A feedback system in residency to evaluate CanMEDS roles and provide high-quality feedback: Exploring its application

Introduction: Residents benefit from regular, high quality feedback on all CanMEDS roles during their training. However, feedback mostly concerns Medical Expert, leaving the other roles behind. A feedback system was developed to guide supervisors in providing feedback on CanMEDS roles. We analyzed whether feedback was provided on the intended roles and explored differences in quality of written feedback.

Methods: In the feedback system, CanMEDS roles were assigned to five authentic situations: Patient Encounter, Morning Report, On-call, CAT, and Oral Presentation. Quality of feedback was operationalized as specificity and inclusion of strengths and improvement points. Differences in specificity between roles were tested with Mann–Whitney U tests with a Bonferroni correction (α?=?0.003).

Results: Supervisors (n?=?126) provided residents (n?=?120) with feedback (591 times). Feedback was provided on the intended roles, most frequently on Scholar (78%) and Communicator (71%); least on Manager (47%), and Collaborator (56%). Strengths (78%) were mentioned more frequently than improvement points (52%), which were lacking in 40% of the feedback on Manager, Professional, and Collaborator. Feedback on Scholar was more frequently (p?=?0.000) and on Reflective Professional was less frequently (p?=?0.003) specific.

Discussion and conclusion: Assigning roles to authentic situations guides supervisors in providing feedback on different CanMEDS roles. We recommend additional supervisor training on how to observe and evaluate the roles.     

Using a self-regulated learning-enhanced video feedback educational intervention to improve junior doctor prescribing

Abstract

Introduction: Medical school graduates in the UK consistently report feeling underprepared for the task of prescribing when embarking on practice. The effective application of self-regulated learning (SRL) approaches and feedback on complex tasks are associated with improved outcomes in practice-based clinical skills.

Aims: This study aimed to investigate the effectiveness of an educational intervention using SRL-enhanced video feedback for improving the prescribing competency of junior doctors.

Methods: A prospective cohort study was designed to compare intervention and control cohorts of junior doctors undertaking simulated clinical encounters at the beginning and end of their 4-month rotation through renal medicine.

Results: The improvement in prescribing competency for the intervention cohort was significant (p?<?0.001) with large effect size (d?=?1.42). Self-efficacy improved in both cohorts with large (control cohort p = 0.026, r= 0.64) and medium (intervention cohort p = 0.083, d = 0.55) effect sizes. Goal setting and self-monitoring skills improved in the intervention cohort only with medium effect size (p?=?0.096, d?=?0.53).

Conclusions: SRL-enhanced video feedback is effective for improving prescribing competency and developing SRL processes such as goal setting and self-monitoring skills in simulated clinical encounters. Further research is required to evaluate transferability to other clinical sub-speciality contexts and investigate the effectiveness of the intervention for improving prescribing in non-simulated settings.     

Reading in the Postgenomic Age: On Contemporary Literature and the Good Bionarrative Citizen

The “postgenomic age,” whose start date roughly corresponds to the turn of the millennium, is characterized not only by the rapid development of genomic technologies and commercial products but also by the widespread publication of literary works focused on genomics and its cultural implications. Defining “postgenomic literature” as literature that is both of and about the postgenomic age, this essay explores how works by nonfiction writer Rebecca Skloot and novelist Richard Powers exemplify a significant trend within the genre: the thematic exploration of ethical questions in the field of literature itself. While both authors address questions of medical and scientific ethics prompted by genomic research, with special emphasis on the exploitation of vulnerable populations, these questions lead readers directly to questions of narrative responsibility: who can tell whose story to whom—and for whose benefit? The Immortal Life of Henrietta Lacks and Generosity: An Enhancement, like other examples of postgenomic literature, invite readers to engage in critical reading practices that resist both textual and genetic determinism.     

Sociobiology: The Debate Continues

Arthur Caplan's review of the reviews of Edward O. Wilson's Sociobiology (“Ethics, Evolution, and the Milk of Human Kindness,” Hastings Center Report, April 1976, pp. 20–25) generated a number of provocative responses. Because of the continuing importance of this subject, we are publishing a selection of these letters in this issue.     

