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Lovink A, Groenier M, van der Niet A, Miedema H, Rethans JJ. How simulated patients contribute to student learning in an authentic way, an interview study. Adv Simul (Lond) 2024; 9:4. [PMID: 38212828 PMCID: PMC10782599 DOI: 10.1186/s41077-023-00277-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/26/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Simulated patients (SPs) play an instrumental role in teaching communication skills and enhancing learning outcomes. Prior research mostly focused on the SP's contribution to students' learning outcomes by providing feedback afterwards. A detailed understanding of the contribution of the SP during SP-student encounters is currently lacking although the majority of the interaction between SPs and students occurs during the SP-student encounter. Therefore, this study focuses on how SPs see their contribution to meaningful student learning experiences during SP-student encounters. METHODS We interviewed fifteen simulated patients from one institution. We explored their perspectives on meaningful learning experiences during SP-student encounters through in-depth, semi-structured interviews and analyzed using thematic analysis. RESULTS SPs view their contribution to meaningful student learning during SP-student encounters from two perspectives. A collective perspective as a member of the community of SPs and an individual perspective. From the collective perspective, SPs believe that the fact that students deal with multiple varied SP-student encounters over time is of value for meaningful learning. From the individual perspective, we noticed that SPs think, act, and react from three different positions. First, as the patient in the role description, second, as a teaching aid and third, as an individual with personal experiences, beliefs, and values. SPs mentioned that the ratio between these different positions can vary within and between encounters. CONCLUSIONS According to SPs, we should value the variation between SPs, thereby creating meaningful variation in authentic interactions in SP-student encounters. SPs should be allowed to act and react from different positions during SP-student encounters, including their role description, as teaching aid, and based on their own experiences. In this way, SP-student encounters are optimized to contribute to meaningful student learning through authenticity.
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Affiliation(s)
- Annelies Lovink
- Department of Technical Medicine, University of Twente, Utwente, Hallenweg 5, Enchede, 75522 NH, the Netherlands.
| | - Marleen Groenier
- Department of Technical Medicine, University of Twente, Utwente, Hallenweg 5, Enchede, 75522 NH, the Netherlands
| | - Anneke van der Niet
- Department IQ Healthcare, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - Heleen Miedema
- Department of Technical Medicine, University of Twente, Utwente, Hallenweg 5, Enchede, 75522 NH, the Netherlands
| | - Jan-Joost Rethans
- Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Fikrat-Wevers S, Stegers-Jager KM, Afonso PM, Koster AS, Van Gestel RA, Groenier M, Ravesloot JH, Wouters A, Van Den Broek WW, Woltman AM. Selection tools and student diversity in health professions education: a multi-site study. Adv Health Sci Educ Theory Pract 2023; 28:1027-1052. [PMID: 36653557 PMCID: PMC9848043 DOI: 10.1007/s10459-022-10204-9] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/29/2022] [Indexed: 06/16/2023]
Abstract
Student diversity in health professions education (HPE) can be affected by selection procedures. Little is known about how different selection tools impact student diversity across programs using different combinations of traditional and broadened selection criteria. The present multi-site study examined the chances in selection of subgroups of applicants to HPE undergraduate programs with distinctive selection procedures, and their performance on corresponding selection tools. Probability of selection of subgroups (based on gender, migration background, prior education, parental education) of applicants (N = 1935) to five selection procedures of corresponding Dutch HPE undergraduate programs was estimated using multilevel logistic regression. Multilevel linear regression was used to analyze performance on four tools: prior-education grade point average (pe-GPA), biomedical knowledge test, curriculum-sampling test, and curriculum vitae (CV). First-generation Western immigrants and applicants with a foreign education background were significantly less likely to be selected than applicants without a migration background and with pre-university education. These effects did not vary across programs. More variability in effects was found between different selection tools. Compared to women, men performed significantly poorer on CVs, while they had higher scores on biomedical knowledge tests. Applicants with a non-Western migration background scored lower on curriculum-sampling tests. First-generation Western immigrants had lower CV-scores. First-generation university applicants had significantly lower pe-GPAs. There was a variety in effects for applicants with different alternative forms of prior education. For curriculum-sampling tests and CVs, effects varied across programs. Our findings highlight the need for continuous evaluation, identifying best practices within existing tools, and applying alternative tools.
