Using design-thinking to investigate and improve patient experience

Understanding and enhancing the patient experience can lead to improved healthcare outcomes. The purpose of this study was to capture a comprehensive and nuanced understanding of the patient experience on an inpatient medical teaching unit in order to identify key deficiencies and unmet needs. We then aim to implement a design-thinking methodology to find innovative ways to solve these deficiencies. Here we present the first two phases of this four-phased study. We retrospectively and prospectively collected quantitative data about patient experience with the Canadian Patient Experiences Survey-Inpatient Care. We then used this data to guide patient interviews. We identified several key deficiencies including call bell response times, noise levels at night, pain control, education about medication side effects, communication between healthcare team members, and how well healthcare team members remain up to date about patient care. In the final two phases of our study, we will select one or more of these deficiencies and collaborate with patients and other stakeholders to rapidly create, employ, and assess the impact of prototypes through an iterative action cycle until effective and sustainable solutions are found. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this len

Mentorat par les pairs dans la résidence en médecine: une revue systématique

Background: Medical residents may experience burnout during their training, and a lack of social support. This can impact their overall wellbeing and ability to master key professional competencies. We explored, in this study, the extent to which peer mentorship promotes psychosocial wellbeing and the development of professional competencies in medical residency education. Methods: We searched six databases (MEDLINE, EMBASE, PsycINFO, Academic Research Complete, ERIC, Education Research Complete) for studies on peer mentoring relationships in medical residency. We selected any study where authors reported on outcomes associated with peer mentoring relationships among medical residents. We applied no date, language, or study design limits to this review. Results: We included nine studies in this systematic review. We found that medical residents received essential psychosocial supports from peers, and motivation to develop academic and career competencies. Medical residents in peer-mentoring relationships also reported increased overall satisfaction with their residency training programs. Conclusions: Peer-mentoring relationships can enhance the development of key professional competencies and coping mechanisms in medical residency education. Further rigorous research is needed to examine the comparative benefits of informal and formal peer mentoring, and identify best practices with respect to effective design of peer-mentorship programs.Contexte : Les résidents en médecine peuvent ressentir un épuisement professionnel durant leur formation, et un manque de soutien social. Ceci peut affecter bien-être global et leur capacité à maîtriser des compétences professionnelles essentielles.  Au cours de cette étude, nous avons examiné dans quelle mesure le mentorat par des pairs favorisait le bien-être psychosocial et l’acquisition de compétences professionnelles chez les médecins résidents. Méthodologie : Nous avons cherché dans six bases de données (MEDLINE, EMBASE, PsycINFO, Academic Research Complete, ERIC, Education Research Complete) des études sur le mentorat par des pairs pendant la résidence en médecine.  Nous avons retenu toutes les études dont les auteurs avaient présenté des résultats associés aux relations de mentorat par des pairs chez les résidents en médecine, sans limite de date, la langue ou le devis. Résultats : Nous avons inclus 9 études dans cette revue systématique. Nous avons découvert que les médecins résidents recevaient un soutien psychosocial essentiel de la part des pairs et que ceux-ci les motivaient à acquérir des compétences universitaires et professionnelles.  On a aussi constaté que les médecins résidents qui bénéficiaient d’un mentorat par des pairs étaient, de façon globale, plus satisfaits de leur programme de résidence. Conclusions : Le mentorat par des pairs peut favoriser l’acquisition de compétences professionnelles clés et de mécanismes d’adaptation au cours de la résidence en médecine.  Il faudrait mener d’autres recherches rigoureuses pour comparer les avantages du mentorat informel à ceux du mentorat structuré et cerner les pratiques exemplaires de conception de programmes efficaces de mentorat par des pairs

Patient Experiences with Cardiac Surgery in Alberta, Canada: Results from a Validated Survey

Introduction Research shows that a better patient experience may be associated with better outcomes. Most investigations, however, have only examined patients’ overall rating of care, which does not identify individual aspects of care which may be improved. Additionally, little is known about the experience of specific clinical groups in acute care. Objectives and Approach The study objective was to examine the experience of patients undergoing cardiac surgery across Alberta. Surveys were completed within 6 weeks of hospital discharge, and linked with inpatient administrative records. Study eligibility was determined using Canadian Classification of Intervention (CCI) procedure codes, to include patients who underwent coronary artery bypass graft (CABG), valve replacement, and/or percutaneous coronary intervention (angioplasty). The survey contained 56 questions and assessed multiple aspects of care. Results for each question were classified as percentage in “top box”, where “top box” represented the best possible result (e.g. nurses “always” explaining things in a way patients could understand). Results From April 2014 to March 2017, 1,921 patients completed a survey following cardiac surgery. This included 1,117 angioplasty only (58.2%), 409 CABG only (21.3%), 308 valve replacements (16.0%) and 87 (4.5%) who underwent multiple procedures. Patients were predominantly male (74.2%), over 50 years of age (88.6%) and admitted to hospital urgently (72.7%). The top three performing questions were nurses treating patients with courtesy and respect (91.4% reporting “always”), receiving written information about symptoms to watch out for after leaving hospital (90.9% “yes”), and discussion with hospital staff about help needed once leaving hospital (90.2% “yes”). The three poorest performing questions were hospital room quietness at night (48.6% “always”), staff describing possible side effects of new medications (51.4% “always”), and hospital room/bathroom cleanliness (64.9% “always”). Conclusion/Implications Our results provide patient-reported feedback about the perceived strengths and areas for improvement associated with cardiac surgery in Alberta. By linking completed surveys with administrative data, we are able to examine the experience of specific clinical groups, while eliminating additional survey burden for patients

