth- and sixth-year students at the Unicamp medical school in Brazil. METHOD Throughout 2011 and 2012, the authors conducted this study with two classes of fourth-year (n = 124) and two classes of sixth-year (n = 123) medical students. Students completed the medical student version of the Jefferson Scale of Physician Empathy before and after simulated medical consultations with SPs, followed by an in-depth debriefing dealing with the feelings of the patient about the disease, such as fear, guilt, anger, and abandonment; the feelings of the doctor towards the patient; and other topics as they arose. RESULTS The simulation activity increased the empathy scores of the fourth-year students (from 115.8 to 121.1, P < .001, effect size = 0.61) and of the sixth-year students (from 117.1 to 123.5, P < .001, effect size = 0.64). CONCLUSIONS Although the study results were obtained via self-report-a limitation-they suggest that the effective simulation of medical consultations with SPs may improve medical students' empathy levels. One unexpected result was that this activity, during the debriefing, became a forum for debating topics such as the doctor-patient relationship, the hidden curriculum, negative role models, and emotionally significant experiences of students in medical school. This kind of activity in itself may influence young doctors to become more empathetic and compassionate with their patients and foster a more meaningful way of practicing medicine.
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Affiliation(s)
- Marcelo Schweller
- Dr. Schweller is assistant professor, Department of Emergency Medicine, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil. Dr. Costa is assistant professor, Department of Oncology, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil. Dr. Antônio is professor of medicine, Department of Pediatrics, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil. Dr. Amaral is professor of medicine, Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil. Dr. Carvalho-Filho is professor of medicine, Department of Emergency Medicine, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
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