Perceptions des résidents sur la formation médicale fondée sur les compétences

Background: Residency training programs in Canada are undergoing a mandated transition to competency-based medical education (CBME).  There is limited literature regarding resident perspectives on CBME.  As upper year residents act as mentors and assessors for incoming cohorts, and are themselves key stakeholders in this educational transition, it is important to understand how they view CBME.  We examined how residents who are not currently enrolled in a competency-based program view that method of training, and what they perceive as potential advantages, disadvantages, and considerations regarding its implementation. Methods: Sixteen residents volunteered to participate in individual semi-structured interviews, with questions focussing on participants’ knowledge of CBME and its implementation.  We used a grounded theory approach to develop explanations of how residents perceive CBME. Results: Residents anticipated improved assessment and feedback, earlier identification of residents experiencing difficulties in training, and greater flexibility to pursue self-identified educational needs.  Disadvantages included logistical issues surrounding CBME implementation, ability of attending physicians to deliver CBME-appropriate feedback, and the possibility of assessment fatigue.  Clear, detailed communication and channels for resident feedback were key considerations regarding implementation. Conclusions: Resident views align with educational experts regarding the practical challenges of implementation.  Expectations of improved assessment and feedback highlight the need for both residents and attending physicians to be equipped in these domains.  Consequently, faculty development and clear communication will be crucial aspects of successful transitioning to CBME

Rétroaction multisources à la suite d’une simulation en réanimation : une étude qualitative

Background: The direct observation and assessment of learners’ resuscitation skills by an attending physician is challenging due to the unpredictable and time-sensitive nature of these events. Multisource feedback (MSF) may address this challenge and improve the quality of assessments provided to learners. We aimed to describe the similarities and differences in the assessment rationale of attending physicians, registered nurses, and resident peers in the context of a simulation-based resuscitation curriculum. Methods: We conducted a qualitative content analysis of narrative MSF of medical residents in their first postgraduate year of training who were participating in a simulation-based resuscitation course at two Canadian institutions. Assessments included an entrustment score and narrative comments from attending physicians, registered nurses, and resident peers in addition to self-assessment. Narrative comments were transcribed and analyzed thematically using a constant comparative method. Results: All 87 residents (100%) participating in the 2017-2018 course provided consent. A total of 223 assessments were included in our analysis. Four themes emerged from the narrative data: 1) Communication, 2) Leadership, 3) Demeanor, and 4) Medical Expert. Relative to other assessor groups, feedback from nurses focused on patient-centred care and communication while attending physicians focused on the medical expert theme. Peer feedback was the most positive. Self-assessments included comments within each of the four themes. Conclusions: In the context of a simulation-based resuscitation curriculum, MSF provided learners with different perspectives in their narrative assessment rationale and may offer a more holistic assessment of resuscitation skills within a competency-based medical education (CBME) program of assessment.Contexte : Le contexte imprévisible et contraignant au niveau du temps lors de l’observation directe et de la rétroaction associée sur les compétences en réanimation des apprenants constituent un défi pour un médecin superviseur. La rétroaction multisources (RMS) peut être un moyen de relever ce défi et d'améliorer la qualité des rétroactions fournies aux apprenants. Nous visons à décrire les similitudes et les différences quant à la démarche évaluative auprès de médecins traitants, d’infirmières cliniciennes et de pairs résidents dans le cadre d'un cours de réanimation offert par simulation. Méthodes : Nous avons réalisé une analyse de contenu à partir des rétroactions narratives offertes aux résidents en première année de formation postdoctorale dans deux universités canadiennes dans le cadre d’un cours de réanimation offert par simulation. En plus de l’auto-évaluation, la rétroaction comportait un score de confiance et des commentaires narratifs de la part de médecins superviseurs, d’infirmières cliniciennes et des pairs. Les commentaires ont été transcrits et analysés par thèmes en appliquant la méthode générale de comparaison constante. Résultats : Un consentement pour participer à l’étude a été obtenu auprès des 87 résidents (100 %) qui ont suivi le cours en 2017-2018. Nous avons analysé un total de 223 rétroactions. Quatre thèmes ont émergé à partir des données narratives soit : 1) la communication, 2) le leadership, 3) le comportement, et 4) l’expertise médicale. Alors que les infirmières ont ciblé leurs commentaires sur les soins centrés sur le patient et la communication, les médecins superviseurs ont les ont ciblés sur l’expertise médicale. Les commentaires des pairs étaient les plus positifs. Les auto-évaluations comportaient des commentaires sur chacun des quatre thèmes. Conclusions : Dans le contexte d’un cours de réanimation offert par simulation, la RMS a permis aux apprenants d’obtenir des évaluations narratives selon différentes perspectives. Permettant ainsi une approche plus holistique de rétroaction sur les habiletés en réanimation dans le cadre d’un programme d’évaluation axé sur les compétences