A generalizability study of the medical judgment vignettes interview to assess students' noncognitive attributes for medical school

<p>Abstract</p> <p>Background</p> <p>Although the reliability of admission interviews has been improved through the use of objective and structured approaches, there still remains the issue of identifying and measuring relevant attributes or noncognitive domains of interest. In this present study, we use generalizability theory to determine the estimated variance associated with participants, judges and stations from a semi-structured, Medical Judgment Vignettes interview used as part of an initiative to improve the reliability and content validity of the interview process used in the selection of students for medical school.</p> <p>Methods</p> <p>A three station, Medical Judgment Vignettes interview was conducted with 29 participants and scored independently by two judges on a well-defined 5-point rubric. Generalizability Theory provides a method for estimating the variability of a number of facets. In the present study each judge (<it>j</it>) rated each participant (<it>p</it>) on all three Medical Judgment Vignette stations (<it>s</it>). A two-facet crossed designed generalizability study was used to determine the optimal number of stations and judges to achieve a 0.80 reliability coefficient.</p> <p>Results</p> <p>The results of the generalizability analysis showed that a three station, two judge Medical Judgment Vignettes interview results in a G coefficient of 0.70. As shown by the adjusted <it>Eρ</it>²scores, since interviewer variability is negligible, increasing the number of judges from two to three does not improve the generalizability coefficient. Increasing the number of stations, however, does have a substantial influence on the overall dependability of this measurement. In a decision study analysis, increasing the number of stations to six with a single judge at each station results in a G coefficient of 0.81.</p> <p>Conclusion</p> <p>The Medical Judgment Vignettes interview provides a reliable approach to the assessment of candidates' noncognitive attributes for medical school. The high inter-rater reliability is attributed to the greater objectivity achieved through the used of the semi-structured interview format and clearly defined scoring rubric created for each of the judgment vignettes. Despite the relatively high generalizability coefficient obtained for only three stations, future research should further explore the reliability, and equally importantly, the validity of the vignettes with a large group of candidates applying for medical school.</p

A latent variable path analysis of the development of pedophilia and its associated pathologies

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Experiences of pressure to conform in postgraduate medical education

Abstract Background Perception of pressure to conform prevents learners from actively participating in educational encounters. We expected that residents would report experiencing different amounts of pressure to conform in a variety of educational settings. Methods A total of 166 residents completed questionnaires about the frequency of conformity pressure they experience across 14 teaching and clinical settings. We examined many individual characteristics such as their age, sex, international student status, level of education, and tolerance of ambiguity; and situational characteristics such as residency program, type of learning session, status of group members, and type of rotation to determine when conformity pressure is most likely to occur. Results The majority of participants (89.8%) reported pressure to conform at least sometimes in at least one educational or clinical setting. Residents reported higher rates of conformity during informal, rather than formal, teaching sessions, p < .001. Also, pressure was greater when residents interacted with higher status group members, but not with the same or lower level status members, p < .001. Effect sizes were in the moderate range. Conclusions The findings suggest that most residents do report feeling pressure to conform in their residency settings. This result is consistent with observations of medical students, nursing students, and clerks conforming in response to inaccurate information within experimental studies. Perception of pressure is associated with the setting rather than the trainee personal characteristics

Racism as a Social Determinant of Health for Newcomers towards Disrupting the Acculturation Process

Previous research has demonstrated that racism is a social determinant of health (SDOH), particularly for racialized minority newcomers residing in developed nations such as the United States, Canada, New Zealand, and European countries. This paper will focus on racism as a SDOH for racialized newcomers in these countries. Racism is defined as “an organized system of privilege and bias that systematically disadvantages a group of people perceived to belong to a specific race”. Racism can be cultural, institutional, or individual. Berry’s model of acculturation describes ways in which racialized newcomers respond to their post-migration experiences, resulting in one of several modes of acculturation; these are integration, assimilation, separation, and marginalization. After examining the definition and description of racism, we argue that racism impacts newcomers at the site of acculturation; specifically, the paths they choose, or are forced to take in response to their settlement experiences. We posit that these acculturation pathways are in part, strategies that refugees use to cope with post-displacement stress and trauma. To support acculturation, which is primarily dependent on reducing the effects of cultural, institutional, and individual racism, health policymakers and practitioners are urged to acknowledge racism as a SDOH and to work to reduce its impact

