La culture de l’annulation : exploration des conséquences involontaires du retrait de l’examen clinique pour l’octroi de la licence au Canada

Assessment drives learning. However, when it comes to high-stakes examinations (e.g., for licensure or certification), these assessments of learning may be seen as unnecessary hurdles by some. Licensing clinical skills assessment in particular have come under fire over the years. Recently, assessments such as the Medical Council of Canada Qualifying Examination Part II, a clinical skills objective structured clinical examination, have been permanently cancelled. The authors explore potential consequences of this cancellation including those that are inadvertent and undesirable. Future next steps for clinical skills assessment are explored.L’évaluation est le moteur de l’apprentissage. Cependant, lorsqu’il s’agit d’examens à enjeux élevés (par exemple, pour l’obtention du titre de licencié ou la certification), ces évaluations de l’apprentissage peuvent être perçues comme inutiles par certains. L’évaluation des compétences cliniques pour l’obtention du titre de licencié, en particulier, a été critiquée au fil des ans. Récemment, des évaluations comme l’examen d’aptitude du Conseil médical du Canada, partie II, un examen clinique objectif structuré permettant d’évaluer les compétences cliniques, ont été définitivement retirées. Les auteurs explorent les conséquences potentielles de l’annulation de ces évaluations incluant celles non intentionnelles et indésirables, ainsi que des perspectives sur l’évaluation des habiletés cliniques.

Vais-je publier ce résumé? Déterminer les caractéristiques de résumés de présentations orales associés au potentiel de publication

Background: Prior studies have shown that most conference submissions fail to be published. Understanding factors that facilitate publication may be of benefit to authors. Using data from the Canadian Conference on Medical Education (CCME), our goal was to identify characteristics of conference submissions that predict the likelihood of publication with a specific focus on the utility of peer-review ratings. Methods: Study characteristics (scholarship type, methodology, population, sites, institutions) from all oral abstracts from 2011-2015 and peer-review ratings for 2014-2015 were extracted by two raters. Publication data was obtained using online database searches. The impact of variables on publication success was analyzed using logistic regressions. Results: Of 531 abstracts with peer-review ratings, 162 (31%) were published. Of the 9 analyzed variables, those associated with a greater odds of publication were: multiple vs. single institutions (odds ratio (OR) = 1.72), post-graduate research vs. others (OR=1.81) and peer-review ratings (OR=1.60). Factors with decreased odds of publication were curriculum development (OR=0.17) and innovation vs. others (OR=0.22).     Conclusion: Similar to other studies, the publication rate of CCME presentations is low. However, peer ratings were predictive of publication success suggesting that ratings could be a useful form of feedback to authors.  Contexte : Des études ont montré que la plupart des résumés soumis pour présentations orales ne sont pas ultérieurement publiés. Il pourrait être utile aux auteurs de comprendre les facteurs qui favorisent la publication. À l’aide de données provenant de la Conférence canadienne sur l’éducation médicale (CCÉM), notre objectif était d’identifier les caractéristiques des résumés permettant de prédire les chances de publication et en particulier l’utilité des cotes attribuées par les réviseurs. Méthodologie : Les caractéristiques des études (type de projet d’érudition, méthodologie, population, établissements, institutions) de tous les résumés de présentation orale soumis pour les conférences de 2011 à 2015 et les cotes attribuées par les réviseurs entre 2014 et 2015 ont été extraites par deux évaluateurs. On a obtenu des données de publication en faisant des recherches dans des bases de données en ligne.  L’effet des variables sur le potentiel de publication a été examiné à l’aide de régressions logistiques. Résultats : Au total, 953 résumés ont été révisé des années 2011 à 2015. Le taux de publication était de 30.5% (291/953) en somme. Des 531 résumés ayant été évalués des pairs, entre 2014 et 2015, 162 (31 %) ont été publiés. Parmi les neuf variables analysées, celles qui ont été associées à un nombre élevé de chances de publication étaient les suivantes : projet multi-institutionnel par rapport à institution unique (risque relatif (RR) = 1,72), travaux de recherche post-graduée par rapport à d’autres types (RR = 1,81) et présence de cotes attribuées par les réviseurs (RR = 1,6). Les facteurs associés à des moindres chances de publication étaient les suivants : articles portant sur le développement de cursus (RR = 0,17) et les innovations, par rapport à d’autres (RR = 0,22).     Conclusion :  Comme ce fut le cas pour d’autres études, le taux de publication à la suite d’une présentation au CCME est faible.  Cependant, les cotes attribuées par les réviseurs permettaient de prédire les chances de publication ce qui semble indiquer que les cotes pourraient constituer une forme de rétroaction utile aux auteurs

Overcoming the barriers of teaching physical examination at the bedside: More than just curriculum design

