Can peer feedback substitute for faculty feedback in predoctoral dental education?

PURPOSE/OBJECTIVES

The ability to give and receive feedback is a key skill to develop during predoctoral dental education, and the use of peer feedback specifically offers distinct benefits including a different understanding of material due to peers' proximity of knowledge development and assisting with overburdened instructors. However, it is unclear if peer feedback offers similar quality to instructor feedback.

METHODS

Dental students in two different graduation years provided quantitative and qualitative peer feedback on a case-based oral and maxillofacial pathology simulation. The data from these exercises were aggregated and analyzed to compare the quality of qualitative feedback to course examination scores. Student perceptions of peer feedback were also recorded.

RESULTS

The mean quality of feedback was not correlated with course examination scores, though the number of times students gave high-quality feedback and received high-quality feedback was correlated with course examination scores. Student feedback overall had a lower quality than instructor feedback, though there was no significant difference between instructor feedback quality and the maximum student feedback quality received. Student perceptions of the utility of feedback were positive.

CONCLUSION

While instructor feedback is more reliable and consistent, our findings suggest that in most instances, at least one peer in moderate-sized groups is able to approximate the quality of instructor feedback on case-based assignments.

Training future leaders: A qualitative study exploring leadership development in predoctoral dental curricula

PURPOSE/OBJECTIVE

Commission on Dental Accreditation (CODA) accreditation standard 2-19 states predoctoral dental schools must assess students' ability to function successfully as the leader of the oral health care team. This study aimed to explore how dental schools incorporate leadership training into their curriculum to better understand the leadership skills students learn, the ways students engage in leadership training, and the opportunities students have to practice leadership skills with their peers.

METHODS

The aim of this 2022 qualitative phenomenology study was to use semi-structured interviews with academic Deans at CODA-accredited dental schools and one subject matter expert to uncover types of cognitive, behavioral, and environmental factors influencing leadership training through the lens of social cognitive theory. All interviews were recorded on Zoom, transcribed, de-identified, and analyzed for recurring themes using NVivo. Eight academic Deans and one subject matter expert participated in the study.

RESULTS

Four major themes emerged from the data: leadership is essential for dental professionals, leadership is incorporated into the curricula in diverse ways, students most often engage in leadership training opportunities with dental peers and interprofessional opportunities could be expanded, and dental schools often face barriers to incorporating leadership training. Vertically integrated case presentations and team-based practice management simulations are meaningful leadership development activities. Prominent barriers include time constraints, lack of faculty champions with teaching leadership expertise, and prioritizing the development of hand skills.

CONCLUSION

Standard practices for student leadership development and assessment do not appear to exist across dental school curricula. Findings support the need for a leadership development framework.

Subject matter changes in the dental curriculum: A scoping review of the last two decades

PURPOSE

In recent years, dental education has witnessed significant advancements and curriculum shifts in response to evolving healthcare needs, technological advances, and changing societal demands. As a result, dental universities worldwide have undergone substantial curriculum changes to ensure the adequate education and training of future dental professionals. The purpose of this study was to delineate the curriculum innovations over the past 20 years, with a focus on content within the current dental curriculum at universities worldwide.

METHOD

The articles reviewed for this manuscript were published from 2000 to June 2023. Search queries were conducted in four databases: Embase, PubMed, Web of Science, and ERIC, yielding 367 unique studies. Of these, 31 were included in the final synthesis.

RESULTS

The nine principal subject matter themes identified in the thematic analysis of these articles were critical scientific thinking, computational thinking, global mindset, geriatric dental care, interprofessional teamwork, transition to practice, local community, integration, and lifelong learning. The themes were modeled and mapped in a three-axis figure, elucidating the interconnections between the themes.

CONCLUSION

The identified themes signify the trajectory that dental education has taken and provide insights into the future course of the dental profession.