Participant perceptions of the faculty development Educational Research Series

Interest in the Scholarship of Teaching and Learning (SoTL) is driven in part by the need to provide systematic academic development for faculty anchored in evidence-based practice such as the introduction of quality assurance frameworks. This article reports on a mixed-method evaluation of one institution’s grassroots multidisciplinary faculty development program, called the Educational Research Series, to determine if it met the needs of its faculty, graduate student, and staff participants. Conducted at one mid-sized university in southern Ontario and framed, as was the program design and implementation, by both adult learning theory and constructivism, the evaluation collected data from session exit surveys, attendee interviews, and facilitator focus groups. The data analysis revealed that reasons for participating included increasing levels of understanding, receiving individual support, and learning about colleagues’ research interests. The major strengths of the program included individual learning, resources, facilitator expertise, interactive sessions, and the multidisciplinary focus. The main challenges centered on depth versus breadth of the sessions, time, and educational language and theory. Participants recommended additional resources, communication among facilitators, institutional recognition, and increased depth of content. As a result of this evaluation, an Advanced Educational Research Series is being offered at the institution. This article will inform other institutions wishing to build SoTL as a field within their institutions

Delivering on the promise of competency based medical education – an institutional approach

The Royal College of Physicians and Surgeons of Canada (RCPSC) adopted a plan to transform, over a seven-year horizon (2014-2021), residency education across all specialties to competency-based medical education (CBME) curriculum models. The RCPSC plan recommended implementing a more responsive and accountable training model with four discrete stages of training, explicit, specialty specific entrustable professional activities, with associated milestones, and a programmatic approach to assessment across residency education. Embracing this vision, the leadership at Queen’s University (in Kingston, Ontario, Canada) applied for and was granted special permission by the RCPSC to embark on an accelerated institutional path. Over a three-year period, Queen’s took CBME from concept to reality through the development and implementation of acomprehensive strategic plan. This perspective paper describes Queen’s University’s approach of creating a shared institutional vision, outlines the process of developing a centralized CBME executive team and twenty-nine CBME program teams, and summarizes proactive measures to ensure program readiness for launch. In so doing, Queen’s created a community of support and CBME expertise that reinforces shared values including fostering co-production, cultivating responsive leadership, emphasizing diffusion of innovation, and adopting a systems-based approach to transformative change.

Getting Inside the Expert's Head:An Analysis of Physician Cognitive Processes During Trauma Resuscitations

Study objective: Crisis resource management skills are integral to leading the resuscitation of a critically ill patient. Despite their importance, crisis resource management skills (and their associated cognitive processes) have traditionally been difficult to study in the real world. The objective of this study was to derive key cognitive processes underpinning expert performance in resuscitation medicine, using a new eye-tracking-based video capture method during clinical cases. Methods: During an 18-month period, a sample of 10 trauma resuscitations led by 4 expert trauma team leaders was analyzed. The physician team leaders were outfitted with mobile eye-tracking glasses for each case. After each resuscitation, participants were debriefed with a modified cognitive task analysis, based on a cued-recall protocol, augmented by viewing their own first-person perspective eye-tracking video from the clinical encounter. Results: Eye-tracking technology was successfully applied as a tool to aid in the qualitative analysis of expert performance in a clinical setting. All participants stated that using these methods helped uncover previously unconscious aspects of their cognition. Overall, 5 major themes were derived from the interviews: logistic awareness, managing uncertainty, visual fixation behaviors, selective attendance to information, and anticipatory behaviors. Conclusion: The novel approach of cognitive task analysis augmented by eye tracking allowed the derivation of 5 unique cognitive processes underpinning expert performance in leading a resuscitation. An understanding of these cognitive processes has the potential to enhance educational methods and to create new assessment modalities of these previously tacit aspects of expertise in this field

La incidencia de distintos métodos de estudio en la retención de información y transferencia de aprendizajes Resumen Understanding the Effects of Different Study Methods on Retention of Information and Transfer of Learning

