Peer and Self-assessment of Professionalism in Undergraduate Medical Students at the University of Calgary

Background: Peer and self assessment processes are integral to the development of professional behaviours. The purpose of this study was to assess the Rochester Peer Assessment Tool (RPAT) among a group of volunteer first year students.Methods: We assessed feasibility through participation rates. The evidence for the validity of instrument scores was ascertained through an exploratory factor analysis, MANOVA to determine age and gender differences, and a discrepancy analysis between the self and peer data. Reliability analyses included the Cronbach's alpha analysis and G- and D-studies. Students completed a feedback questionnaire to provide data about acceptability.Results: Self and peer data were collected for 46 and 44 students, respectively. Each student had a mean of 7.2 peer assessments (out of a possible 8).  The factor analysis identified two factors, interpersonal skills and work study habits. The discrepancy analysis showed students in the lowest/highest quartiles, as assessed by peers, had higher/lower self means than peer means. The G-coefficient was Ep2 = 0.77. Student feedback was positive.Conclusions: RPAT was feasible in our setting, was acceptable to the students, and has been adopted as a mandatory part of our program for first and second year students. The study added to the evidence base for the reliability and validity of the RPAT instrument scores as a method of assessing professional behaviours

Participation des médecins aux séances scientifiques planifiées

Background: Physician participation in regularly scheduled series (RSS), also known as grand rounds, was explored with a particular focus on physician perceptions about the elements that affected their engagement in RSS and the unanticipated benefits to RSS. Methods: A qualitative study using semi-structured interviews and thematic analysis examined physicians’ perception of their knowledge and educational needs and the factors that contributed to engagement in their local hospital RSS. Results: Physician engagement in RSS was affected by four major themes: Features that Affect the RSS’ Quality; Collegial Interactions; Perceived Outcomes of RSS; and Barriers to participation in RSS. Features that Affect RSS’ Quality were specific modifiable features that impacted the perceived quality of the RSS. Collegial Interactions were interactions that occurred between colleagues directly or indirectly as a result of attending RSS. Outcomes of RSS were specific outcome measures used in RSS sessions. Barriers were seen as reasons why physicians were unwilling or unable to participate in RSS. All of the elements identified within the four themes contributed to the development of physician engagement. Physicians also identified changes directly and indirectly due to RSS. Discussion: Specific features of RSS result in enhanced physician engagement. There are benefits that may not be accounted for in continuing medical education (CME) outcome study designsContexte : Nous examinons la participation des médecins aux séries de conférences planifiées (SCP) planifiées à l’avance, également connues sous le nom de séances scientifiques, plus particulièrement sous l’angle des perceptions des médecins quant aux éléments qui ont déterminé leur participation et quant aux avantages inattendus des SAR. Méthode : La perception qu'ont les médecins de leurs connaissances et de leurs besoins de formation, ainsi que des facteurs qui les ont poussés à participer aux SCP de leur hôpital sont examinés par le biais d’une étude qualitative comprenant des entretiens semi-dirigés et une analyse thématique. Résultats : Les facteurs qui déterminent la participation des médecins aux SCP se classent en quatre grands thèmes : les caractéristiques qui affectent la qualité des SCP, l’interaction entre collègues, les résultats perçus des SAR et les obstacles à leur participation aux SCP. Les premières sont des caractéristiques modifiables précises, qui influencent la qualité perçue des SCP. Les secondes sont les interactions entre collègues qui se produisent directement ou indirectement à la suite de la participation à une SCP. Les résultats des SCP sont des indicateurs de résultats précis utilisés dans les séances d’activités régulières. Sont considérés comme obstacles les raisons pour lesquelles les médecins ne voulaient pas ou ne pouvaient pas prendre part aux SCP. Tous les éléments décelés de chacun des quatre thèmes ont contribué à favoriser la participation des médecins. Les médecins ont également trouvé des changements qui sont directement ou indirectement liés aux SCP. Discussion : Certains traits spécifiques des SCP favorisent une participation accrue des médecins. Il est possible que les études de résultats du développement professionnel continu (DPC) ne tiennent pas compte de tous les avantages que les SCP procurent