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Affiliation(s)
- S Fikrat-Wevers
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-207, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - K M Stegers-Jager
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-207, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - P M Afonso
- Department of Biostatistics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A S Koster
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - R A Van Gestel
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - M Groenier
- Technical Medical Centre, Technical Medicine, University of Twente, Enschede, The Netherlands
| | - J H Ravesloot
- Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Wouters
- Faculty of Medicine VU, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - W W Van Den Broek
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-207, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - A M Woltman
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-207, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Gerretsen ECF, Chen A, Annema JT, Groenier M, van der Heijden EHFM, van Mook WNKA, Smeenk FWJM. Effectiveness of Flexible Bronchoscopy Simulation-Based Training: A Systematic Review. Chest 2023; 164:952-962. [PMID: 37178972 PMCID: PMC10645598 DOI: 10.1016/j.chest.2023.05.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The implementation of simulation-based training (SBT) to teach flexible bronchoscopy (FB) skills to novice trainees has increased during the last decade. However, it is unknown whether SBT is effective to teach FB to novices and which instructional features contribute to training effectiveness. RESEARCH QUESTION How effective is FB SBT and which instructional features contribute to training effectiveness? STUDY DESIGN AND METHODS We searched Embase, PubMed, Scopus, and Web of Science for articles on FB SBT for novice trainees, considering all available literature until November 10, 2022. We assessed methodological quality of included studies using a modified version of the Medical Education Research Study Quality Instrument, evaluated risk of bias with relevant tools depending on study design, assessed instructional features, and intended to correlate instructional features to outcome measures. RESULTS We identified 14 studies from an initial pool of 544 studies. Eleven studies reported positive effects of FB SBT on most of their outcome measures. However, risk of bias was moderate or high in eight studies, and only six studies were of high quality (modified Medical Education Research Study Quality Instrument score ≥ 12.5). Moreover, instructional features and outcome measures varied highly across studies, and only four studies evaluated intervention effects on behavioral outcome measures in the patient setting. All of the simulation training programs in studies with the highest methodological quality and most relevant outcome measures included curriculum integration and a range in task difficulty. INTERPRETATION Although most studies reported positive effects of simulation training programs on their outcome measures, definitive conclusions regarding training effectiveness on actual bronchoscopy performance in patients could not be made because of heterogeneity of training features and the sparse evidence of training effectiveness on validated behavioral outcome measures in a patient setting. TRIAL REGISTRATION PROSPERO; No.: CRD42021262853; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Eveline C F Gerretsen
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
| | - Aoben Chen
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Marleen Groenier
- Technical Medical Center, University of Twente, Enschede, The Netherlands
| | | | - Walther N K A van Mook
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands; Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Frank W J M Smeenk
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands; Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
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Groenier M, Spijkerboer K, Venix L, Bannink L, Yperlaan S, Eyck Q, van Manen JG, Miedema HAT. Evaluation of the impact of technical physicians on improving individual patient care with technology. BMC Med Educ 2023; 23:181. [PMID: 36959581 PMCID: PMC10037766 DOI: 10.1186/s12909-023-04137-z] [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: 10/28/2022] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The rapid introduction of technical innovations in healthcare requires that professionals are adequately prepared for correct clinical use of medical technology. In response to the technological transformation of healthcare, a new type of professional, the Technical Physician (TP), was created and is trained to improve individual patient care using technology tailored to the needs of individual patients. This study investigates the TPs' impact on patient care in terms of innovation, effectiveness, efficiency, and patient safety. METHOD Semi-structured, in-depth interviews were conducted with 30 TPs and 17 medical specialists (MSs) working in academic or teaching hospitals in the Netherlands. The pre-structured and open-ended interview questions focused on: 1) the perceived impact on innovation, effectiveness, efficiency, and safety, and 2) opportunities and challenges in daily work. RESULTS TPs and MSs unanimously experienced that TPs contributed to innovation. A majority indicated that effectiveness (TP 57%; MS 71%) and efficiency (TP 67%; MS 65%) of clinical practice had increased. For safety, 87% of TPs but only 47% of MSs reported an increase. The main explanation given for TPs positive impact was combining medical and technical knowledge. Mainly organizational barriers were mentioned as a potential cause for a less visible contribution of TPs. CONCLUSION AND DISCUSSION TPs and MSs unanimously agreed that TPs contributed to innovating patient care through their integrative medical and technical competencies. Most TPs and MSs also reported increased effectiveness, efficiency, and safety of patient care due to the TPs' work. TPs and MSs expected that the TPs' impact on direct and indirect patient care will be enhanced once organizational barriers are removed.
