Psychometric properties of a test in evidence based practice: the Spanish version of the Fresno test

Background  

Validated instruments are needed to evaluate the programmatic impact of Evidence Based Practice (EBP) training and to document the competence of individual trainees. This study aimed to translate the Fresno test into Spanish and subsequently validate it, in order to ensure the equivalence of the Spanish version against the original English version.     

International medical graduates (IMGs) needs assessment study: comparison between current IMG trainees and program directors

Background  

International Medical Graduates (IMGs) training within the Canadian medical education system face unique difficulties. The purpose of this study was to explore the challenges IMGs encounter from the perspective of trainees and their Program Directors.     

CPR in medical schools: learning by teaching BLS to sudden cardiac death survivors – a promising strategy for medical students?

Background  

Cardiopulmonary resuscitation (CPR) training is gaining more importance for medical students. There were many attempts to improve the basic life support (BLS) skills in medical students, some being rather successful, some less. We developed a new problem based learning curriculum, where students had to teach CPR to cardiac arrest survivors in order to improve the knowledge about life support skills of trainers and trainees.     

Educational supervision and the impact of workplace-based assessments: a survey of psychiatry trainees and their supervisors

Background  

Educational supervision (ES) is considered to be an essential component of basic specialist training in psychiatry in the UK. However, previous studies have indicated variation in its provision, and uncertainty about structure and content. Workplace-based assessments (WPBAs) were introduced in 2007 as part of major postgraduate medical training reform. Placing considerable time demands on trainees and supervisors alike, the extent to which WPBAs should utilise ES time has not been specified. As ES and WPBAs have discrete (although complementary) functions, there is the potential for this increased emphasis on assessment to displace other educational needs.     

What do medical trainees think is so difficult about communicating with patients?

Objective

To identify the communication skills medical trainees perceive themselves to avoid or use during initial clinical encounters and the areas of communication learning need they identify.

Methods

446 2nd year undergraduate medical students were invited to take part in the study. Details of four encounters with patients were entered into a web-based electronic logbook by the student. Details included perception of use, success and requests for further training from a list of communication process skills.

Results

395 (89%) students took part. Factor analysis yielded three types of skills: those used to manage the flow of interaction; the emotional content of the interaction; and structuring the interaction. Skills perceived as being used least often and least successfully and identified by the students as requiring further training were primarily those that involved managing the emotional aspects of interactions with patients rather than managing the flow of information.

Conclusion

Communication training should focus further on the emotional aspects of patient interactions in order to support students during early clinical encounters.

Practice implications

Skills required to manage emotional encounters need to be made more explicit to students. Opportunities to obtain feedback and develop competency should be offered as part of the core curriculum.     

Opening the black box: the patient mix of GP trainees

Background

The variety of health problems (patient mix) that medical trainees encounter is presumed to be sufficient to masterthe required competencies.

Aim

To describe the patient mix of GP trainees, to study differences in patient mix between first-year and third-year GP trainees, and to investigate differences in exposure to sex-specific diseases between male and female trainees.

Design and setting

Prospective cohort study in Dutch primary care.

Method

During a 6-month period, aggregated data about International Classification of Primary Care diagnosis codes, and data on the sex and age of all contacts were collected from the electronic patient record (EPR) system.

Results

Seventy-three trainees participated in this study. The mean coding percentage was 86% and the mean number of face-to-face consultations per trimester was 450.0 in the first year and 485.4 in the third year, indicating greater variance in the number of patient contacts among third-year trainees. Diseases seen most frequently were: musculoskeletal (mean per trimester = 89.2 in the first year/91.0 in the third year), respiratory (98.2/92.7) and skin diseases (89.5/96.0). Least often seen were diseases of the blood and blood-forming organs (5.3/7.2), male genital disorders (6.1/7.1), and social problems (4.3/4.2). The mean number of chronic diseases seen per trimester was 48.0 for first-year trainees and 62.4 for third-year trainees. Female trainees saw an average of 39.8 female conditions per trimester — twice as many as male trainees (mean = 21.3).

Conclusion

Considerable variation exists trainees in the number of patient contacts. Differences in patient mix between first- and third-year trainees seem at least partly related to year-specific learning objectives. The use of an EPR-derived educational instrument provides insight into the trainees'' patient mix at both the group and the individual level. This offers opportunities for GP trainers, trainees, and curriculum designers to optimise learning when exposure may be low.     