Musculoskeletal education: a curriculum evaluation at one university

<p>Abstract</p> <p>Background</p> <p>The increasing burden of illness related to musculoskeletal diseases makes it essential that attention be paid to musculoskeletal education in medical schools. This case study examines the undergraduate musculoskeletal curriculum at one medical school.</p> <p>Methods</p> <p>A case study research methodology used quantitative and qualitative approaches to systematically examine the undergraduate musculoskeletal course at the University of Calgary (Alberta, Canada) Faculty of Medicine. The aim of the study was to understand the strengths and weaknesses of the curriculum guided by four questions: (1) Was the course structured according to standard principles for curriculum design as described in the Kern framework? (2) How did students and faculty perceive the course? (3) Was the assessment of the students valid and reliable? (4) Were the course evaluations completed by student and faculty valid and reliable?</p> <p><b>Results</b></p> <p>The analysis showed that the structure of the musculoskeletal course mapped to many components of Kern's framework in course design. The course had a high level of commitment by teachers, included a valid and reliable final examination, and valid evaluation questionnaires that provided relevant information to assess curriculum function. The curricular review identified several weaknesses in the course: the apparent absence of a formalized needs assessment, course objectives that were not specific or measurable, poor development of clinical presentations, small group sessions that exceeded normal 'small group' sizes, and poor alignment between the course objectives, examination blueprint and the examination. Both students and faculty members perceived the same strengths and weaknesses in the curriculum. Course evaluation data provided information that was consistent with the findings from the interviews with the key stakeholders.</p> <p>Conclusions</p> <p>The case study approach using the Kern framework and selected questions provided a robust way to assess a curriculum, identify its strengths and weaknesses and guide improvements.</p

Outcomes-Based Courses: Using Pre and Post Course Measurements to Examine and Enhance Course Success

Questionnaire-based pre/post course testing can be used to extend the cognitive processes provided in short (2- to 6-hour) courses. When participants participate in pre-and post-course assessments and implement the changes they commit to at the end of a course, course designers can have an impact on knowledge and workplace practices. A carefully designed pre-course assessment offered prior to an educational activity can help professionals draw upon their workplace experiences prior to a course and during that course

Palliative and end of life care communication as emerging priorities in postgraduate medical education

Background: Reliance on surveys and qualitative studies of trainees to guide postgraduate education about palliative and end of life (EOL) communication may lead to gaps in the curriculum. We aimed to develop a deeper understanding of internal medicine trainees’ educational needs for a palliative and EOL communication curriculum and how these needs could be met.Methods: Mixed methods, including a survey and focus groups with trainees, and interviews with clinical faculty and medical educators, were applied to develop a broader perspective on current experiences and needs for further education. Quantitative descriptive and thematic analyses were conducted.Results: Surveyed trainees were least confident and least satisfied with teaching in counseling about the emotional impact of emergencies and discussing organ donation. Direct observation with feedback, small group discussion, and viewing videos of personal consultations were perceived as effective, yet infrequently identified as instructional methods. Focus groups and interviews identified goals of care conversations as the highest educational priority, with education adapted to learner needs and accompanied by feedback and concurrent clinical and organizational support.Conclusions: Our work expands on previous research describing needs for postgraduate education in palliative and EOL communication to include the importance of support, culture change, and faculty development, and provides insight into why such needs exist

Factors influencing responsiveness to feedback: on the interplay between fear, confidence, and reasoning processes

Self-appraisal has repeatedly been shown to be inadequate as a mechanism for performance improvement. This has placed greater emphasis on understanding the processes through which self-perception and external feedback interact to influence professional development. As feedback is inevitably interpreted through the lens of one’s self-perceptions it is important to understand how learners interpret, accept, and use feedback (or not) and the factors that influence those interpretations. 134 participants from 8 health professional training/continuing competence programs were recruited to participate in focus groups. Analyses were designed to (a) elicit understandings of the processes used by learners and physicians to interpret, accept and use (or not) data to inform their perceptions of their clinical performance, and (b) further understand the factors (internal and external) believed to influence interpretation of feedback. Multiple influences appear to impact upon the interpretation and uptake of feedback. These include confidence, experience, and fear of not appearing knowledgeable. Importantly, however, each could have a paradoxical effect of both increasing and decreasing receptivity. Less prevalent but nonetheless important themes suggested mechanisms through which cognitive reasoning processes might impede growth from formative feedback. Many studies have examined the effectiveness of feedback through variable interventions focused on feedback delivery. This study suggests that it is equally important to consider feedback from the perspective of how it is received. The interplay observed between fear, confidence, and reasoning processes reinforces the notion that there is no simple recipe for the delivery of effective feedback. These factors should be taken into account when trying to understand (a) why self-appraisal can be flawed, (b) why appropriate external feedback is vital (yet can be ineffective), and (c) why we may need to disentangle the goals of performance improvement from the goals of improving self-assessment