Online versus in-person surgical near-peer teaching in undergraduate medical education during the COVID-19 pandemic: A mixed-methods study

Background and Aims

The coronavirus disease 2019 (COVID-19) pandemic stimulated a paradigm shift in medical and surgical education from in-person teaching to online teaching. It is unclear whether an in-person or online approach to surgical teaching for medical students is superior. We aim to compare the outcomes of in-person versus online surgical teaching in generating interest in and improving knowledge of surgery in medical students. We also aim the quantify the impact of a peer-run surgical teaching course.

Methods

A six-session course was developed by medical students and covered various introductory surgical topics. The first iteration was offered online to 70 UK medical students in March 2021, and the second iteration was in-person for 20 students in November 2021. Objective and subjective knowledge was assessed through questionnaires before and after each session, and also for the entire course. Data were analyzed from this mixed-methods study to compare the impact of online versus in-person teaching on surgical knowledge and engagement.

Results

Students in both iterations showed significant improvement of 33%-282% across the six sessions in knowledge and confidence after completing the course (p < 0.001). There was no significant difference in the level of objective knowledge, enjoyment, or organization of the course between online and in-person groups, although the in-person course was rated as more engaging (mean Likert score 9.1 vs. 9.7, p = 0.033).

Discussion

Similar objective and subjective surgical teaching outcomes were achieved in both iterations, including in "hands-on" topics such as suturing, gowning, and gloving. Students who completed the online course did not have any lower knowledge or confidence in their surgical skills; however, the in-person course was reported to be more engaging. Surgical teaching online and in-person may be similarly effective and can be delivered according to what is most convenient for the circumstances, such as in COVID-19.

Pediatric Intersession: An Upfront Flipped-Classroom Curriculum to Promote Pediatric Clerkship Readiness

OBJECTIVES

Best practices for content selection, mode of delivery, and timing of pediatric clerkship readiness curricula for medical students have, by and large, not been established. Capitalizing on changes in structure of the clinical clerkships during the COVID-19 pandemic, we created an upfront clerkship readiness curriculum, termed Pediatric Intersession (PI), to replace the existing weekly lecture-based clerkship didactics.

METHODS

Our goal was to develop an interactive curriculum with innovative instructional design methodology intended to promote broad foundational pediatric knowledge and clerkship preparedness using case-based learning. We first conducted a needs assessment and crafted curriculum content using guiding principles from the 2019 Council on Medical Student Education in Pediatrics (COMSEP) curriculum. We then organized material into four daily modules prior to the start of the clerkship and employed flipped classroom (FC) methodology.

RESULTS

Sixty-six percent of students completed course evaluations, and >90% of the 100 respondents reported that the PI enhanced their clinical learning. Pre-/post-testing demonstrated some knowledge gain following the small-group sessions and there was no change on the National Board of Medical Examiners (NBME) Subject Exam mean scores compared to prior cohorts of students.

CONCLUSIONS

The global pandemic provided an opportunity to re-envision our pediatric clerkship didactics content, while also incorporating instructional design methodology preferred by students. Our curriculum promotes a small group-based, interactive approach to clerkship readiness that fosters learning in the clinical environment that can be adapted for various settings. Our evaluation suggests that the transition to a FC readiness curriculum can be done successfully while effectively preparing students for their pediatric clerkship.

Implementing a Prenatal Oral Health Program for Dental Students: Lessons Learned

The Prenatal Oral Health Program (pOHP) was developed to educate dental students on prenatal oral health and promote access to dental care for pregnant women. Program advancement has occurred in support of quality improvement. This mixed-methods design combined quantitative data from fourth-year dental students who participated the pOHP (N = 81) and qualitative data from a student-faculty-staff focus group discussion (N = 7). Different clinical structures, appropriate leveling in the curriculum, management with a patient care coordinator, and inclusion of interprofessional learning experiences (IPE) were compared. The survey response rate was 96.4% (N = 81). Trends were noted between students who provided clinical care for a pregnant patient (31%) versus those who did not. Results indicated that an integrated clinic was preferred, though students who had treated a pOHP patient showed greater support for a standalone clinic model. Survey and focus group data agreed that pOHP should occur during the third-year dental school training; however, students with patient experience favored second-year placement. Survey and focus group data emphasize the importance of a patient care coordinator for clinical management and IPE as an essential learning element. Innovating new clinical models requires a period of evolution to determine preferred and sustainable infrastructure. Results reveal the advantages and disadvantages of various program implementation models and demonstrate that student perceptions were influenced by their clinical experiences. Study findings will inform implementation and guide other programs as they create and modify existing curricula to enhance prenatal oral health.

