Reasons to Engage in and Learning Experiences From Different Play Strategies in a Web-Based Serious Game on Delirium for Medical Students:Mixed Methods Design

BACKGROUND: Although many studies have recently been published on the value of serious games for medical education, little attention has been given to the role of dark play (choosing unacceptable actions in games). OBJECTIVE: This study aimed to investigate potential differences in the characteristics of medical students who have the opportunity to choose normal or dark play in a serious game. This study also aimed to compare their reasons for choosing a play strategy and their perceptions of what they learned from their game play. METHODS: We asked undergraduate medical students to play a serious game in which they had to take care of a patient with delirium (The Delirium Experience). After getting acquainted with the game, students could opt for normal or dark play. Student characteristics (age, gender, experience with caring for older or delirious patients, and number of completed clerkships) were collected, and the Delirium Attitude Scale and Learning Motivation and Engagement Questionnaire were administered. Reasons for choosing normal or dark play were evaluated with an open-ended question. Information on lessons they had learned from the game was collected using an open-ended question and self-reported knowledge on delirium. RESULTS: This study had 160 participants (89 normal play, 71 dark play). Male students (26/160, 56.5%) chose dark play significantly more often than female students (45/160, 39.5%; P=.049). We did not find significant differences in student characteristics or measurement outcomes between play strategies. Participants' main reason for choosing normal play was to learn how to provide care to delirious patients, and the main reason for dark play was to gain insight into what a delirious patient has to endure during delirious episodes. All participants learned what to do when taking care of a delirious patient and gained insight into how a patient experiences delirium. We found no differences in self-reported knowledge. CONCLUSIONS: When medical students have the opportunity to choose dark play in a serious game, half of them will probably choose this play strategy. Male students will more likely opt for dark play than female students. Choice of play strategy is not affected by any other student characteristic or measurement outcome. All students learned the same lessons from playing the game, irrespective of their learning strategy

Evidence-based practice in well-child care

Evidence-based practice (EBP) significantly improves the quality of healthcare, but its use in community pediatrics has not yet been proven. We aimed to assess how Dutch community pediatricians use scientific findings and apply evidence-based practice in everyday well-child care. We interviewed a purposive sample of 14 community pediatricians in the Netherlands regarding their professional activities in daily practice, focusing on instances in which their professional knowledge was insufficient to address the issue at hand. We transcribed the interviews verbatim, and coded them using ATLAS.ti software. We structured the information using template analysis. Community pediatricians relied largely on guidelines of their own profession. If these were not sufficient, they first consulted other medical specialists or colleagues, or used different sources that they considered reliable. They only rarely performed an EBP search, and if so, only for somatic problems. For psychosocial problems, they used a strategy of extensive interaction with clients and members of multidisciplinary teams. We identified five barriers to performing an EBP search: (1) a conviction that not every community pediatrician needs to be able to perform an EBP search; (2) a conviction that an EBP search is not suitable for psychosocial problems; (3) lack of confidence in one’s own abilities to perform an EBP search; (4) limited access to literature; (5) lack of time. Conclusions: Community pediatricians rely on professional guidelines; this indicates a need to keep these up-to-date and user-friendly. Furthermore, pediatricians should be better trained in performing EBP searches, and in working in multidisciplinary teams, especially for psychosocial problems. What is Known: • Conducting an evidence-based practice search is considered indispensable to determine the best management of the patient’s problem. • Conducting such a search is still considered challenging in many medical disciplines, including pediatrics. What is New: • There is a need to strengthen skills of community pediatricians to find evidence on psychosocial problems and to present this effectively in multidisciplinary teams. • The pediatricians’ broad use of other sources of evidence, like experts and online sources, shows the importance of critical evaluation skills

Effects of a 1 year development program for recently graduated veterinary professionals on personal and job resources::a combined quantitative and qualitative approach