An exploration of contextual dimensions impacting goals of care conversations in postgraduate medical education

BACKGROUND: Postgraduate medical trainees are not well prepared difficult conversations about goals of care with patients and families in the acute care clinical setting. While contextual nuances within the workplace can impact communication, research to date has largely focused on individual communication skills. Our objective was to explore contextual factors that influence conversations between trainees and patients/families about goals of care in the acute care setting. METHODS: We conducted an exploratory qualitative study involving five focus groups with Internal Medicine trainees (n&thinsp;=&thinsp;20) and a series of interviews with clinical faculty (n&thinsp;=&thinsp;11) within a single Canadian centre. Thematic framework analysis was applied to categorize the data and identify themes and subthemes. RESULTS: Challenges and factors enabling goals of care conversations emerged within individual, interpersonal and system dimensions. Challenges included inadequate preparation for these conversations, disconnection between trainees, faculty and patients, policies around documentation, the structure of postgraduate medical education, and resource limitations; these challenges led to missed opportunities, uncertainty and emotional distress. Enabling factors were awareness of the importance of goals of care conversations, support in these discussions, collaboration with colleagues, and educational initiatives enabling skill development; these factors have resulted in learning, appreciation, and an established foundation for future educational initiatives. CONCLUSIONS: Contextual factors impact how postgraduate medical trainees communicate with patients/families about goals of care. Attention to individual, interpersonal and system-related factors will be important in designing educational programs that help trainees develop the capacities needed for challenging conversations

Palliative and end of life care communication as emerging priorities in postgraduate medical education

BACKGROUND: Reliance on surveys and qualitative studies of trainees to guide postgraduate education about palliative and end of life (EOL) communication may lead to gaps in the curriculum. We aimed to develop a deeper understanding of internal medicine trainees\u27 educational needs for a palliative and EOL communication curriculum and how these needs could be met. METHODS: Mixed methods, including a survey and focus groups with trainees, and interviews with clinical faculty and medical educators, were applied to develop a broader perspective on current experiences and needs for further education. Quantitative descriptive and thematic analyses were conducted. RESULTS: Surveyed trainees were least confident and least satisfied with teaching in counseling about the emotional impact of emergencies and discussing organ donation. Direct observation with feedback, small group discussion, and viewing videos of personal consultations were perceived as effective, yet infrequently identified as instructional methods. Focus groups and interviews identified goals of care conversations as the highest educational priority, with education adapted to learner needs and accompanied by feedback and concurrent clinical and organizational support. CONCLUSIONS: Our work expands on previous research describing needs for postgraduate education in palliative and EOL communication to include the importance of support, culture change, and faculty development, and provides insight into why such needs exist

Evaluation of an educational program for essential newborn care in resource-limited settings: Essential Care for Every Baby

Abstract Background Essential Care for Every Baby (ECEB) is an evidence-based educational program designed to increase cognitive knowledge and develop skills of health care professionals in essential newborn care in low-resource areas. The course focuses on the immediate care of the newborn after birth and during the first day or until discharge from the health facility. This study assessed the overall design of the course; the ability of facilitators to teach the course; and the knowledge and skills acquired by the learners. Methods Testing occurred at 2 global sites. Data from a facilitator evaluation survey, a learner satisfaction survey, a multiple choice question (MCQ) examination, performance on two objective structured clinical evaluations (OSCE), and pre- and post-course confidence assessments were analyzed using descriptive statistics. Pre-post course differences were examined. Comments on the evaluation form and post-course group discussions were analyzed to identify potential program improvements. Results Using ECEB course material, master trainers taught 12 facilitators in India and 11 in Kenya who subsequently taught 62 providers of newborn care in India and 64 in Kenya. Facilitators and learners were satisfied with their ability to teach and learn from the program. Confidence (3.5 to 5) and MCQ scores (India: pre 19.4, post 24.8; Kenya: pre 20.8, post 25.0) improved (p < 0.001). Most participants demonstrated satisfactory skills on the OSCEs. Qualitative data suggested the course was effective, but also identified areas for course improvement. These included additional time for hands-on practice, including practice in a clinical setting, the addition of video learning aids and the adaptation of content to conform to locally recommended practices. Conclusion ECEB program was highly acceptable, demonstrated improved confidence, improved knowledge and developed skills. ECEB may improve newborn care in low resource settings if it is part of an overall implementation plan that addresses local needs and serves to further strengthen health systems