IRB Becomes E&HR

In January 2019, under the new name Ethics & Human Research, The Hastings Center relaunched its forty‐year‐old journal that focuses on the ethical, regulatory, and policy issues related to research with humans. Formerly called IRB: Ethics & Human Research, E&HR has the same editorial team, led by the Hastings scholar Karen Maschke, and is meant to continue the work of IRB but will also feature a greater range of scholarship on issues in science and health care that have implications for research with humans. While E&HR is formally a continuation of IRB, it feels like a new journal. It is similar in design and format to its sister journal, the Hastings Center Report, and it has a closely linked channel for publication and distribution. Like HCR, it is published through John Wiley & Sons in both paper and electronic formats. Its home on the Wiley Online Library is https://onlinelibrary.wiley.com/journal/25782363 .     

Risk factors for a delay in medical education: Results of an online survey among four German medical schools

Background: Delayed study progress in medical school is a challenging issue for the tax paying community, the faculty and the medical students themselves. Reasons for a delay might be different from known risk factors for academic difficulties.

Methods: An online survey regarding delays in the study progress and including a personality test (BFI-10) was presented to medical students from four German medical schools after completion of their 3rd year of study.

Results: Of 617 students, 51.2% reported a mean delay of 2.1?±?1.5 semesters. Frequent risk factors were secondary employment (69.5%, odds ratio (OR) 1.7, p?=?0.004), female gender (69.8%, OR 1.6, p?=?0.007), work or study abroad (35.9%, OR 1.5, p?=?0.02), a late graduation (5.9%, OR 2.4, p?=?0.02), as well as support through scholarship or mentoring (19.9%, OR 1.8, p?=?0.004). “Working on doctoral thesis” (11.3%, OR 1.9, p?=?0.03) and structural curricular issues (36.6%, OR 0.9, p?=?0.7) were frequently identified as obstacles. “Support by friends/family” was considered helpful by 24.1% (OR 1.4, p?=?0.09), as well as a high intrinsic motivation (19.1%, OR 0.5, p?=?0.01). In the BFI-10, students with study delay were more prone to openness and agreeableness.

Conclusions: Risk factors for delay are not identical to those for academic difficulties. To decrease the risk for delays, firm curricular structures should be identified and alleviated. Intrinsic motivation is a strong impetus of study progress and additionally might be strengthened by curricular changes.     

Effects of Team-Based Learning on short-term and long-term retention of factual knowledge

Purpose: We investigated the effect of Team-Based Learning (TBL) on long-term retention of knowledge in comparison to a traditional curriculum.

Methods: As TBL was incorporated into our curriculum in the 2008–2009 academic year, students were compared with those who received the traditional curriculum the year prior. Students in both the groups completed multiple-choice knowledge test at four time points spanning two years. Test performance was compared at each time point to assess changes in knowledge retention as a function of time.

Results: Baseline knowledge did not differ significantly between the TBL and control groups [51% versus 46%; t(84)?=?0.91, p?=?0.37, d?=?0.20]. Performance improved after the course for both the groups, but was significantly higher in the TBL group [79% versus 59%; t(84)?=?4.96, p?=?0.000004, d?=?0.95]. However, when assessed prior to the pediatrics clerkship, learning gains from TBL had largely disappeared and the small difference in performance was not significant [57% versus 51%; t(84)?=?1.51, p?=?0.14, d?=?0.32].

Conclusion: Incorporating TBL into the pre-clinical pediatrics curriculum led to large gains in knowledge over the short-term, but these gains did not persist. Further research should focus on extending the impact of TBL on long-term knowledge retention.     

The Fieldworker as Watcher and Witness

In a field like genetic counseling, a medical sociologist is not only a doctor-watcher but a witness who tries to interpret the moral conflicts that lie beneath the surface of an advancing technology.     

The Familial and the Familiar: Locating Relatedness in Colombian Donor Conception

In this article, I explore how women undergoing in vitro fertilization with familial or anonymous egg donors located relatedness with a donor-conceived child through familial and social identities. Recognizing gametes as substances that contain biological and sociocultural/behavioral traits shaped women’s narratives around interconnected notions of the familial and familiar, or the social understanding of biological and social inheritance, and knowledge of the genetic materials involved. Women’s narratives of relatedness reflect their relationships with family and society and their desire to reproduce these relationships in their child(ren), a process that reproduces prevailing Colombian social values and notions of ideal citizens.     