Preparing learners to ACT as change agents: Early implementation of leadership curricula in dental education

OBJECTIVE

Graduates of dental schools are expected to become leaders in their practices, communities, and profession. Yet, formal leadership training is underutilized in U.S. dental school curricula to help learners develop these skills. The objective of this study was to understand third- and fourth-year dental students' perceptions of their initial semester of Bell Leadership Institute training as part of the novel Advocate, Clinician, Thinker curriculum at the UNC Adams School of Dentistry.

METHODS

Focus groups of 52 third- and fourth-year dental students were conducted after the completion of the first semester of leadership seminars. Session notes were transcribed, and qualitative analysis was performed to help elucidate student perceptions of the value and pertinence of the leadership seminars.

RESULTS

Participants valued the opportunities to self-reflect, develop listening skills, and learn strategies to address and mitigate conflict through the leadership seminars. Perceptions of seminar length, frequency, and structure were varied. Participants also noted that explicit connections and applications of leadership topics to the field of dentistry would improve the quality of the programing. Feedback from 52 focus group participants suggests a general appreciation for curriculum-integrated leadership training.

CONCLUSION

Early implementation of seminar-style leadership training in dental school curricula appears to be a productive avenue for developing critical leadership skills in dental school graduates.

US students' perceptions on environmental sustainability in dental school

OBJECTIVES

At present, there are no published reports assessing pre-doctoral curricular experience or participatory involvement with Environmental Sustainability in Dentistry (ESD) in the United States. This study aims to assess whether students enrolled in US dental schools receive any training with ESD and gauge dental students' level of interest and attitudes regarding ESD within their dental education.

METHODS

A descriptive cross-sectional study utilizing a 16-questions validated survey was conducted on Qualtrics. Data analysis included descriptive statistics.

RESULTS

A total of 378 dental students from 17 US dental schools participated (response rate 5%). Students reported that ESD was "quite" or "extremely" important (83%). However, 75% of students reported being "not at all" or "slightly" knowledgeable. Only 5% reported ESD content in their dental education. Students suggested that ESD could be integrated into existing coursework relating to infection control, practice management, and dental public health.

CONCLUSION

By understanding students' level of interest, attitudes toward importance, and current level of curricular content on ESD, dental educators can develop best practices for educating future practitioners on environmental sustainability.

Practical guidelines to build Sense of Community in online medical education

OBJECTIVES

Sense of Community (SoC) refers to the cognitive or emotional connections established between physically separated learners; it is essential for study success. The recent COVID-19 pandemic highlighted the need for practical guidelines to facilitate building a SoC in online medical preclerkship education in the Netherlands. Therefore, this qualitative study aims to (a) examine perceptions of SoC from both students' and teachers' perspectives in an online elective course during the COVID-19 pandemic in order to (b) provide a conceptual framework with practical guidelines to medical educators on how to build SoC in online education.

METHODS

The study had an exploratory qualitative design. Semi-structured focus groups with student (n = 15) and teacher (n = 5) volunteers were conducted. Participants discussed their experienced SoC using the storyline method. In addition, course developers (n = 2) were interviewed and lecturers (n = 5) wrote an experience story. Audio- and video-recordings were transcribed verbatim and both the ensuing transcripts and experience stories were analysed using an inductive thematic analysis.

RESULTS

All students experienced an increase of SoC during the eight-week course. Five themes were identified: 'social contacts made possible by a physical campus', 'group dynamics', 'teacher influence', 'education format' and 'teachers' Sense of Community'. The authors formulated challenges and practical guidelines on how to build SoC based on these themes.