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Affiliation(s)
- Marleen Groenier
- Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Koen Spijkerboer
- Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Lisanne Venix
- Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Lars Bannink
- Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Saskia Yperlaan
- Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Quinten Eyck
- Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Jeannette G. van Manen
- Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Heleen A. Th. Miedema
- Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
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Fikrat‐Wevers S, Stegers‐Jager K, Groenier M, Koster A, Ravesloot JH, Van Gestel R, Wouters A, van den Broek W, Woltman A. Applicant perceptions of selection methods for health professions education: Rationales and subgroup differences. Med Educ 2023; 57:170-185. [PMID: 36215062 PMCID: PMC10092456 DOI: 10.1111/medu.14949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
CONTEXT Applicant perceptions of selection methods can affect motivation, performance and withdrawal and may therefore be of relevance in the context of widening access. However, it is unknown how applicant subgroups perceive different selection methods. OBJECTIVES Using organisational justice theory, the present multi-site study examined applicant perceptions of various selection methods, rationales behind perceptions and subgroup differences. METHODS Applicants to five Dutch undergraduate health professions programmes (N = 704) completed an online survey including demographics and a questionnaire on applicant perceptions applied to 11 commonly used selection methods. Applicants rated general favourability and justice dimensions (7-point Likert scale) and could add comments for each method. RESULTS Descriptive statistics revealed a preference for selection methods on which applicants feel more 'in control': General favourability ratings were highest for curriculum-sampling tests (mean [M] = 5.32) and skills tests (M = 5.13), while weighted lottery (M = 3.05) and unweighted lottery (M = 2.97) were perceived least favourable. Additionally, applicants preferred to distinguish themselves on methods that assess attributes beyond cognitive abilities. Qualitative content analysis of comments revealed several conflicting preferences, including a desire for multiple selection methods versus concerns of experiencing too much stress. Results from a linear mixed model of general favourability indicated some small subgroup differences in perceptions (based on gender, migration background, prior education and parental education), but practical meaning of these differences was negligible. Nevertheless, concerns were expressed that certain selection methods can hinder equitable admission due to inequal access to resources. CONCLUSIONS Our findings illustrate that applicants desire to demonstrate a variety of attributes on a combination of selection tools, but also observe that this can result in multiple drawbacks. The present study can help programmes in deciding which selection methods to include, which more negatively perceived methods should be better justified to applicants, and how to adapt methods to meet applicants' needs.
