Tutor Training, Evaluation Criteria and Teaching Environment Influence Students' Ratings of Tutor Feedback in Problem-Based Learning

Aim: In a problem-based learning (PBL) curriculum, tutor's feedback skills are important. However, evaluation studies often show that students rate many tutors as ineffective in providing feedback. We explored whether this is related: (a) to tutors' skills, and hence a teaching intervention might improve their performance; (b) to the formulation of the evaluation item, hence a more specific wording might help students better recognize a feedback when received; (c) to PBL teaching environment, and hence the tutors' teaching unit might influence students' ratings. Methods: Students rated 126 tutors of 13 one-month teaching units over three consecutive years on their ability of providing feedback. We assessed how (a) a teaching intervention given between years 1 and 2, (b) a rewording of the evaluation item which took place in year 3, and (c) the tutors' teaching unit, influenced students' ratings. Results: The ratings of tutors considered as effective by students at year 1 improved after the teaching intervention, while those of unsatisfactory tutors did not progress. However the ratings of the latter increased after reformulation of the evaluation item. This increase varied across teaching units. Discussion: Students' ratings of tutors' ability to give feedback seem to vary in function of the tutors'␣training, of the formulation of the evaluation item, and of the tutors' teaching environment. These variables should be considered for setting up effective strategies in faculty developmen

Trainee doctors' preparedness for clinical work in geriatric psychiatry: A survey on 18 preliminary entrustable professional activities.

BACKGROUND Research concerning transitions from one rotation to another during medical specialist training is scarce. This study examined trainee doctors' perceived preparedness for core clinical activities, trainee doctors' preparedness levels, and general perceptions of medical specialist training in geriatric psychiatry. METHOD Swiss trainee doctors in geriatric psychiatry were surveyed about their perceived preparedness for 18 preliminary entrustable professional activities (EPAs), curricular support, and general perceptions of their medical specialist training. Closed questions were analysed using descriptive statistics, while open questions were subjected to content analysis. RESULTS The participants comprised 48 trainee doctors (30.4% response rate) who differed in their educational experience (years of residency and specialism) and clinical subspecialisation goals. Trainee doctors felt adequately prepared for most EPAs but less prepared for some, including electroconvulsive therapy, psychotherapy, and treating older adults in the home environment or residential facilities. Despite the trainee doctors' diversity, they did not differ significantly in perceived preparedness for most EPAs. The most often offered suggestions for improving geriatric psychiatry training were intensified clinical supervision and a structured induction programme. CONCLUSION Trainee doctors reported that they felt sufficiently prepared for most EPAs, regardless of their backgrounds and professional goals. However, several professional activities in geriatric psychiatry warrant further training. Our findings indicate the need for a higher intensity of clinical supervision (e.g. more direct observation and specific feedback), the introduction of structured induction programmes (e.g. orientation week), and specific teachings (e.g. on neurocognitive assessment)

Parsonage-Turner Syndrome rather than Zoster Neuritis?

We report the case of an 86-year-old man with acute left shoulder pain, followed by left limb monoparesis and a herpetic rash on the left upper limb and thoracic region. This situation presented a diagnostic challenge because of the simultaneity of symptoms attributable to Parsonage-Turner syndrome and herpes zoster neuropathy. A detailed clinical history, physical examination and electroneuromyography were essential to distinguish the neurological structures involved and to ascertain the diagnosis

Is COVID-19 perceived as a threat to equal career opportunities amongst Swiss medical students? A cross-sectional survey study from Bern and Geneva.

INTRODUCTION Students frequently rely on part-time jobs to earn a living wage. We sought to evaluate the sociodemographic status of Swiss medical students and their perception regarding equal career opportunities in view of impaired part-time job opportunities under the COVID-19 pandemic. METHODS We conducted an anonymous online survey among Swiss medical students from Bern and Geneva over a period of 4 months between December 2020 and April 2021. We evaluated sociodemographic data, current living situation, part-time job occupation as well as other sources of income to fund living expenses, and, by means of a five-point Likert scale (1=strongly disagree and 5=strongly agree), whether COVID-19 was perceived as impeding equal career opportunities. RESULTS Of 968 participants, corresponding to around 13.8% of all medical students in Switzerland, 81.3% had part-time jobs. Amongst the employed, 54.8% worked to afford living expenses and 28.9% reported a negative financial impact due to reduced part-time jobs under the pandemic. The loss of part-time jobs was perceived to make medical studies a privilege for students with higher socioeconomic status (4.11±1.0), whose opportunity to study is independent of a regular income. A governmental backup plan was considered crucial to support affected students (4.22±0.91). DISCUSSION COVID-19 and its sequelae are perceived as a threat for Swiss medical students and lead to a disadvantage for those with lower socioeconomic status. Nationwide measures should be established to foster equal career opportunities