Implementation of a novel population panel management curriculum among interprofessional health care trainees

Background

Gaps in chronic disease management have led to calls for novel methods of interprofessional, team-based care. Population panel management (PPM), the process of continuous quality improvement across groups of patients, is rarely included in health professions training for physicians, nurses, or pharmacists. The feasibility and acceptance of such training across different healthcare professions is unknown. We developed and implemented a novel, interprofessional PPM curriculum targeted to diverse health professions trainees.

Methods

The curriculum was implemented annually among internal medicine residents, nurse practitioner students and residents, and pharmacy residents co-located in a large, academic primary care site. Small groups of interprofessional trainees participated in supervised quarterly seminars focusing on chronic disease management (e.g., diabetes mellitus, hypertension, or chronic obstructive pulmonary disease) or processes of care (e.g., emergency department utilization for nonacute conditions or chronic opioid management). Following brief didactic presentations, trainees self-assessed their clinic performance using patient-level chart review, presented individual cases to interprofessional staff and faculty, and implemented subsequent feedback with their clinic team. We report data from 2011 to 2015. Program evaluation included post-session participant surveys regarding attitudes, knowledge and confidence towards PPM, ability to identify patients for referral to interprofessional team members, and major learning points from the session. Directed content analysis was performed on an open-ended survey question.

Results

Trainees (n?=?168) completed 122 evaluation assessments. Trainees overwhelmingly reported increased confidence in using PPM and increased knowledge about managing their patient panel. Trainees reported improved ability to identify patients who would benefit from multidisciplinary care or referral to another team member. Directed content analysis revealed that trainees viewed team members as important system resources (n?=?82).

Conclusions

Structured interprofessional training in PPM is both feasible and acceptable to trainees across multiple professions. Curriculum participants reported improved panel management skills, increased confidence in using PPM, and increased confidence in identifying candidates for interprofessional care. The curriculum could be readily exported to other programs and contexts.

     

Learning styles of medical students,general surgery residents,and general surgeons: implications for surgical education

Background  

Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn.     

Do community medicine residency trainees learn through journal club? An experience from a developing country

Background  

Journal clubs are an internationally recognized teaching tool in many postgraduate medical education fields. In developing countries lack of funds for current print materials may have limited journal club use. But with advancing information technology trainees in developing countries increasingly have more access to high quality journals online. However, we are aware of no studies describing journal club existence and effectiveness in postgraduate medical training in Pakistan. Also we have found no published effectiveness studies of this teaching modality in Community Medicine (Public Health) in any country. This study evaluated the effectiveness of Community Medicine (Public Health) Resident Journal Club (CMR-JC) in Aga Khan University, Pakistan using international criteria for successful journal clubs (2 years continuous existence and more than 50% attendance) and examining resident and alumni satisfaction.     

Evidence based practice profiles: Differences among allied health professions

Background  

Most previous studies of allied health professionals' evidence based practice (EBP) attitudes, knowledge and behaviours have been conducted with profession specific questionnaires of variable psychometric strength. This study compared the self-report EBP profiles of allied health professionals/trainees in an Australian university.     

Implementing a Virtual Community of Practice for Family Physician Training: A Mixed-Methods Case Study

Background

GP training in Australia can be professionally isolating, with trainees spread across large geographic areas, leading to problems with rural workforce retention. Virtual communities of practice (VCoPs) may provide a way of improving knowledge sharing and thus reducing professional isolation.

Objective

The goal of our study was to review the usefulness of a 7-step framework for implementing a VCoP for general practitioner (GP) training and then evaluated the usefulness of the resulting VCoP in facilitating knowledge sharing and reducing professional isolation.

Methods

The case was set in an Australian general practice training region involving 55 first-term trainees (GPT1s), from January to July 2012. ConnectGPR was a secure, online community site that included standard community options such as discussion forums, blogs, newsletter broadcasts, webchats, and photo sharing. A mixed-methods case study methodology was used. Results are presented and interpreted for each step of the VCoP 7-step framework and then in terms of the outcomes of knowledge sharing and overcoming isolation.