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Affiliation(s)
- Suzanne Fikrat‐Wevers
- Institute of Medical Education Research RotterdamErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Karen Stegers‐Jager
- Institute of Medical Education Research RotterdamErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Marleen Groenier
- Technical Medical Centre, Technical MedicineUniversity of TwenteEnschedeThe Netherlands
| | - Andries Koster
- Department of Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Jan Hindrik Ravesloot
- Department of Medical Biology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Renske Van Gestel
- Department of Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Anouk Wouters
- Faculty of Medicine VUAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and EducationVU University AmsterdamAmsterdamThe Netherlands
| | - Walter van den Broek
- Institute of Medical Education Research RotterdamErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Andrea Woltman
- Institute of Medical Education Research RotterdamErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
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Lovink A, Groenier M, van der Niet A, Miedema H, Rethans JJ. The contribution of simulated patients to meaningful student learning. Perspect Med Educ 2021; 10:341-346. [PMID: 34637120 PMCID: PMC8633349 DOI: 10.1007/s40037-021-00684-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Communication training with simulated patients (SPs) is widely accepted as a valuable and effective means of teaching communication skills. However, it is unclear which elements within SP-student encounters make these learning experiences meaningful. This study focuses on the SP's role during meaningful learning of the student by giving an in-depth understanding of the contribution of the SP from a student perspective. METHODS Fifteen bachelor Technical Medicine students were interviewed. Technical medicine students become technical physicians who optimize individual patient care through the use of personalized technology. Their perceptions of meaningful learning experiences during SP-student encounters were explored through in-depth, semi-structured interviews, and analyzed using thematic analysis. RESULTS Three main themes were identified that described what students considered to be important for meaningful learning experiences. First, SPs provide implicit feedback-in-action. Through this, students received an impression of their communication during the encounter. Implicit feedback-in-action was perceived as an authentic reaction of the SPs. Second, implicit feedback-in-action could lead to a process of reflection-in-action, meaning that students reflect on their own actions during the consultation. Third, interactions with SPs contributed to students' identity development, enabling them to know themselves on a professional and personal level. DISCUSSION During SP encounters, students learn more than just communication skills; the interaction with SPs contributes to their professional and personal identity development. Primarily, the authentic response of an SP during the interaction provides students an understanding of how well they communicate. This raises issues whether standardizing SPs might limit opportunities for meaningful learning.
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Affiliation(s)
- Annelies Lovink
- Department of Technical Medicine, University of Twente, Twente, The Netherlands.
| | - Marleen Groenier
- Department of Technical Medicine, University of Twente, Twente, The Netherlands
| | - Anneke van der Niet
- Department IQ Healthcare, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Heleen Miedema
- Department of Technical Medicine, University of Twente, Twente, The Netherlands
| | - Jan-Joost Rethans
- Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Groenier M, Christoph N, Smeenk C, Endedijk MD. The process of slowing down in clinical reasoning during ultrasound consultations. Med Educ 2021; 55:242-251. [PMID: 32888219 PMCID: PMC7891410 DOI: 10.1111/medu.14365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/12/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES In clinical reasoning, clinicians need to switch between automatic and effortful reasoning to solve both routine and non-routine problems. This requires the ability to recognise when a problem is non-routine and adapt one's reasoning mode accordingly, that is to 'slow down' the reasoning process. In the current study, we explored the process of these transitions between automatic and effortful reasoning by radiologists who performed ultrasound examinations during consultations at the polyclinic. METHODS Manifestations of slowing down in clinical reasoning were explored in 41 out-patient consultations performed by five radiologists. Interviews before and after the consultations were combined with observations during the consultations to obtain proactively planned triggers, slowing down manifestations and situationally responsive initiators. Transcripts of the interviews and field notes of the observations were coded. The constant comparative method was used to classify slowing down manifestations. RESULTS In thirteen of the 41 consultations, slowing down moments were observed. Four manifestations of slowing down were identified: shifting, checking, searching and focusing. These manifestations mainly differed in how long radiologists maintained effortful reasoning, varying from very short periods (shifting and checking) to sustained periods (searching and focusing). Unexpected patient statements and ambiguous ultrasound images initiated the slowing down moments. DISCUSSION The results from this study contribute to understanding how clinicians transition from automatic to effortful reasoning. Also, this study revealed two sources of initiators of this transition in radiologists' consultations: statements made by the patient and conflicting or ambiguous visual information, in this case from ultrasound images. Natural variations in patient statements and visual information can be used as input of what might be meaningful variation in the domain of radiology education to support expertise development.