Background: Physicians in training must achieve a high degree of proficiency in performing physical examinations and must strive to become experts in the field. Concerns are emerging about physicians' abilities to perform these basic skills, essential for clinical decision making. Learning at the bedside has the potential to support skill acquisition through deliberate practice. Previous skills improvement programs, targeted at teaching physical examinations, have been successful at increasing the frequency of performing and teaching physical examinations. It remains unclear what barriers might persist after such program implementation. This study explores residents' and physicians' perceptions of physical examinations teaching at the bedside following the implementation of a new structured bedside curriculum: What are the potentially persisting barriers and proposed solutions for improvement? Methods: The study used a constructivist approach using a qualitative inductive thematic analysis that was oriented to construct an understanding of the barriers and facilitators of physical examination teaching in the context of a new bedside curriculum. Participants took part in individual interviews and subsequently focus groups. Transcripts were coded and themes were identified. Results: Data analyses yielded three main themes: (1) the culture of teaching physical examination at the bedside is shaped and threatened by the lack of hospital support, physicians' motivation and expertise, residents' attitudes and dependence on technology, (2) the hospital environment makes bedside teaching difficult because of its chaotic nature, time constraints and conflicting responsibilities, and finally (3) structured physical examination curricula create missed opportunities in being restrictive and pose difficulties in identifying patients with findings. Conclusions: Despite the implementation of a structured bedside curriculum for physical examination teaching, our study suggests that cultural, environmental and curriculum-related barriers remain important issues to be addressed. Institutions wishing to develop and implement similar bedside curricula should prioritize recruitment of expert clinical teachers, recognizing their time and efforts. Teaching should be delivered in a protected environment, away from clinical duties, and with patients with real findings. Physicians must value teaching and learning of physical examination skills, with multiple hands-on opportunities for direct role modeling, coaching, observation and deliberate practice. Ideally, clinical teachers should master the art of combining both patient care and educational activities

Supervising New PGY-1 Residents: Faculty Expectations vs. Residents’ Perceptions - A Case Study

BACKGROUND: Postgraduate year-1 residents (PGY-1s) begin clinical practice in a setting where attending staff and senior residents are available to supervise their work. There is an expectation that, while being supervised and as they become more experienced, the PGY-1s will gradually take on more responsibilities and function independently. OBJECTIVE: To determine the degree of agreement between the level of supervision expected by clinical supervisors (CSs) and the level of supervision reported by PGY-1s. METHODS: Using a nominal group technique, subject matter experts (SMEs) from multiple specialties defined “entrustable professional activities” (EPAs) for PGY-1s, that is, a set of activities to be performed independently by PGY-1s by the end of their first year of residency, regardless of specialty. We then surveyed and compared CSs and PGY-1s from one institution regarding levels of supervision expected and received during the daytime and nighttime for each EPA. RESULTS: The SMEs defined 10 EPAs (e.g., completing admission orders, obtaining informed consent), ratified by a national panel, and 113 CSs and 48 PGY-1s completed the survey. CSs had the same expectations regardless of the time of day. For three EPAs (managing intravenous fluids, obtaining informed consent, and obtaining advanced directives) the level of supervision reported by PGY-1s was lower than what CSs expected (p<0.001) regardless of the time of day (i.e., day versus night). For four more EPAs (initiating the management of critically ill patients, handing over the care of patients to colleagues, writing discharge prescriptions, and coordinating a patient discharge) the differences only occurred during nighttime work (p0.001). CONCLUSION: PGY-1s reported performing EPAs with less supervision than expected by CSs, especially during nighttime work. Using EPAs to guide the content of the undergraduate curriculum and during examinations could help better align CSs’ and PGY-1s’ expectations about early residency supervision

Cancel culture: Exploring the unintended consequences of cancelling the Canadian national licensing clinical examination

Assessment drives learning. However, when it comes to high-stakes examinations (e.g., for licensure or certification), these assessments of learning may be seen as unnecessary hurdles by some. Licensing clinical skills assessment in particular have come under fire over the years. Recently, assessments such as the Medical Council of Canada Qualifying Examination Part II, a clinical skills objective structured clinical examination, have been permanently cancelled. The authors explore potential consequences of this cancellation including those that are inadvertent and undesirable. Future next steps for clinical skills assessment are explored.L’évaluation est le moteur de l’apprentissage. Cependant, lorsqu’il s’agit d’examens à enjeux élevés (par exemple, pour l’obtention du titre de licencié ou la certification), ces évaluations de l’apprentissage peuvent être perçues comme inutiles par certains. L’évaluation des compétences cliniques pour l’obtention du titre de licencié, en particulier, a été critiquée au fil des ans. Récemment, des évaluations comme l’examen d’aptitude du Conseil médical du Canada, partie II, un examen clinique objectif structuré permettant d’évaluer les compétences cliniques, ont été définitivement retirées. Les auteurs explorent les conséquences potentielles de l’annulation de ces évaluations incluant celles non intentionnelles et indésirables, ainsi que des perspectives sur l’évaluation des habiletés cliniques

Teaching and assessing procedural skills: a qualitative study

Abstract Background Graduating Internal Medicine residents must possess sufficient skills to perform a variety of medical procedures. Little is known about resident experiences of acquiring procedural skills proficiency, of practicing these techniques, or of being assessed on their proficiency. The purpose of this study was to qualitatively investigate resident 1) experiences of the acquisition of procedural skills and 2) perceptions of procedural skills assessment methods available to them. Methods Focus groups were conducted in the weeks following an assessment of procedural skills incorporated into an objective structured clinical examination (OSCE). Using fundamental qualitative description, emergent themes were identified and analyzed. Results Residents perceived procedural skills assessment on the OSCE as a useful formative tool for direct observation and immediate feedback. This positive reaction was regularly expressed in conjunction with a frustration with available assessment systems. Participants reported that proficiency was acquired through resident directed learning with no formal mechanism to ensure acquisition or maintenance of skills. Conclusions The acquisition and assessment of procedural skills in Internal Medicine programs should move toward a more structured system of teaching, deliberate practice and objective assessment. We propose that directed, self-guided learning might meet these needs