Results

Step 1, Facilitation: Regular, personal facilitation by a group of GP trainers with a co-ordinating facilitator was an important factor in the success of ConnectGPR. Step 2, Champion and Support: Leadership and stakeholder engagement were vital. Further benefits are possible if the site is recognized as contributing to training time. Step 3, Clear Goals: Clear goals of facilitating knowledge sharing and improving connectedness helped to keep the site discussions focused. Step 4, A Broad Church: The ConnectGPR community was too narrow, focusing only on first-term trainees (GPT1s). Ideally there should be more involvement of senior trainees, trainers, and specialists. Step 5, A Supportive Environment: Facilitators maintained community standards and encouraged participation. Step 6, Measurement Benchmarking and Feedback: Site activity was primarily driven by centrally generated newsletter feedback. Viewing comments by other participants helped users benchmark their own knowledge, particularly around applying guidelines. Step 7, Technology and Community: All the community tools were useful, but chat was limited and users suggested webinars in future. A larger user base and more training may also be helpful. Time is a common barrier. Trust can be built online, which may have benefit for trainees that cannot attend face-to-face workshops. Knowledge sharing and isolation outcomes: 28/34 (82%) of the eligible GPT1s enrolled on ConnectGPR. Trainees shared knowledge through online chat, forums, and shared photos. In terms of knowledge needs, GPT1s rated their need for cardiovascular knowledge more highly than supervisors. Isolation was a common theme among interview respondents, and ConnectGPR users felt more supported in their general practice (13/14, 92.9%).

Conclusions

The 7-step framework for implementation of an online community was useful. Overcoming isolation and improving connectedness through an online knowledge sharing community shows promise in GP training. Time and technology are barriers that may be overcome by training, technology, and valuable content. In a VCoP, trust can be built online. This has implications for course delivery, particularly in regional areas. VCoPs may also have a specific role assisting overseas trained doctors to interpret their medical knowledge in a new context.     

Antibiotic prescribing for the future: exploring the attitudes of trainees in general practice

Background

Antibiotic resistance is a public health concern worldwide. A high proportion of antibiotics are prescribed in primary care, often for conditions where there is no evidence of benefit. Without a change in these prescribing patterns, resistance will persist as a significant problem in the future. Little is known about how trainees in general practice perceive and develop their prescribing.

Aim

To explore the attitudes of trainees in general practice towards antibiotic use and resistance, and the perceived influences on their prescribing.

Design and setting

A qualitative study of 17 vocational trainees in general practice (GP registrars) in both rural and urban areas in Australia employing semi-structured interviews and a focus group.

Method

Maximum variation purposive sampling of GP registrars from diverse backgrounds and training stages continued until thematic saturation was achieved. Topics of discussion included awareness of antibiotic resistance, use of evidence-based guidelines, and perceived influences on prescribing. Transcribed interviews were coded independently by two researchers. Data collection and analysis were concurrent and cumulative, using a process of iterative thematic analysis.

Results

Registrars were aware of the importance of evidence-based antibiotic prescribing and the impact of their decisions on resistance. Many expressed a sense of dissonance between their knowledge and behaviours. Contextual influences on their decisions included patient and system factors, diagnostic uncertainty, transitioning from hospital medicine, and the habits of, and relationship with, their supervisor.

Conclusion

Understanding how trainees in general practice perceive and develop antibiotic prescribing habits will enable targeted educational interventions to be designed and implemented at a crucial stage in training, working towards ensuring appropriate antibiotic prescribing in the future.     

The Clinical Education Partnership Initiative: an innovative approach to global health education

Background

Despite evidence that international clinical electives can be educationally and professionally beneficial to both visiting and in-country trainees, these opportunities remain challenging for American residents to participate in abroad. Additionally, even when logistically possible, they are often poorly structured. The Universities of Washington (UW) and Nairobi (UoN) have enjoyed a long-standing research collaboration, which recently expanded into the UoN Medical Education Partnership Initiative (MEPI). Based on MEPI in Kenya, the Clinical Education Partnership Initiative (CEPI) is a new educational exchange program between UoN and UW. CEPI allows UW residents to partner with Kenyan trainees in clinical care and teaching activities at Naivasha District Hospital (NDH), one of UoN’s MEPI training sites in Kenya.

Methods

UW and UoN faculty collaborated to create a curriculum and structure for the program. A Chief Resident from the UW Department of Medicine coordinated the program at NDH. From August 2012 through April 2014, 32 UW participants from 5 medical specialties spent between 4 and 12 weeks working in NDH. In addition to clinical duties, all took part in formal and informal educational activities. Before and after their rotations, UW residents completed surveys evaluating clinical competencies and cross-cultural educational and research skills. Kenyan trainees also completed surveys after working with UW residents for three months.

Results

UW trainees reported a significant increase in exposure to various tropical and other diseases, an increased sense of self-reliance, particularly in a resource-limited setting, and an improved understanding of how social and cultural factors can affect health. Kenyan trainees reported both an increase in clinical skills and confidence, and an appreciation for learning a different approach to patient care and professionalism.