Background\u3cbr/\u3e\u3cbr/\u3eThe early years in professional practice are for many veterinary and medical professionals a period of great challenges and consequently increased stress levels. Personal resources appear to have a positive impact on the course of this transition period. Personal resources are defined as developable systems of positive beliefs about one’s self and the world that are generally linked to resilience. They are negatively related to burnout and positively and reciprocally to job resources, work engagement and job performance. With the aim of enhancing personal resources of recently graduated veterinarians, a 1 year multi-modular resources development programme was designed. This study was conducted to analyse:1.\u3cbr/\u3e\u3cbr/\u3eif and how the development programme affected participants’ personal resources, and\u3cbr/\u3e\u3cbr/\u3e \u3cbr/\u3e\u3cbr/\u3e2.\u3cbr/\u3e\u3cbr/\u3eif and how personal resources affected participants’ work characteristics and work engagement.Results\u3cbr/\u3e\u3cbr/\u3eᅟ\u3cbr/\u3e\u3cbr/\u3eQuantitative study: Twenty-five participants and ten non-participants completed an online survey covering personal resources, job resources and work engagement at the start and finish of the programme. Results showed a significant increase of personal resources in participants for self-reported ratings of proactive behaviour (Effect Size =−0.4), self-efficacy (Effect Size =−0.6) and reflective behaviour (Effect Size =−0.6). Results of the control group were not significant, although some moderate effect sizes were found.\u3cbr/\u3e\u3cbr/\u3eQualitative study: Additionally 16 semi-structured interviews with participants of the programme were taken 6 months after finishing the programme. Analysis of the interviews revealed that participants also developed other important personal resources namely self-acceptance, self-esteem, awareness of own influence and responsibility. The reflection process, which took place in the course of the programme, seemed to be a necessary step for the development of the other personal resources. According to participants of the resources development programme, the increase in personal resources also gave rise to an increase in job resources.\u3cbr/\u3eConclusion\u3cbr/\u3e\u3cbr/\u3eThe multi-modular resources development programme seems to support development of participants’ personal resources. Because personal resources are beneficial in improving well-being irrespective of where an individual starts working, it is important to give them explicit attention in educational settings.\u3cbr/\u3e\u3cbr/\u3e\u3cbr/\u3

Residents Think in the “Now” and Supervisors Think Ahead in the Operating Room. A Survey Study About Task Perception of Residents and Supervising Surgeons

Objective: Progressive autonomous task performance is the cornerstone of teaching residents in the operating room, where they are entrusted with autonomy when they meet their supervisors’ preferences. To optimize the teaching, supervisors need to be aware of how residents experience parts of the procedure. This study provides insight into how supervisors and residents perceive different tasks of a single surgical procedure. Design: In this qualitative survey study a cognitive task analysis (CTA) of supervisors and residents for the 47 tasks of an uncemented total hip arthroplasty was executed. Both groups rated the level of attention they would assign to each task and were asked to explain attention scores of 4 or 5. Setting: University Medical Centre Groningen (the Netherlands) and its 5 affiliated teaching hospitals. Participants: Seventeen supervising surgeons and 21 residents. Results: Normal attention (median attention score 3) was assigned by supervisors to 34 tasks (72.3%) and by residents to 35 tasks (74.5 %). Supervisors rated 12 tasks (25.6%) and residents 9 tasks (19.1%) with a median attention score of 4. In general, supervisors associated high attention with patient outcome and prevention of complications, while residents associated high attention with “effort.” Conclusions: Supervisors and residents assigned attention to tasks for different reasons. Supervisors think ahead and emphasize patient outcome and prevention of complications when they indicate high attention, while residents think in the “now” and raise attention to execute the tasks themselves. The results of this study allow residents and supervisors to anticipate preferences: residents are able to appreciate why supervisors increase attention to specific tasks, and supervisors obtain information on which tasks require individual guidance of residents. This information can contribute to improve the learning climate in the operating room and task-specific procedural training

Residents Think in the “Now” and Supervisors Think Ahead in the Operating Room. A Survey Study About Task Perception of Residents and Supervising Surgeons

