Graduate medical education competencies for international health electives: A qualitative study

Background: Residency programs offer international health electives (IHEs), providing multiple educational benefits. This study aimed to identify how IHEs fulfill the Accreditation Council for Graduate Medical Education (ACGME) core competencies.

Methods: We conducted a thematic analysis of post-rotation reflective reports from residents who participated in IHEs through the Mayo International Health Program. We coded reports using a codebook created from the ACGME competencies. Using a constant comparative method, we identified significant themes within each competency.

Results: Residents from 40 specialties participated in 377 IHEs in 56 countries from 2001 to 2014. Multiple themes were identified within each of the six ACGME core competencies: Patient Care and Procedural Skills (4), Medical Knowledge (5), Practice-Based Learning and Improvement (3), Interpersonal and Communication Skills (5), Professionalism (4), and Systems-Based Practice and Improvement (3). Themes included improving physical exam and procedural skills, providing care in resource-limited setting, gaining knowledge of tropical and non-tropical diseases, identifying socioeconomic determinants of health, engaging in the education of others, and increasing communication across cultures and multidisciplinary teams.

Conclusions: Through IHEs, residents advanced their knowledge, skills, and attitudes in each of the six ACGME competencies. These data can be used for development of IHE competencies and milestones for resident assessment.     

Assessing medical students for non-traditional competencies

Assessing medical student competence in non-traditional domains can be challenging. Conventional methods of assessment are generally unsatisfactory. The authors discuss the approach taken at the Brown Medical School, USA to assess students at the beginner, intermediate, and advanced levels in the social and community contexts of health care - one of the nine abilities that comprise Brown's competency-based curriculum. At the beginner level, faculty use weekly field notes written by students about their experiences in community practice placements as the means for assessment. At the intermediate level, faculty assess students based on their completion of a project focused on a community health problem. At the advanced level, a screening process is used in which students first meet individually with a member of the assessment committee who determines if the student's efforts appear to meet the expected standards. If success seemed likely, then the student was encouraged to appear before the whole committee. The authors discuss the common use of subjective judgments at all three levels and the importance of diverse perspectives in achieving a consensus. Allowing students wide latitude in expressing themselves and their accomplishments helps to ensure success.     

The role of online videos in teaching procedural skills to post-graduate medical learners: A systematic narrative review

Abstract

Objective: Online videos are commonly used in medical education. The aim of this review was to investigate the role of online instructional videos in teaching procedural skills to postgraduate medical learners.

Methods: This systematic narrative review was conducted according to the PRISMA guidelines. MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, ERIC and Google Scholar were searched. Full texts that applied to online videos, postgraduate medical learners and procedural skills were included without language restrictions. The methodological quality of the studies was evaluated using a validated tool. A thematic analysis of the studies was carried out using a general inductive approach.

Results: A total of 785 articles were retrieved and the full text was reviewed for 66 articles that met the inclusion and exclusion criteria of the study. Twenty papers that were relevant to the role of online videos in postgraduate medical education of procedural skills were used for this review. They were heterogenous in the outcomes collected and the evidence was of variable quality. There was strong evidence for the use of online videos for procedural skill knowledge acquisition and retention. Online videos were used for various purposes, such as supervision, assessment, postoperative debriefing, providing feedback, and promoting reflection.

Conclusion: Online videos are a valuable educational tool especially for procedural skill knowledge acquisition and retention. Future research needs to be carried out on the appropriate use of platforms in disseminating and using online videos, identifying the factors surrounding the learners, video characteristics, and data protection.     

The need for narrative reflection and experiential learning in medical education: A lesson learned through an urban indigenous health elective

In this personal view article, I discuss a formative experience I had during an Urban Indigenous Health elective in which I participated while in my final year of medical school. The elective was developed on the foundation of an experiential learning model, which is central to Indigenous pedagogy and emphasizes learning through experience and narrative reflection. By transforming medical education into a place where such concepts are integrated and valued, I argue that we will create physicians who are self-aware, compassionate and able to provide culturally safe care to all patient populations they will serve in their future practices.     

The failure to fail underperforming trainees in health professions education: A BEME systematic review: BEME Guide No. 42

Background: Many clinical educators feel unprepared and/or unwilling to report unsatisfactory trainee performance. This systematic review consolidates knowledge from medical, nursing, and dental literature on the experiences and perceptions of evaluators or assessors with this failure to fail phenomenon.