CONCLUSIONS

This exploratory qualitative study provides a conceptual framework with practical guidelines for medical educators on how to build SoC in online medical preclerkship education. These guidelines provide a valuable starting point to build SoC in online education for medical educators and students alike.

Oral health curriculum evaluation tool (OHCET) for primary care training programs

BACKGROUND

Primary care training schools and programs lack a validated tool to assess their oral health curriculum, and researchers lack a tool to compare oral health curricula across programs/schools and different disciplines.

OBJECTIVE

This study describes the process and results of creating a 15-item oral health curriculum evaluation tool (OHCET).

METHODS

Three-phased development of the OHCET from 2018 to 2020 including (a) Delphi group/tool development; (b) tool pilot test; and (c) tool validation/cognitive interviews.

RESULTS

A total of 23 program deans/directors participated in the tool validation/cognitive interviews. Summarizing accuracy scores of all 15 items, the mean accuracy score was 87.1. There was a high correlation (0.917) between the program's total score and the program director's self-assessed competence of their learners at the time of graduation.

CONCLUSIONS

The OHCET was validated and can be used in primary care training programs and schools across the country for institutional evaluation and for research purposes. Program directors and deans can also have some confidence that their ability to subjectively assess their learner's oral health knowledge and skills at graduation is accurate.

Reimagining the pipeline: Saturday Academy at New York University College of Dentistry goes virtual

PURPOSE/OBJECTIVES

This study describes and evaluates efforts to transition an established pre-dental pipeline program to a remote platform, in response to the coronavirus disease 2019 pandemic.

METHODS

The semester-long pipeline program, Saturday Academy at New York University College of Dentistry, was conducted remotely through Zoom, and materials for hands-on, pre-clinical activities, were mailed to participants. Saturday Academy aims to educate underrepresented minority and low-income high school students about the college application process and the dental profession. After the program's completion, program applications and engagement data were analyzed. An anonymous online survey was administered to the high school student participants. The survey questions included topics about their interest in the profession of dentistry, satisfaction with the Saturday Academy programming, and program engagement.

RESULTS

In its remote format, Saturday Academy had an average attendance of 87.8% at each session. All (60/60, 100%) of the high school student participants responded to the anonymous program satisfaction survey. Sixty-seven percent reported an interest in the profession of dentistry before participating in the program and 82% after participating in the program. Ninety-eight percent agreed with the statement "I enjoyed my experience participating in Saturday Academy." Additionally, 97% agreed with the statement "Saturday Academy's virtual programming was effective." There were no statistically significant differences in program satisfaction when data from the virtual program were compared to 2 years of in-person program satisfaction data.

CONCLUSION

Challenges to fulfilling the missions of dental institutions in response to the coronavirus pandemic impact service and recruitment efforts, in addition to formal dental education. Transitioning pipeline programming efforts, with hands-on components, to a remote format is possible and was met with favorable engagement and responses from program participants.

Moving toward a competency-based curriculum: Analyzing patients' information and students' evaluation in geriatric dentistry

OBJECTIVE

There is no core competency for geriatric dentistry and special patient care (GSP) in Thailand. Therefore, GSP program was developed as a knowledge-based curriculum. This study aimed to describe the development and architecture of the GSP curriculum by analyzing patients' information and students' evaluation to move toward a competency-based curriculum. Comparisons with the original GSP curriculum and future direction are discussed.

METHODS

Development and architecture of the GSP curriculum were described. Information of 130 patients attending the GSP clinic, and those who participated in a maintenance recall was analyzed. Students' evaluation was performed using a 21-item questionnaire within seven domains based on the ASEAN University Network-Quality Assurance (AUN-QA) checklist. The responses were made using a five-point ordinal scale ranging from totally agree to totally disagree.

RESULTS

Only 50% of the patients attended a maintenance recall. Among the recalled patients, 74.2% reported emerging problems. The AUN-QA questionnaire responses indicated that students mostly agreed with the program specification, teaching and learning approach, students' assessment methods, student quality, and support domains. The modified curriculum was developed based on the patients' information and students' evaluation. The original and modified GSP curricula were compared.