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Affiliation(s)
- Marleen Groenier
- Technical Medical CentreTechnical MedicineUniversity of TwenteEnschedeThe Netherlands
| | - Noor Christoph
- Center of Evidence Based EducationFaculty of MedicineAcademic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Carmen Smeenk
- Center of Evidence Based EducationFaculty of MedicineAcademic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Educational SciencesFaculty of Behavioral, Management, and Social SciencesUniversity of TwenteEnschedeThe Netherlands
| | - Maaike D. Endedijk
- Department of Educational SciencesFaculty of Behavioral, Management, and Social SciencesUniversity of TwenteEnschedeThe Netherlands
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Halfwerk F, Groot Jebbink E, Groenier M. Development and Evaluation of a Proficiency-based and Simulation-based Surgical Skills Training for Technical Medicine Students. MedEdPublish (2016) 2020; 9:284. [PMID: 38058860 PMCID: PMC10697565 DOI: 10.15694/mep.2020.000284.1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
This article was migrated. The article was marked as recommended. Objective Surgical graduate training to achieve practice-ready students is needed, yet is often lacking. This study developed and evaluated a proficiency-based, simulation-based course for basic surgical skills at graduate level. Learning outcomes were measured at the level of knowledge and skills and evaluated with a post-course questionnaire after students' clinical rotations. Methods The surgical skills course was anchored to surgical patient flow and covered topics and skills related to pre-, intra-, and post-operative care, including case-based medical reasoning, patient safety, infection management, operating theatre etiquette, scrubbing and donning, instrument handling, local anaesthesia, excision of tissue, and suturing. Students were assessed on knowledge and procedural skills. Results 155 graduate Technical Medicine students from academic years 2015-2016 and 2016-2017 entered this 10-week, 3 ECTS credits graduate Surgical Skills course. Pass rates of the knowledge test were 78%, and 87% for the procedural skill assessment. Graduate students reached proficiency level in a simulation-based basic surgical skills course. Students stated to go with confidence to the operating room and felt competent in performing four basic surgical skills. Conclusion Based on this study, we recommend that proficiency-based training using simulation should be standard in surgical curricula before students are allowed to practice on patients.
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Groenier M, Brummer L, Bunting BP, Gallagher AG. Reliability of Observational Assessment Methods for Outcome-based Assessment of Surgical Skill: Systematic Review and Meta-analyses. J Surg Educ 2020; 77:189-201. [PMID: 31444148 DOI: 10.1016/j.jsurg.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/18/2019] [Revised: 06/24/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Reliable performance assessment is a necessary prerequisite for outcome-based assessment of surgical technical skill. Numerous observational instruments for technical skill assessment have been developed in recent years. However, methodological shortcomings of reported studies might negatively impinge on the interpretation of inter-rater reliability. OBJECTIVE To synthesize the evidence about the inter-rater reliability of observational instruments for technical skill assessment for high-stakes decisions. DESIGN A systematic review and meta-analysis were performed. We searched Scopus (including MEDLINE) and Pubmed, and key publications through December, 2016. This included original studies that evaluated reliability of instruments for the observational assessment of technical skills. Two reviewers independently extracted information on the primary outcome (the reliability statistic), secondary outcomes, and general information. We calculated pooled estimates using multilevel random effects meta-analyses where appropriate. RESULTS A total of 247 documents met our inclusion criteria and provided 491 inter-rater reliability estimates. Inappropriate inter-rater reliability indices were reported for 40% of the checklists estimates, 50% of the rating scales estimates and 41% of the other types of assessment instruments estimates. Only 14 documents provided sufficient information to be included in the meta-analyses. The pooled Cohen's kappa was .78 (95% CI 0.69-0.89, p < 0.001) and pooled proportion agreement was 0.84 (95% CI 0.71-0.96, p < 0.001). A moderator analysis was performed to explore the influence of type of assessment instrument as a possible source of heterogeneity. CONCLUSIONS AND RELEVANCE For high-stakes decisions, there was often insufficient information available on which to base conclusions. The use of suboptimal statistical methods and incomplete reporting of reliability estimates does not support the use of observational assessment instruments for technical skill for high-stakes decisions. Interpretations of inter-rater reliability should consider the reliability index and assessment instrument used. Reporting of inter-rater reliability needs to be improved by detailed descriptions of the assessment process.