Brief report: Beyond clinical experience: Features of data collection and interpretation that contribute to diagnostic accuracy

BACKGROUND: Clinical experience, features of data collection process, or both, affect diagnostic accuracy, but their respective role is unclear. OBJECTIVE, DESIGN: Prospective, observational study, to determine the respective contribution of clinical experience and data collection features to diagnostic accuracy. METHODS: Six Internists, 6 second year internal medicine residents, and 6 senior medical students worked up the same 7 cases with a standardized patient. Each encounter was audiotaped and immediately assessed by the subjects who indicated the reasons underlying their data collection. We analyzed the encounters according to diagnostic accuracy, information collected, organ systems explored, diagnoses evaluated, and final decisions made, and we determined predictors of diagnostic accuracy by logistic regression models. RESULTS: Several features significantly predicted diagnostic accuracy after correction for clinical experience: early exploration of correct diagnosis (odds ratio [OR] 24.35) or of relevant diagnostic hypotheses (OR 2.22) to frame clinical data collection, larger number of diagnostic hypotheses evaluated (OR 1.08), and collection of relevant clinical data (OR 1.19). CONCLUSION: Some features of data collection and interpretation are related to diagnostic accuracy beyond clinical experience and should be explicitly included in clinical training and modeled by clinical teachers. Thoroughness in data collection should not be considered a privileged way to diagnostic succes

Looking back: twenty years of reforming undergraduate medical training and curriculum frameworks in Switzerland

Introduction: To date, hardly any reports exist that outline the reforms in medical studies in Switzerland from the first partial reforms in the 1970s until today.Methods: This article outlines the recent history of medical curricula, their reforms in the early 1970s and, based on these, the key reasons for the major curricular reforms of the 2000s from the perspective of the authors.Results: The various projects, initiatives and legislative elements at the national level include the introduction of new quality control instruments – federal examination and programme accreditation, the introduction of a national catalogue of learning objectives and its two follow-up editions, as well as the implementation of the Bologna reform in undergraduate medical curricula. Examples of the key new elements found in all medical training in Switzerland include: the interdisciplinary orientation of learning content in organ and functional system-oriented subject areas or modules, the enhanced valorisation of practical clinical training, as well as the introduction of problem-oriented formats and the integration of partly formative, partly summative exams according to the format of the objective structured practical examination (OSCE). Characteristics unique to the four medical faculties and their medical training programme are also highlighted.Discussion: The described projects, initiatives and legislative elements have led to a dynamic, continuous development of medical curricula in Switzerland. The close cooperation between the faculties and the Federal Office of Public Health (FOPH) has also resulted in a redefinition of the roles and responsibilities of universities and the Federal Government according to the new Law on Medical Professions. This guarantees the medical faculties a great deal of autonomy, without neglecting quality assurance.Einleitung: Bisher existieren kaum Berichte, die die Schweizer Reformen des Medizinstudiums von den ersten Teilreformen in den 1970er Jahren bis heute skizzieren. Methoden: In der vorliegenden Arbeit werden kursorisch die jüngere Geschichte der humanmedizinischen Curricula, deren erste Teilreformen in den frühen 1970er Jahren und darauf aufbauend die wesentlichen Ausgangspunkte für die grossen Curriculumsreformen der 2000er Jahre aus Sicht der Autoren beschrieben. Ergebnisse: Die vielfältigen Projekte, Initiativen und gesetzgebenden Elemente auf Eidgenössischer Ebene umfassen die Einführung von neuen Qualitätsentwicklungsinstrumenten – Eidgenössische Prüfung und Programmakkreditierung, die Einführung und Weiterentwicklung eines nationalen Lernzielkataloges über insgesamt drei Editionen sowie die Einführung der Bologna Reformen auch in den humanmedizinischen Studiengängen. Im Sinne der Entwicklung von ausdifferenzierten Modellstudiengängen können exemplarisch die wesentlichen neuen Elemente aller Studiengänge in der Schweiz charakterisiert werden: die interdisziplinäre Ausrichtung der Lerninhalte in organ- und funktionssystem-orientierten Themenblöcken oder Modulen, die Aufwertung der klinisch-praktischen Ausbildung sowie die Einführung von problem-orientierten Formaten und der Integration von teils formativen, teils summativen Prüfungen nach dem OSCE-Format. Aufgezeigt werden auch die besonderen standort-spezifischen Charakteristika von vier Medizinischen Fakultäten und deren humanmedizinischen Studiengängen. Diskussion: Die beschriebenen Projekte, Initiativen und gesetzgebenden Elemente haben in der Schweiz zu einer dynamischen, weiterhin anhaltenden Entwicklung der humanmedizinischen Curricula geführt. Die enge Zusammenarbeit zwischen den Fakultäten und dem Bundesamt für Gesundheit (BAG) hat zudem bewirkt, dass mit dem neuen Medizinalberufegesetz Rollen und Verantwortungen zwischen Universitäten und Bund neu definiert worden sind. Dies gewährleistet den Fakultäten eine grosse Autonomie ohne die Qualitätssicherung zu vernachlässigen