CONCLUSIONS

Information analysis of the patients and students' evaluation are essential to move a knowledge-based curriculum for geriatric and special patient care dentistry toward a competency-based curriculum that is appropriate for patients' condition and serves students' requirements. Oral health care in elderly and special care patients requires a multidisciplinary approach, and should encompass oral disease problems, behavior, and social context.

Expert consensus on Didactic Clinical Skills Development for orthodontic curricula

PURPOSE/OBJECTIVE

Competence is expected of each beginning dentist and orthodontist. However, the broad definition of competence presents a challenge to academic programs in identifying the level of cognition for students to achieve competence. This study aimed to determine the Didactic Clinical Skills Development curriculum content and competency in predoctoral and advanced education orthodontic programs.

METHOD

A modified Delphi method with a consensus threshold of 70% was employed using an expert panel of academic orthodontists.

RESULTS

Round One (n = 26) identified that all topics proposed by a focus group were necessary, except for predoctoral Appliances, which was at 65%. Round Two (n = 23) included subtopics of Appliances to confirm the lack of consensus, plus subtopics of all the other topics and the level of cognition required for each subtopic. The expert panel reached a consensus that all 24 subtopics, hence all topics, were necessary. In Round Three, subtopic responses in Round Two were assigned a value between 1 (remember) and 6 (create) to generate a hierarchical level-of-learning scale. Mean values were calculated for each subtopic response. For all subtopics, the mean level of cognition for predoctoral education was at understand; for advanced education, it was at evaluate.

CONCLUSION

This consensus suggests that, to be deemed competent, beginning dentists must learn these topics and subtopics in the cognitive domain of understand, and beginning orthodontists in the cognitive domain of evaluate. This study showed an expert consensus on Didactic Clinical Skills Development orthodontic curriculum content and a panorama of educational objectives that could be used as a template for curriculum design.

Dental students' OMFS-related experiences and interest in OMFS careers: An exploration

PURPOSE

While the numbers of oral maxillofacial surgery (OMFS) residents increased over time, women and residents from underrepresented minority backgrounds are still underrepresented. The objectives were to assess dental students' OMFS-related personal and educational experiences and attitudes and explore which factors correlate with their interest in future OMFS careers.

METHODS

Data were collected from 493 dental students in 1 dental school and 206 students from 15 other US and Canadian dental schools.

RESULTS

The students in the national sample were more likely to have experienced an OMFS procedure themselves (64.6% vs. 50.7%; P = 0.001), have shadowed an OMFS in an operating room (23.2% vs. 14.9%; P = 0.009) prior to coming to dental school and to be much/very much interested in an OMFS career (36.4% vs. 12%; P < 0.001) than the students at the home school. While the majority of both groups rated their experiences with rotations in the OMFS department in the dental school (68% vs. 62.5%) and in the hospital (80.3% vs. 85.7%) as very interesting, the students in the national sample were more likely to agree/strongly agree that they were satisfied with their OMFS experiences (68.1% vs. 36.3%; P < 0.001) and had learned a lot from the OMFS faculty (57.9% vs. 30.8%) than the students in the home school. For both groups, the degree of interest in an OMFS career correlated with having had more personal OMFS experiences (home: r = 0.28; P < 0.001/other: r = 0.39; P < 0.001), more interesting OMFS experiences in the dental school (r = 0.23; P < 0.05/r = 0.40; P < 0.001) and the hospital (0.33; P < 0.05/r = 0.50; P < 0.001) and more positive attitudes toward OMFS faculty (r = 0.26; P < 0.001/r = 0.37; P < 0.001).

CONCLUSIONS

Positive personal and educational OMFS experiences and positive attitudes toward OMFS faculty were associated with an interest in OMFS careers. These findings provide a basis for developing educational interventions aimed at increasing the percentage of women and residents from URM backgrounds in OMFS programs.