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Affiliation(s)
- Marleen Groenier
- Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Leonie Brummer
- Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Brendan P Bunting
- Psychology Research Institute, Ulster University, Coleraine, Northern Ireland
| | - Anthony G Gallagher
- ASSERT Centre, College of Medicine and Health, University College Cork, Cork, Ireland
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Boon M, van Baalen S, Groenier M. Interdisciplinary expertise in medical practice: Challenges of using and producing knowledge in complex problem-solving. Med Teach 2019; 41:668-677. [PMID: 30661424 DOI: 10.1080/0142159x.2018.1544417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Purpose: Clarification of interdisciplinary expertise as the ability to deal with the cognitive and epistemological challenges of multi- and interdisciplinary problem-solving-such as in developing and implementing medical technology for diagnoses and treatment of patients in collaborations between clinicians, technicians, and engineers-and of the higher-order cognitive skills needed as part of this expertise. Method: Clarify the epistemological difficulties of combining scientific knowledge, methodologies and technologies from different disciplines in problem-solving, by drawing on recent developments in the philosophy of science. Conclusion: We argue that interdisciplinary expertise involves the cognitive ability to connect, translate and establish links between disciplinary knowledge, as well as the metacognitive ability to understand and explain the role of the disciplinary perspective-consisting of, e.g. basic concepts, theories, models, methodologies, technologies, and specific ways of measuring, reasoning and modeling in a discipline-in how knowledge is used and produced.
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Affiliation(s)
- Mieke Boon
- a Department of Philosophy , University of Twente , Enschede , The Netherlands
| | - Sophie van Baalen
- a Department of Philosophy , University of Twente , Enschede , The Netherlands
| | - Marleen Groenier
- b Department of Technical Medicine , University of Twente , Enschede , The Netherlands
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Groenier M, Groenier KH, Miedema HAT, Broeders IAMJ. Perceptual Speed and Psychomotor Ability Predict Laparoscopic Skill Acquisition on a Simulator. J Surg Educ 2015; 72:1224-1232. [PMID: 26341168 DOI: 10.1016/j.jsurg.2015.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 02/04/2015] [Revised: 05/11/2015] [Accepted: 07/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Performing minimally invasive surgery puts high demands on a surgeon's cognitive and psychomotor abilities. Assessment of these abilities can be used to predict a surgeon's learning curve, to create individualized training programs, and ultimately in selection programs for surgical training. The aim of this study was to examine the influence of cognitive and psychomotor ability on the training duration and learning rate. DESIGN A prospective quasiexperimental field study regarding the influence of cognitive and psychomotor ability, baseline measures of time to complete task, damage to tissue, and efficiency of movement, age, and gender on the number of sessions needed to reach a predefined performance level on a laparoscopy simulator. The same variables were investigated as predictors of the learning rate. SETTING The study was performed at the Experimental Center for Technical Medicine at the University of Twente, The Netherlands. PARTICIPANTS In all, 98 novices from the Master program of Technical Medicine followed a proficiency-based basic laparoscopic skills training. RESULTS Perceptual speed (PS) predicted training duration (hazard ratio = 1.578; 95% CI = 1.084, 2.300; p = 0.017). Cognitive (b = -0.721, p = 0.014) and psychomotor ability (b = 0.182, p = 0.009) predicted the learning rate of time to complete the task. Also, the learning rate for participants with higher levels of PS was lower (b = 0.167, p = 0.036). Psychomotor ability also predicted the learning rate for damage to tissue (b = 0.194, p = 0.015) and efficiency of movement (b = 0.229, p = 0.004). Participants with better psychomotor ability outperformed other participants across all sessions on all outcome measures. CONCLUSIONS PS predicted training duration in a basic laparoscopic skills training and the learning rate for the time to complete the task. Psychomotor ability predicted the learning rate for laparoscopic skill acquisition in terms of time to complete task, damage to tissue, and efficiency of movements. These results indicate early automation of basic laparoscopic skill. Careful selection of the cognitive abilities tests is advised for use in training programs and to identify individuals who need more training.