Conclusions

After participating in CEPI, both Kenyan and US trainees noted improvement in their clinical knowledge and skills and a broader understanding of what it means to be clinicians. Through structured partnerships between institutions, educational exchange that benefits both parties is possible.

     

Can ill-structured problems reveal beliefs about medical knowledge and knowing? A focus-group approach

Background

Epistemological beliefs (EB) are an individual's cognitions about knowledge and knowing. In several non-medical domains, EB have been found to contribute to the way individuals reason when faced with ill-structured problems (i.e. problems with no clear-cut, right or wrong solutions). Such problems are very common in medical practice. Determining whether EB are also influential in reasoning processes with regard to medical issues to which there is no straightforward answer, could have implications for medical education. This study focused on 2 research questions: 1. Can ill-structured problems be used to elicit general practice trainees' and trainers' EB? and 2. What are the views of general practice trainees and trainers about knowledge and how do they justify knowing?

Methods

2 focus groups of trainees (n = 18) were convened on 3 occasions during their 1^st year of postgraduate GP training. 2 groups of GP trainers (n = 11) met on one occasion. Based on the methodology of the Reflective Judgement Interview (RJI), participants were asked to comment on 11 ill-structured problems. The sessions were audio taped and transcribed and an adapted version of the RJI scoring rules was used to assess the trainees' reasoning about ill-structured problems.

Results

Participants made a number of statements illustrating their EB and their importance in clinical reasoning. The level of EB varied widely form one meeting to another and depending on the problem addressed. Overall, the EB expressed by trainees did not differ from those of trainers except on a particular ill-structured problem regarding shoulder pain.

Conclusion

The use of focus groups has entailed some difficulties in the interpretation of the results, but a number of preliminary conclusions can be drawn. Ill-structured medical problems can be used to elicit EB. Most trainees and trainers displayed pre-reflective and quasi-reflective EB. The way trainees and doctors view and justify knowledge are likely to be involved in medical reasoning processes.     

Students’ perspectives on research and assessment of a model template designed to guide beginners in research in a medical school in Cameroon

Background

Research activities for medical students and residents (trainees) are expected to serve as a foundation for the acquisition of basic research skills. Some medical schools therefore recommend research work as partial requirement for certification. However medical trainees have many difficulties concerning research, for which reason potential remedial strategies need to be constantly developed and tested. The views of medical trainees are assessed followed by their use and appraisal of a novel “self-help” tool designed for the purposes of this study with potential for improvement and a wider application.

Methods

This study was a cross-sectional survey of volunteering final-year medical students and residents of a medical school in Cameroon.

Results

This study surveyed the opinions of a total of 120 volunteers of which 82 (68%) were medical students. Three out of 82 (4%) medical students reported they had participated in research activities with a publication versus 10 out of 38 residents (26%). The reported difficulties in research for these trainees included referencing of material (84%), writing a research proposal (79%), searching for literature (73%) and knowledge of applicable statistical tests (72%) amongst others. All participants declared the “self-help” tool was simple to use, guided them to think and better understand their research focus.

Conclusion

Medical trainees require much assistance on research and some “self-help” tools such as the template used in this study might be a useful adjunct to didactic lectures.

     

‘They’ve just got symptoms without science’: Medical trainees’ acquisition of negative attitudes towards patients with medically unexplained symptoms

Objective

Doctors find patients with medically unexplained symptoms (MUS) challenging to manage and some hold negative attitudes towards these patients. It is unknown when and how these views form. This study examines medical trainees’ beliefs and influences about MUS.

Methods

Semi-structured interviews with 43 medical trainees. Using an iterative approach, initial emergent themes were explored in subsequent interviews. Data generation continued until thematic saturation was achieved.

Results

Participants had received no training in MUS but had developed views about causes and management. They struggled with the concept of ‘diagnosis by exclusion’. Attitudes towards patients had developed through informal clinical observation and interactions with doctors. Many welcomed formal training but identified a need to integrate theoretical learning with clinical application.

Conclusion

Despite limited teaching, medical trainees are aware of the challenges in diagnosing and managing patients with MUS, acquiring attitudes through a hidden curriculum. To be welcomed, training must be evidence-based, theoretically informed, but clinically applicable.

Practical implications

Current medical training fails to equip doctors to engage with MUS and potentially fosters the development of unhelpful views of these patients. Informed teaching on diagnosis and management of MUS is necessary at a trainee level to limit the development of negative attitudes.