Addressing health workforce inequities in the Mindanao regions of the Philippines: Tracer study of graduates from a socially-accountable,community-engaged medical school and graduates from a conventional medical school

Developing and retaining a high-quality medical workforce in low-resource countries is a worldwide challenge. The Filipino Ateneo de Zamboanga University–School of Medicine (ADZU-SOM) has adopted a strong focus on socially accountable health professional education (SAHPE) in order to address the shortage of physicians across rural and urban communities in the Western Mindanao region. A cross-sectional survey of graduates from two Philippines medical schools: ADZU-SOM in the Mindanao region and a medical school with a more conventional curriculum, found ADZU-SOM graduates were more likely to have joined the medical profession due to a desire to help others (p?=?0.002), came from lower socioeconomic strata (p?=?0.001) and had significantly (p?p?p?p?=?0.003). ADZU graduates were also less likely to work in private or specialist Government hospitals (p?=?0.033 and p?=?0.040, respectively) and be surgical or medical specialists (p?=?0.010 and p?相似文献   

The impact of socially-accountable,community-engaged medical education on graduates in the Central Philippines: Implications for the global rural medical workforce

Introduction: Developing and retaining a high quality medical workforce, especially within low-resource countries has been a world-wide challenge exacerbated by a lack of medical schools, the maldistribution of doctors towards urban practice, health system inequities, and training doctors in tertiary centers rather than in rural communities.

Aim: To describe the impact of socially-accountable health professional education on graduates; specifically: their motivation towards community-based service, preparation for addressing local priority health issues, career choices, and practice location.

Methods: Cross-sectional survey of graduates from two medical schools in the Philippines: the University of Manila-School of Health Sciences (SHS-Palo) and a medical school with a more conventional curriculum.

Results: SHS-Palo graduates had significantly (p?p?p?=?0.032) or in rural government health services (p?p?p?=?0.028) and their current position (p?Conclusions: SHS-Palo medical graduates fulfilled a key aim of their socially-accountable institution to develop a health professional workforce willing and able, and have a commitment to work in underserved rural communties.     

Coding the Self: The Infopolitics and Biopolitics of Genetic Sciences

This essay compares three models for conceptualizing the political and ethical challenges of contemporary genetics, genomics, and postgenomics. The three analytical approaches are referred to as the state-politics model, the biopolitical model, and the infopolitical model. Each of these models is valuable for different purposes. In terms of their influence in contemporary discussions, the first is by far the dominant approach, the second is gaining in importance, and the third is almost entirely neglected. The widespread neglect of the infopolitical dimensions of genetic sciences that are the focus of the third model is puzzling in light of the fact that genetics, genomics, and postgenomics are all preeminent information sciences. The infopolitical model thus aims to bring into clearer view the specific political and ethical problems engendered by this informational nature of the genetic sciences. This model offers a way of understanding how ethically salient and politically fraught conceptual assumptions can be embedded in informational architectures such as algorithms and the formats (or data structures) upon which they rely.     

A unique flipped classroom approach shows promising results in physician assistant education

Abstract

Aims: The flipped classroom (FC) model utilizes pre-class foundational learning with in-class higher-order application exercises. FC approaches have reported positive perceptions and mixed academic performance outcomes in medical education; however, little evidence exists on their impact in the 56-week didactic curriculum of Physician Assistant (PA) education.

Methods: A 4-week FC curriculum was piloted in a PA behavioral medicine course (n?=?34). Before class, students completed online video modules. During class, students completed a pre-class quiz and answered clinical case-based questions in a think-pair-share format.

Results: Students rated in-class time higher than a lecture-based segment of the same course (p?=?0.028). Assessment of achievement emotions demonstrated increased enjoyment (p?=?0.028) and decreased boredom (p?<?0.001) in the FC curriculum with no difference in anxiety. The FC curriculum produced a 57.2?min increase in pre-class preparation time with no change in post-class studying time. Compared to historical lecture-based controls (n?=?35), students in the FC curriculum scored significantly higher on clinical vignette questions (p?=?0.019) with equivalent performance on other question formats.

Conclusions: This study offers the first positive outcomes of an FC approach in PA education and provides a framework for improving academic performance while scaling back in-class time.     

Springtime for Fetal Tissue Research?

We are pleased to inaugurate a new feature to appear three times annually. “ Capital Report ” is designed to keep readers abreast of bioethics debates in Congress, federal agencies, and other branches of the federal government. Tabitha M. Powledge , a former Center associate, brings to the Report her experience as founding editor of The Scientist and as editor of AAAS Observer. Ms. Powledge is currently a contributing editor to Issues in Science and Technology.     

The OSCE progress test – Measuring clinical skill development over residency training

Purpose: The purpose of this study was to explore the use of an objective structured clinical examination for Internal Medicine residents (IM-OSCE) as a progress test for clinical skills.

Methods: Data from eight administrations of an IM-OSCE were analyzed retrospectively. Data were scaled to a mean of 500 and standard deviation (SD) of 100. A time-based comparison, treating post-graduate year (PGY) as a repeated-measures factor, was used to determine how residents’ performance progressed over time.