Methods: We searched the English language literature in CINAHL, EMBASE, and MEDLINE from January 2005 to January 2015. Qualitative and quantitative studies were included. Following our review protocol, registered with BEME, reviewers worked in pairs to identify relevant articles. The investigators participated in thematic analysis of the qualitative data reported in these studies. Through several cycles of analysis, discussion and reflection, the team identified the barriers and enablers to failing a trainee.

Results: From 5330 articles, we included 28 publications in the review. The barriers identified were (1) assessor’s professional considerations, (2) assessor’s personal considerations, (3) trainee related considerations, (4) unsatisfactory evaluator development and evaluation tools, (5) institutional culture and (6) consideration of available remediation for the trainee. The enablers identified were: (1) duty to patients, to society, and to the profession, (2) institutional support such as backing a failing evaluation, support from colleagues, evaluator development, and strong assessment systems, and (3) opportunities for students after failing.

Discussion/conclusions: The inhibiting and enabling factors to failing an underperforming trainee were common across the professions included in this study, across the 10 years of data, and across the educational continuum. We suggest that these results can inform efforts aimed at addressing the failure to fail problem.     

A collaborative clinical simulation model for the development of competencies by medical students

Herein, we present a new collaborative clinical simulation (CCS) model for the development of medical competencies by medical students. The model is a comprehensive compendium of published considerations and recommendations on clinical simulation (CS) and computer-supported collaborative learning (CSCL). Currently, there are no educational models combining CS and CSCL. The CCS model was designed for the acquisition and assessment of clinical competencies; working collaboratively and supported by technology, small groups of medical students independently design and perform simulated cases. The model includes four phases in which the learning objectives, short case scenarios, materials, indices, and the clinical simulation are designed, monitored, rated and debriefed.     

Working in global health: A planning and implementation framework for international electives

Abstract

Purpose: Propose a framework for planning and undertaking an international elective.

Methods: On returning from conducting maternal health and well-being research in several remote communities in India, two undergraduate medical students have reflected on and documented their experiences with the view to assisting other students (and their supervisors) considering undertaking an international elective.

Results: A framework for undertaking clinical or research electives in remote or rural communities is presented. The framework comprises three distinct phases: Pre-departure planning and briefing, in-country experiences and returning from the elective and considers a range of factors to ensure that, as a minimum, visiting students “do no harm” and are themselves not harmed.

Conclusions: Students’ home institutions have a duty of care for preparing them for their international electives by providing pre-departure training, support during the elective and comprehensive de-briefing on their return. These electives should be evaluated (including by host communities) to ensure that exchanges are socially accountable, with no harm to the often-vulnerable communities in which students gain considerable experience. Also important is that future students build on the positive experiences of their predecessors to ensure sustainability of any interventions in host communities.     

Eye-tracking technology in medical education: A systematic review

Background: Eye-tracking technology is an established research tool within allied industries such as advertising, psychology and aerospace. This review aims to consolidate literature describing the evidence for use of eye-tracking as an adjunct to traditional teaching methods in medical education.

Methods: A systematic literature review was conducted in line with STORIES guidelines. A search of EMBASE, OVID MEDLINE, PsycINFO, TRIP database, and Science Direct was conducted until January 2017. Studies describing the use of eye-tracking in the training, assessment, and feedback of clinicians were included in the review.

Results: Thirty-three studies were included in the final qualitative synthesis. Three studies were based on the use of gaze training, three studies on the changes in gaze behavior during the learning curve, 17 studies on clinical assessment and six studies focused on the use of eye-tracking methodology as a feedback tool. The studies demonstrated feasibility and validity in the use of eye-tracking as a training and assessment method.

Conclusions: Overall, eye-tracking methodology has contributed significantly to the training, assessment, and feedback practices used in the clinical setting. The technology provides reliable quantitative data, which can be interpreted to give an indication of clinical skill, provide training solutions and aid in feedback and reflection. This review provides a detailed summary of evidence relating to eye-tracking methodology and its uses as a training method, changes in visual gaze behavior during the learning curve, eye-tracking methodology for proficiency assessment and its uses as a feedback tool.     

Influences on the implementation of Mini-CEX and DOPS for postgraduate medical trainees’ learning: A grounded theory study

Abstract

Introduction: In order for Mini-Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) to actually have a positive effect on trainees’ learning, the way in which the tools are implemented is of key importance. However, there are many factors influencing their implementation. In this study, we aim to develop a comprehensive model of such factors.

Methods: Using a constructivist grounded theory approach, we performed eight focus groups. Participants were postgraduate trainees and supervisors from three different specialties; all were experienced with Mini-CEX and/or DOPS. Data were analyzed for recurring themes, underlying concepts and their interactions using constant comparison.