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Affiliation(s)
- Marleen Groenier
- Department of Technical Medicine, University of Twente, Enschede, The Netherlands.
| | - Klaas H Groenier
- Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Heleen A T Miedema
- Department of Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Ivo A M J Broeders
- Department of Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
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Abstract
Abstract. The present study investigated whether diagnostic anchors, that is: diagnoses suggested in referral letters, influence judgments made by clinical psychologists with different levels of experience. Moderately experienced clinicians (N = 98) and very experienced clinicians (n = 126) were randomly assigned to reading a referral letter suggesting either depression or anxiety, or no referral letter. They then read a psychiatric report about a depressed patient, and gave a preliminary and final diagnosis. Results showed that the correctness of the diagnoses by very experienced clinicians was unaffected by the referral diagnosis. Moderately experienced clinicians did use the suggested diagnosis as anchor; when they had read a referral letter suggesting depressive complaints they were more inclined to classify the patient with a depressive disorder. In conclusion, the diagnosis in a referral letter influences the diagnostic decision made by moderately experienced clinicians.
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Affiliation(s)
- Nanon L. Spaanjaars
- Diagnostic Decision Making, Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
| | - Marleen Groenier
- Instructional Technology, University of Twente, Enschede, The Netherlands
| | - Monique O. M. van de Ven
- Diagnostic Decision Making, Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
| | - Cilia L. M. Witteman
- Diagnostic Decision Making, Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
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Luursema JM, Rovers MM, Groenier M, van Goor H. Performance variables and professional experience in simulated laparoscopy: a two-group learning curve study. J Surg Educ 2014; 71:568-573. [PMID: 24776879 DOI: 10.1016/j.jsurg.2013.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 09/23/2013] [Revised: 11/20/2013] [Accepted: 12/19/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Virtual reality simulators are increasingly used in laparoscopy training. Such simulators allow objective assessment of performance. However, both low-level variables and overall scores generated by the simulator can be hard to interpret. We present a method to generate intermediate performance variables and show how the resulting variables can be used to investigate the development of laparoscopic skills. DESIGN A beginner group (n = 16) and a group with intermediate laparoscopic experience (n = 9) participated in a 5-session, basic skills training course hosted by the Department of Technical Medicine at the University of Twente. Multiple simulator-generated variables were aggregated into 4 performance variables: duration, left-hand motion, right-hand motion, and damage. Differences in performance were analyzed in relation to proficiency values. RESULTS Damage performance differentiated the most between groups and proficiency values; motion performance variables differentiated the least. The more experienced group outperformed the beginner group at damage by the end of the course. CONCLUSIONS Differentiating between duration, left-hand motion, right-hand motion, and damage is a useful way to investigate laparoscopic performance development. Different performance variables follow different trajectories toward expertise. Valid and reliable clinical damage parameters are needed to investigate the relation of real-world damage to simulator damage.