A Critical Lens on Health: Key Principles of Critical Discourse Analysis and Its Benefits to Anti-Racism in Population Public Health Research

Critical discourse analysis (CDA) is an interdisciplinary research methodology used to analyze discourse as a form of &ldquo;social practice&rdquo;, exploring how meaning is socially constructed. In addition, the methodology draws from the field of critical studies, in which research places deliberate focus on the social and political forces that produce social phenomena as a means to challenge and change societal practices. The purpose of this article is to demonstrate the benefits of CDA to population public health (PPH) research. We will do this by providing a brief overview of CDA and its history and purpose in research and then identifying and discussing three crucial principles that we argue are crucial to successful CDA research: (1) CDA research should contribute to social justice; (2) CDA is strongly based in theory; and (3) CDA draws from constructivist epistemology. A key benefit that CDA brings to PPH research is its critical lens, which aligns with the fundamental goals of PPH including addressing the social determinants of health and reducing health inequities. Our analysis demonstrates the need for researchers in population public health to strongly consider critical discourse analysis as an approach to understanding the social determinants of health and eliminating health inequities in order to achieve health and wellness for all

High-Stakes Examinations The Predictive Validity of the MCAT for Medical School Performance and Medical Board Licensing Examinations: A Meta- Analysis of the Published Research

Abstract Purpose To conduct a meta-analysis of published studies to determine the predictive validity of the MCAT on medical school performance and medical board licensing examinations. Method The authors included all peer-reviewed published studies reporting empirical data on the relationship between MCAT scores and medical school performance or medical board licensing exam measures. Moderator variables, participant characteristics, and medical school performance/medical board licensing exam measures were extracted and reviewed separately by three reviewers using a standardized protocol. Results Medical school performance measures from 11 studies and medical board licensing examinations from 18 studies, for a total of 23 studies, were selected. A random-effects model meta-analysis of weighted effects sizes (r) resulted in (1) a predictive validity coefficient for the MCAT in the preclinical years of r ϭ 0.39 (95% confidence interval [CI], 0.21-0.54) and on the USMLE Step 1 of r ϭ 0.60 (95% CI, 0.50 -0.67); and (2) the biological sciences subtest as the best predictor of medical school performance in the preclinical years (r ϭ 0.32 95% CI, 0.21-0.42) and on the USMLE Step 1 (r ϭ 0.48 95% CI, 0.41-0.54). Conclusions The predictive validity of the MCAT ranges from small to medium for both medical school performance and medical board licensing exam measures. The medical profession is challenged to develop screening and selection criteria with improved validity that can supplement the MCAT as an important criterion for admission to medical schools. Acad Med. 2007; 82:100-106. TheMCATcontinuestobewidelyused for screening and selection for many medical schools in the United States and Canada. 1 But how good is the MCAT at predicting students&apos; performance in medical school and beyond? Notwithstanding substantial research efforts, the predictive validity of the MCAT and, in particular, its subtest domains remains unclear. Specifically, Baker et al 2 computed a range of predictive validity coefficients from r ϭ Ϫ0.18 to 0.13 on the MCAT subtests in a small sample of 63 students on first-and second-year medical school performance measures, and Hojat et al. Step examinations (Step 1, r ϭ 0.61; Step 2, r ϭ 0.49; Step 3, r ϭ 0.49). Accordingly, the major purpose of the present study was to conduct a metaanalysis of the predictive validity of the MCAT and its various subtests on medical school and licensing examination performance measures, to determine both the magnitude of the coefficients as well as their confidence intervals. In part because the MCAT has evolved over the course of a number of years and in part because of research challenges, the predictive validity of this test within and beyond medical school needs further exploration. Moreover, the MCAT remains a high-stakes examination and is widely used for medical school admission as a selection criterion into the medical profession. The main purpose of our study, therefore, was to conduct an empirical integration of all published data-a meta-analysis-of the predictive validity of the post-1991 version of the MCAT. We focused on two specific questions: What are the magnitude and the confidence intervals of the predictive validity coefficients of the total MCAT and its subtests on (1) medical school performance and (2) medical board licensing examinations? To address these two questions, we performed a systematic review and empirical integration of published research on the predictive validity of the current version of the MCAT. Method Selection of studies For this study, we followed the guidelines for the reporting of observational studies in a meta-analysis