Alexander I of Molossia and the creation of Apeiros

Epeiros, sometimes ‹Apeiros› in the sources, was a region in the northwest of the ancient Balkan peninsula. It ran roughly from the Gulf of Ambrakia in the south to Apollonia in the north, and as far inland as the Pindos mountain range. Epeiros was a region of substantial political and ethnic variety. For instance, Thucydides (2. 80. 5–6), when relating the local forces campaigning with the Spartan admiral Knemos in Akarnania in the summer of 429, describes a variety of ‹barbarian› contingents from Epeiros, some coming from communities with kings (Molossians, Atintanians, Parauaians, Orestians) and others kingless (Chaonians, Thesprotians). Three of these ethne came to dominate the region in the fourth, third, and second centuries: the Molossians, the Thesprotians, and the Chaonians. The Molossians and their ruling house, the Aiakids, appear most frequently in our standard narratives: Olympias, mother of Alexander the Great, and Pyrrhos, enemy of Rome, were both Aiakids

Effectiveness of a training program in supervisors' ability to provide feedback on residents' communication skills

Teaching communication skills (CS) to residents during clinical practice remains problematic. Direct observation followed by feedback is a powerful way to teach CS in clinical practice. However, little is known about the effect of training on feedback skills in this field. Controlled studies are scarce as well as studies that go beyond self-reported data. The aim of the study was to develop and assess the effectiveness of a training program for clinical supervisors on how to give feedback on residents' CS in clinical practice. The authors designed a pretest-posttest controlled study in which clinical supervisors working in two different medical services were invited to attend a sequenced and multifaceted program in teaching CS over a period of 6-9months. Outcome measures were self-perceived and observed feedback skills collected during questionnaires and three videotaped objective structured teaching encounters. The videotaped feedbacks made by the supervisors were analysed using a 20-item feedback rating instrument. Forty-eight clinical supervisors participated (28 in the intervention, 20 in the control group). After training, a higher percentage of trained participants self-reported and demonstrated statistically significant improvement in making residents more active by exploring residents' needs, stimulating self-assessment, and using role playing to test strategies and checking understanding, with effect sizes ranging from 0.93 to 4.94. A training program on how to give feedback on residents' communication skills was successful in improving clinical supervisors' feedback skills and in helping them operate a shift from a teacher-centered to a more learner-centered approac

The Role of Power in Health Care Conflict: Recommendations for Shifting Toward Constructive Approaches

Purpose The combination of power and conflict is frequently reported to have a detrimental impact on communication and on patient care, and it is avoided and perceived negatively by health care professionals. In view of recent recommendations to explicitly address power and conflict in health professions education, adopting more constructive approaches toward power and conflict may be helpful. Method The authors used social bases of power (positional, expert, informational, reward, coercive, referent) identified in the literature to examine the role of power in conflicts between health care professionals in different cultural settings. They drew upon semistructured interviews conducted from 2013 to 2016 with 249 health care professionals working at health centers in the United States, Switzerland, and Hungary, in which participants shared stories of conflict they had experienced with coworkers. The authors used a directed approach to content analysis to analyze the data. Results The social bases of power tended to be comparable across sites and included positional, expert, and coercive power. The rigid hierarchies that divide health care professionals, their professions, and their specialties contributed to negative experiences in conflicts. In addition, the presence of an audience, such as supervisors, coworkers, patients, and patients’ families, prevented health care professionals from addressing conflicts when they occurred, resulting in conflict escalation. Conclusions These findings suggest that fostering more positive approaches toward power and conflict could be achieved by using social bases of power such as referent power and by addressing conflicts in a more private, backstage, manner