Results: Residents’ total IM-OSCE scores (n?=?244) increased over training from a mean of 445 (SD?=?84) in PGY-1 to 534 (SD?=?71) in PGY-3 (p?<?0.001). In an analysis of sub-scores, including only those who participated in the IM OSCE for all three years of training (n?=?46), mean structured oral scores increased from 464 (SD?=?92) to 533 (SD?=?83) (p?<?0.001), physical examination scores increased from 464 (SD?=?82) to 520 (SD?=?75) (p?<?0.001), and procedural skills increased from 495 (SD?=?99) to 555 (SD?=?67) (p?=?0.033). There was no significant change in communication scores (p?=?0.97).

Conclusions: The IM-OSCE can be used to demonstrate progression of clinical skills throughout residency training. Although most of the clinical skills assessed improved as residents progressed through their training, communication skills did not appear to change.     

Admiring Dan's Creation

Dan Callahan never tired of probing the fundamental ethical question that Socrates asked, “How should we live?” The investigation animated him. He asked, Can we, for a moment, set aside our preoccupation with better health and a longer life and think together about what we want those things for ? Can we explore what a good life consists in? It turned out there was no better alibi for asking that fundamental question than taking up the seemingly more manageable ones that were arising in the context of emerging medicine, science, and technology. When one asked about who should be born, or how we should die, or how we should prioritize investments in the myriad institutions that help to promote human well‐being, the question concerning what we mean by a good life was always and palpably present.     

Evolutions in clinical reasoning assessment: The Evolving Script Concordance Test

Introduction: Script concordance testing (SCT) is a method of assessment of clinical reasoning. We developed a new type of SCT case design, the evolving SCT (E-SCT), whereby the patient’s clinical story is “evolving” and with thoughtful integration of new information at each stage, decisions related to clinical decision-making become increasingly clear.

Objectives: We aimed to: (1) determine whether an E-SCT could differentiate clinical reasoning ability among junior residents (JR), senior residents (SR), and pediatricians, (2) evaluate the reliability of an E-SCT, and (3) obtain qualitative feedback from participants to help inform the potential acceptability of the E-SCT.

Methods: A 12-case E-SCT, embedded within a 24-case pediatric SCT (PaedSCT), was administered to 91 pediatric residents (JR: n?=?50; SR: n?=?41). A total of 21 pediatricians served on the panel of experts (POE). A one-way analysis of variance (ANOVA) was conducted across the levels of experience. Participants’ feedback on the E-SCT was obtained with a post-test survey and analyzed using two methods: percentage preference and thematic analysis.

Results: Statistical differences existed across levels of training: F?=?19.31 (df?=?2); p?p?p?p?α) was 0.83. Participants found the E-SCT engaging, easy to follow and true to the daily clinical decision-making process.

Conclusions: The E-SCT demonstrated very good reliability and was effective in distinguishing clinical reasoning ability across three levels of experience. Participants found the E-SCT engaging and representative of real-life clinical reasoning and decision-making processes. We suggest that further refinement and utilization of the evolving style case will enhance SCT as a robust, engaging, and relevant method for the assessment of clinical reasoning.     

Comparison of faculty assessment and students’ self-assessment of performance during clinical case discussions in a pharmacotherapy capstone course

Objectives: The primary objective of this study was to compare faculty assessment and third year students' self-assessment of performance in clinical case discussions. The secondary objective was to evaluate if student characteristics influence self-assessments.

Methods: This retrospective analysis compared faculty and student self-assessment scores for two clinical case discussions using Spearman’s correlation and Wilcoxon’s signed ranks test. Chi-squared test was used to compare frequency of faculty and student self-assessments indicating the highest possible rating for the pooled score and for each individual component. The pooled score included three individual components: level of engagement, quality of contribution, and professionalism.

Results: Pooled faculty and student self-assessments correlated for both the first (r?=?0.41, p?r?=?0.35; p?p?=?0.25) and second (58.6% vs. 47.4%, p?=?0.05) clinical case discussions. Student characteristics (age, gender, and grade point average at graduation) did not influence self-assessments.

Conclusions: Students’ self-assessment correlated with faculty assessment of performance during clinical case discussions. Increased use of self-assessments for professional development in pharmacy and other healthcare professional curricula should be considered.     

Words Matter

The lead article in this, the September-October 2020, issue of the Hastings Center Report considers the use of metaphors in communications with clinicians and patients.