Creating assessments as an active learning strategy: what are students' perceptions? A mixed methods study

Background: Teaching students how to create assessments, such as those involving multiple-choice questions (MCQs), has the potential to be a useful active learning strategy. In order to optimize students' learning, it is essential to understand how they engage with such activities. Objective: To explore medical students' perceptions of how completing rigorous MCQ training and subsequently writing MCQs affects their learning. Design: In this mixed methods exploratory qualitative study, eighteen second-year medical students, trained in MCQ-writing best practices, collaboratively generated a question bank. Subsequently, the authors conducted focus groups with eight students to probe impressions of the process and the effect on learning. Responses partially informed a survey consisting of open-ended and Likert rating scale questions that the remaining ten students completed. Focus group and survey data from the eighteen participants were iteratively coded and categorized into themes related to perceptions of training and of collaborative MCQ writing. Results: Medical students felt that training in MCQ construction affected their appreciation for MCQ examinations and their test-taking strategy. They perceived that writing MCQs required more problem-solving and content-integration compared to their preferred study strategies. Specifically, generating plausible distractors required the most critical reasoning to make subtle distinctions between diagnoses and treatments. Additionally, collaborating with other students was beneficial in providing exposure to different learning and question-writing approaches. Conclusions: Completing MCQ-writing training increases appreciation for MCQ assessments. Writing MCQs requires medical students to make conceptual connections, distinguish between diagnostic and therapeutic options, and learn from colleagues, but requires extensive time and knowledge base.

Teaching dental undergraduate students restorative CAD/CAM technology: evaluation of a new concept

OBJECTIVES

The use of computer-aided design/computer-aided manufacturing (CAD/CAM) technology in restorative dentistry has increased significantly and should consequently be taught more intensively at university dental schools. This study describes the evaluation of a new CAD/CAM teaching concept.

METHODS

CAD/CAM technology was implemented into a 4th-year clinical student course according to Miller's pyramid principle. Fifty-eight students with no clinical experience participated in a 2-day theoretical and practical introductory course and rated its didactic outcome (Questionnaire 1). Students selected the fabrication method for indirect single tooth restorations during a 5-month patient treatment course. 54 conventional (e.max Press) and 68 CAD/CAM (Lava Ultimate) indirect Cerec-method restorations were fabricated and seated adhesively (Syntac, Variolink II). The success of the CAD/CAM integration was analyzed by the students, who were grouped according to their selected fabrication method (Questionnaire 2), as follows: Group A (CAD/CAM, n = 18); Group B (conventional and CAD/CAM, n = 17); Group C (conventional, n = 23).

RESULTS

The questionnaire ratings were expressed as a percentage of the number of students' answers and are presented as diagrams. 95% of all the students in all the groups wanted CAD/CAM technology to be integrated into the subsequent (5th-year) clinical course. The rating for the CAD/CAM introductory course on a scale of 1 (very good) to 6 (poor) was 1.86 on average for the theoretical part, and 2.20 for the practical part. Statistically significant differences were found among the technology groupings (Pearson's chi-squared test, P < 0.05).

CONCLUSIONS

CAD/CAM technology was highly welcomed by the 4th-year students and was introduced successfully into the clinical student course. Students tended to favor technology in accordance with the extent of its clinical application.

How was the intern year?: self and clinical assessment of four cohorts, from two medical curricula

BACKGROUND

Problem-based curricula have provoked controversy amongst educators and students regarding outcome in medical graduates, supporting the need for longitudinal evaluation of curriculum change. As part of a longitudinal evaluation program at the University of Adelaide, a mixed method approach was used to compare the graduate outcomes of two curriculum cohorts: traditional lecture-based 'old' and problem-based 'new' learning.

METHODS

Graduates were asked to self-assess preparedness for hospital practice and consent to a comparative analysis of their work-place based assessments from their intern year. Comparative data were extracted from 692 work-place based assessments for 124 doctors who graduated from the University of Adelaide Medical School between 2003 and 2006.