Objective: Progressive autonomous task performance is the cornerstone of teaching residents in the operating room, where they are entrusted with autonomy when they meet their supervisors’ preferences. To optimize the teaching, supervisors need to be aware of how residents experience parts of the procedure. This study provides insight into how supervisors and residents perceive different tasks of a single surgical procedure. Design: In this qualitative survey study a cognitive task analysis (CTA) of supervisors and residents for the 47 tasks of an uncemented total hip arthroplasty was executed. Both groups rated the level of attention they would assign to each task and were asked to explain attention scores of 4 or 5. Setting: University Medical Centre Groningen (the Netherlands) and its 5 affiliated teaching hospitals. Participants: Seventeen supervising surgeons and 21 residents. Results: Normal attention (median attention score 3) was assigned by supervisors to 34 tasks (72.3%) and by residents to 35 tasks (74.5 %). Supervisors rated 12 tasks (25.6%) and residents 9 tasks (19.1%) with a median attention score of 4. In general, supervisors associated high attention with patient outcome and prevention of complications, while residents associated high attention with “effort.” Conclusions: Supervisors and residents assigned attention to tasks for different reasons. Supervisors think ahead and emphasize patient outcome and prevention of complications when they indicate high attention, while residents think in the “now” and raise attention to execute the tasks themselves. The results of this study allow residents and supervisors to anticipate preferences: residents are able to appreciate why supervisors increase attention to specific tasks, and supervisors obtain information on which tasks require individual guidance of residents. This information can contribute to improve the learning climate in the operating room and task-specific procedural training

Programmatic assessment of competency-based workplace learning: when theory meets practice

Contains fulltext : 125808.pdf (publisher's version ) (Open Access)BACKGROUND: In competency-based medical education emphasis has shifted towards outcomes, capabilities, and learner-centeredness. Together with a focus on sustained evidence of professional competence this calls for new methods of teaching and assessment. Recently, medical educators advocated the use of a holistic, programmatic approach towards assessment. Besides maximum facilitation of learning it should improve the validity and reliability of measurements and documentation of competence development. We explored how, in a competency-based curriculum, current theories on programmatic assessment interacted with educational practice. METHODS: In a development study including evaluation, we investigated the implementation of a theory-based programme of assessment. Between April 2011 and May 2012 quantitative evaluation data were collected and used to guide group interviews that explored the experiences of students and clinical supervisors with the assessment programme. We coded the transcripts and emerging topics were organised into a list of lessons learned. RESULTS: The programme mainly focuses on the integration of learning and assessment by motivating and supporting students to seek and accumulate feedback. The assessment instruments were aligned to cover predefined competencies to enable aggregation of information in a structured and meaningful way. Assessments that were designed as formative learning experiences were increasingly perceived as summative by students. Peer feedback was experienced as a valuable method for formative feedback. Social interaction and external guidance seemed to be of crucial importance to scaffold self-directed learning. Aggregating data from individual assessments into a holistic portfolio judgement required expertise and extensive training and supervision of judges. CONCLUSIONS: A programme of assessment with low-stakes assessments providing simultaneously formative feedback and input for summative decisions proved not easy to implement. Careful preparation and guidance of the implementation process was crucial. Assessment for learning requires meaningful feedback with each assessment. Special attention should be paid to the quality of feedback at individual assessment moments. Comprehensive attention for faculty development and training for students is essential for the successful implementation of an assessment programme

Development and validation of a competency framework for veterinarians.

Item does not contain fulltextChanging demands from society and the veterinary profession call for veterinary medical curricula that can deliver veterinarians who are able to integrate specific and generic competencies in their professional practice. This requires educational innovation directed by an integrative veterinary competency framework to guide curriculum development. Given the paucity of relevant information from the veterinary literature, a qualitative multi-method study was conducted to develop and validate such a framework. A competency framework was developed based on the analysis of focus group interviews with 54 recently graduated veterinarians and clients and subsequently validated in a Delphi procedure with a panel of 29 experts, representing the full range and diversity of the veterinary profession. The study resulted in an integrated competency framework for veterinary professionals, which consists of 16 competencies organized in seven domains: veterinary expertise, communication, collaboration, entrepreneurship, health and welfare, scholarship, and personal development. Training veterinarians who are able to use and integrate the seven domains in their professional practice is an important challenge for today's veterinary medical schools. The Veterinary Professional (VetPro) framework provides a sound empirical basis for the ongoing debate about the direction of veterinary education and curriculum development