Results: We developed a model demonstrating how the implementation of Mini-CEX and DOPS for trainees’ learning is influenced by 13 factors relating to four categories: organizational culture (e.g. value of teaching and feedback), work structure (e.g. time for Mini-CEX and DOPS, faculty development), instruments (e.g. content of assessment), and users (e.g. relationship between trainees and supervisors), and their interaction.

Conclusions: We developed a complex model of influencing factors relating to four categories. Consideration of this model might support successful implementation and trainees’ learning with Mini-CEX and DOPS.     

Simulation-based trauma education for medical students: A review of literature

Background: Medical students often do not feel prepared to manage emergency situations after graduation. They experience a lack of practical skills and show significant deficits in cognitive performance to assess and stabilize trauma patients. Most reports in the literature about simulation-based education pertain to postgraduate training. Simulation-based trauma education (SBTE) in undergraduate medical education could improve confidence and performance of recently graduated doctors in trauma resuscitation. We reviewed the literature in search of SBTE effectiveness for medical students.

Methods: A PubMed, Embase and CINAHL literature search was performed to identify all studies that reported on the effectiveness of SBTE for medical students, on student perception on SBTE or on the effectiveness of different simulation modalities.

Results: Eight studies were included. Three out of four studies reporting on the effectiveness of SBTE demonstrated an increase in performance of students after SBTE. SBTE is generally highly appreciated by medical students. Only one study directly compared two modalities of SBTE and reported favorable results for the mechanical model rather than the standardized live patient model.

Conclusion: SBTE appears to be an effective method to prepare medical students for trauma resuscitation. Furthermore, students enjoy SBTE and they perceive SBTE as a very useful learning method.     

Traveling for medical care in a global world

The international medical travel of Yemenis provides insight on terminology and models to use for the growing global phenomenon. Terminology for medical travelers ranges from "medical tourists" to "medical exiles." Differing models prioritize the global arena in which transnational medical travel occurs as (1) a global medical marketplace, (2) a global medical commons, (3) interlinked nation-states, and (4) national or global citizens. Medical anthropology has a specific role in uncovering the lived experiences of patients who travel to often unfamiliar destinations to pursue care believed capable of alleviating suffering.     

Implications for tertiary education: managerial competencies required of beginning practitioners in the health service sector

Five hundred and three experienced practitioners involved in management from four professional fields (medical radiation science, occupational therapy, speech pathology and physiotherapy) representing a range of health care settings participated in a survey. The survey examined the importance attached to managerial competencies for the beginning practitioner. The most important grouping related to management of future planning. Underlying competencies included decision making regarding time management and communication with other staff. The second most important grouping of managerial competencies related to organisational practices. These competencies included strategic and organisation-wide management processes associated with change, vision, organisational awareness and decision making. The third grouping of managerial competencies related to knowledge regarding legislation and in particular compliance with occupational health and safety regulations. Other competencies were seen as less important for the beginning practitioner. The implications of these findings are discussed in relation to health science curriculum development in higher education.     

Global health electives: Ethical engagement in building global health capacity

Abstract

Purpose: Little is known about the impact medical trainees undertaking global health electives (GHEs) have on host institutions and their communities in low-and middle-income countries. The goal of this study was to explore the relationship dynamics associated with GHEs as perceived by host stakeholders at three sites in sub-Saharan Africa.

Method: This case-based interpretive phenomenological study examined stakeholder perspectives in Mwanza, Tanzania, and Mbarara and Rugazi, Uganda, where the University of Calgary, Alberta, Canada has long-standing institutional collaborations. Between September and November 2017, 33 host stakeholders participated in semi-structured interviews and 28 host stakeholders participated in focus group discussions. Participant experiences were analyzed using interpretive phenomenological techniques.

Results: The findings revealed that, although GHEs are well-established and a common experience for host stakeholders, their perceptions about who visiting medical trainees (VMTs) are remains indistinct. Participants acknowledged that there are a variety of benefits to GHEs, but overall VMTs appear to benefit the most from this unique learning opportunity. Host stakeholders described significant challenges and burdens of GHEs and recommended ways in which GHEs could be improved.

Conclusions: GHEs need to be designed to better embrace ethical engagement and reciprocity with host stakeholders to ensure equity in benefits and responsibilities.     

The structure of the situation. A narrative on high-intensity medical care

The decisions that doctors make are formed in part through the ways in which medical care is organized. Given that the structure of a situation affects people's actions in the context of medical care, it is a matter of moral concern in any attempt to create cultures of safety in a medical environment.