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Affiliation(s)
- Jan-Maarten Luursema
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Operating Rooms, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Epidemiology, Biostatistics & HTA, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Marleen Groenier
- Department of Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Groenier M, Schraagen JMC, Miedema HAT, Broeders IAJM. The role of cognitive abilities in laparoscopic simulator training. Adv Health Sci Educ Theory Pract 2014; 19:203-217. [PMID: 23568181 DOI: 10.1007/s10459-013-9455-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 03/25/2013] [Indexed: 06/02/2023]
Abstract
Learning minimally invasive surgery (MIS) differs substantially from learning open surgery and trainees differ in their ability to learn MIS. Previous studies mainly focused on the role of visuo-spatial ability (VSA) on the learning curve for MIS. In the current study, the relationship between spatial memory, perceptual speed, and general reasoning ability, in addition to VSA, and performance on a MIS simulator is examined. Fifty-three laparoscopic novices were tested for cognitive aptitude. Laparoscopic performance was assessed with the LapSim simulator (Surgical Science Ltd., Gothenburg, Sweden). Participants trained multiple sessions on the simulator until proficiency was reached. Participants showed significant improvement on the time to complete the task and efficiency of movement. Performance was related to different cognitive abilities, depending on the performance measure and type of cognitive ability. No relationship between cognitive aptitude and duration of training or steepness of the learning curve was found. Cognitive aptitude mediates certain aspects of performance during training on a laparoscopic simulator. Based on the current study, we conclude that cognitive aptitude tests cannot be used for resident selection but are potentially useful for developing individualized training programs. More research will be performed to examine how cognitive aptitude testing can be used to design training programs.
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Affiliation(s)
- M Groenier
- Faculty of Science and Technology, Department of Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands,
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Groenier M, Pieters JM, Witteman CLM, Lehmann SRS. The Effect of Client Case Complexity on Clinical Decision Making. European Journal of Psychological Assessment 2014. [DOI: 10.1027/1015-5759/a000184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In mental health care, clinicians’ treatment decisions are expected to be based on the formulation (i.e., exploration of the causing and maintaining mechanisms) of the client’s problems. Previous research showed two things: clinicians’ case formulations mainly contain descriptive information instead of explanatory information and it is unclear to what extent treatment decisions are actually based on case formulations. In this study, we tested whether the complexity of client problems influences case formulation quality and we investigated to what extent case formulations explain treatment decisions for simple and complex client problems. Results show that case formulations for complex problems were of lower quality than those for simple problems. Also, we found that case formulations are only weakly associated with treatment decisions, for both types of problems. We conclude that clinicians give higher quality case formulations when these may be least needed, that is: for simple cases, for which an empirically supported treatment is available. Clinicians appear to base treatment decisions on descriptions of overt client symptoms rather than on case formulations.
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Affiliation(s)
- Marleen Groenier
- University of Twente, Faculty of Behavioral Sciences, Enschede, The Netherlands
| | - Jules M. Pieters
- University of Twente, Faculty of Behavioral Sciences, Enschede, The Netherlands
| | | | - Souja R. S. Lehmann
- University of Twente, Faculty of Behavioral Sciences, Enschede, The Netherlands
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Groenier M, Pieters JM, Hulshof CD, Wilhelm P, Witteman CLM. Psychologists' judgements of diagnostic activities: deviations from a theoretical model. Clin Psychol Psychother 2008; 15:256-65. [PMID: 19115446 DOI: 10.1002/cpp.587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this article, we describe an investigation into the diagnostic activities of practicing clinical psychologists. Two questionnaires were filled in by 313 psychologists. One group of psychologists (N = 175) judged the necessity of diagnostic activities; the other group (N = 138) selected the activities they would actually perform. Results showed that more participants thought that diagnostic activities were necessary than there were participants who intended to actually perform those activities. Causal analysis, by generating and testing diagnostic hypotheses to form an integrated client model with an explanation for the problem, was judged least necessary and would not be performed. We conclude that a discrepancy exists between the number and types of activities psychologists judged to be necessary and they intend to actually perform. The lack of attention for causal analysis is remarkable as causal explanations are crucial to effective treatment planning.
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Affiliation(s)
- Marleen Groenier
- Faculty of Behavioural Sciences, University of Twente, Enschede, the Netherlands.
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