Introducción. El presente estudio investiga las relaciones entre la práctica de espacio (reestudiando después de una pusa) y la transferencia de aprendizaje. En concreto, el impacto en la capacidad de los estudiantes para transferir el aprendizaje después de participar en un espacio de construcción de modelos o no estructurado de texto narrado. Método. Los sujetos fueron asignados aleatoriamente a un modelo de capacidad o de un grupo de estudios libre. Todos los sujetos completaron una prueba previa de conocimiento tema. Además, los participantes en el grupo de construcción de modelos vieron una demostración breve de la tarea de construcción del modelo. Los participantes realizaron listas de los pasajes y, o bien, construyeron un modelo o estudiaron una transcripción de la narración para aumentar los recuerdos temporales. Por último, los participantes escribieron una prueba de memoria para los detalles y una prueba de la extensión de la transferencia de conocimiento. Resultados. Los exámenes de conocimiento de transferencia de resultados mejoraron en el grupo de construcción de modelos, con intervalo de tiempo, entre la codificación y reestudio aumentado. No se encontraron diferencias entre los lapsos de tiempo en el grupo de estudio libre. Sin afectar el tiempo de retraso estadísticamente detectable se encontró para la prueba de detalle. Discusión. El presente estudio proporciona evidencia de tranfer mejor conocimiento resultante de la constructiva elaborada de la construcción de modelos. Cuando los métodos de estudio eran con participantes no estructurados o libres, los resultados de la transferencia no era estadísticamente significativos, pero se detectaron las mejorasr a medida que aumentaron los desfases entre los intervalos de estudio

Adjusting Curricular Design to “CREATE” a Culture of Self-Regulation

Developing learners’ ability to self-regulate their own learning has been an ideal sought after by researchers and practitioners alike. Over the past 40 years a plethora of educational psychology research on self-regulated learning (SRL) has flooded the literature. In this article I attempt to consolidate key theories from this literature base and propose a 6-point strategy to CREATE a culture of SRL. I will argue that instructors must communicate proximal and long-term goals that have been negotiated by a community of learners, substantially reward all positive aspects of the learning process, judge and reward the learning process by assigning elaborative learning assessments, realistically attribute success and failure to appropriate processes, and tune ineffective strategies and goals to allow the curriculum to evolve in accordance with learner difficulty and success. Enseigner aux apprenants la capacité d’autoréguler leur propre apprentissage est un idéal que poursuivent les chercheurs et les praticiens. Au cours des quarante dernières années, il y a eu surabondance d’études sur l’autorégulation de l’apprentissage dans la littérature sur la psychologie de l’éducation. Dans cet article, l’auteur tente de regrouper les principales théories tirées de cette documentation et de proposer une stratégie composée de six éléments contribuant à la création d’une culture de l’autorégulation. Il soutient que les enseignants doivent communiquer les objectifs à court et à long terme convenus par les apprenants, reconnaître de façon marquée tous aspects positifs du processus d’apprentissage, évaluer et reconnaître ce processus en donnant des travaux élaborés afin de mesurer l’apprentissage, attribuer de façon réaliste les succès et les échecs aux processus appropriés et adapter les stratégies et buts inefficaces afin de permettre l’évolution du curriculum en tenant compte des difficultés et des réussites des apprenants

Reconceptualizing metacomprehension calibration accuracy

Accurate judgment of text comprehension is compulsory for learners to effectively self-regulate learning from text. Unfortunately, until relatively recently the literature on text comprehension judgment, termed metacomprehension, has shown learners to be inaccurate in their judgments. Over the last decade researchers have discovered that when learners use delayed summaries of text to make judgments metacomprehension accuracy increases. In contrast, when learners use individual differences (e.g., knowledge and interest) to make judgments they are less accurate. Traditionally metacomprehension accuracy has been construed as the average correlation of judgments and comprehension assessments across multiple texts. In the current study multiple alterations to the delayed summarization paradigm were evaluated. Specifically, the difference between learners’ comprehension assessments and assessment scores were calculated within text to assess text specific differences in judgment cue use and accuracy. Second, pre-reading prompts were provided to focus learners on connections within the text (graphic organizer) and specific factual information (a list of facts). Third, the relative influence of individual differences (i.e., interest, knowledge, GPA, understanding of university text and Need-For-Cognition), text, pre-reading prompts, and summary delay on comprehension judgments were evaluated. Finally, experimental influences on judgment/assessment score differentials were considered. Results indicated that the two obscure texts in this experiment, with similar structures, and different levels of interest resulted in statistically detectably different judgments, scores, and accuracy. Delayed summarization did not improve metacomprehension accuracy for either text. This is a departure from the current literature, and may indicate that within-text measures of metacomprehension accuracy react differently to delayed summarization. Individual differences also affected judgments differently across texts and groups. Finally, participants used different cues to make judgments at the detailed and explanation levels of understanding