RESULTS

Self-assessment: Overall, graduates of the lecture-based curriculum rated the medical program significantly higher than graduates of the problem-based curriculum. However, there was no significant difference between the two curriculum cohorts with respect to their preparedness in 13 clinical skills. There were however, two areas where the cohorts rated their preparedness in the 13 broad practitioner competencies as significantly different: problem-based graduates rated themselves as better prepared in their 'awareness of legal and ethical issues' and the lecture-based graduates rated themselves better prepared in their 'understanding of disease processes'.Work-place based assessment: There were no significant differences between the two curriculum cohorts for 'Appropriate Level of Competence' and 'Overall Appraisal'. Of the 14 work-place based assessment skills assessed for competence, no significant difference was found between the cohorts.

CONCLUSIONS

The differences in the perceived preparedness for hospital practice of two curriculum cohorts do not reflect the work-place based assessments of their competence as interns. No significant difference was found between the two cohorts in relation to their knowledge and clinical skills. However results suggest a trend in 'communication with peers and colleagues in other disciplines' (χ2 (3, N = 596) =13.10, p = 0.056) that requires further exploration. In addition we have learned that student confidence in a new curriculum may impact on their self-perception of preparedness, while not affecting their actual competence.

Toward safe hospital discharge: a transitions in care curriculum for medical students

BACKGROUND

Medical errors often occur when patients move between care settings. Physicians generally receive little formal education on improving patient care transitions.

OBJECTIVE

To develop a sustainable and effective Transition in Care Curriculum (TICC). Specific goals were to increase student confidence in and knowledge of skills necessary during care transitions at the time of hospital discharge, and to quantify the frequency of student-identified medication discrepancies during a post-discharge home visit.

DESIGN

TICC was delivered to 136 3rd-year medical students during their required inpatient medicine clerkship at six urban Denver hospitals. TICC consists of small and large group interactive sessions and self-directed learning exercises to provide foundational knowledge of care transitions. Experiential learning occurs through direct patient care at the time of discharge and during a follow-up home, hospice, or skilled nursing visit. Students completed a pre-post confidence measure, short answer and multiple choice questions, a post-clerkship satisfaction survey, and a standardized medication discrepancy tool.

MAIN RESULTS

Overall combined confidence in transitional care skills improved following the TICC from an average score of 2.7 (SD 0.9) to 4.0 (SD 0.8) (p < 0.01) on a 5-point confidence scale. They scored an average of 77% on the written discharge plan portion of the final exam. Students rated the usefulness of TICC at a mean of 3.1 (SD 0.7), above the combined mean of 2.7 for project work in all required clerkships. Students identified medication discrepancies during 43% of post-discharge visits (58 of 136). The most common reasons for discrepancies were patient lack of understanding of instructions and intentional non-adherence to medication plan.

CONCLUSION

TICC represents a feasible and effective program to teach evidence-based transitional care.

Development and implementation of an oral sign-out skills curriculum

INTRODUCTION

Imperfect sign-out of patient information between providers has been shown to contribute to medical error, but there are no standardized curricula to teach sign-out skills. At our institution, we identified several deficiencies in skills and a lack of any existing training.

AIM

To develop a sign-out curriculum for medical house staff.

SETTING

Internal medicine residency program.

PROGRAM DESCRIPTION

We developed a 1-h curriculum and implemented it in August of 2006 at three hospital sites. Teaching strategies included facilitated discussion, modeling, and observed individual practice with feedback. We emphasized interactive communication, a structured sign-out format summarized by an easy-to-remember mnemonic ("SIGNOUT"), consistent inclusion of key content items such as anticipatory guidance, and use of concrete language.

PROGRAM EVALUATION

We received 34 evaluations. The mean score for the course was 4.44 +/- 0.61 on a 1-5 scale. Perceived usefulness of the structured oral communication format was 4.46 +/- 0.78. Participants rated their comfort with providing oral sign-out significantly higher after the session than before (3.27 +/- 1.0 before vs. 3.94 +/- 0.90 after; p < .001).

DISCUSSION

We developed an oral sign-out curriculum that was brief, structured, and well received by participants. Further study is necessary to determine the long-term impact of the curriculum.