Crew resource management training in healthcare: a systematic review of intervention design, training conditions and evaluation

Objectives Crew resource management (CRM) training formats have become a popular method to increase patient safety by consideration of the role that human factors play in healthcare delivery. The purposes of this review were to identify what is subsumed under the label of CRM in a healthcare context and to determine how such training is delivered and evaluated. Design Systematic review of published literature. Data sources PubMed, PsycINFO and ERIC were searched through 8 October 2018. Eligibility criteria for selecting studies Individually constructed interventions for healthcare staff that were labelled as CRM training, or described as based on CRM principles or on aviation-derived human factors training. Only studies reporting both an intervention and results were included. Data extraction and synthesis The studies were examined and coded for relevant passages. Characteristics regarding intervention design, training conditions and evaluation methods were analysed and summarised both qualitatively and quantitatively. Results Sixty-one interventions were included. 48% did not explain any keyword of their CRM intervention to a reproducible detail. Operating room teams and surgery, emergency medicine, intensive care unit staff and anaesthesiology came in contact most with a majority of the CRM interventions delivered in a 1-day or half-day format. Trainer qualification is reported seldomly. Evaluation methods and levels display strong variation. Conclusions Critical topics were identified for the CRM training community and include the following: the need to agree on common terms and definitions for CRM in healthcare, standards of good practice for reporting CRM interventions and their effects, as well as the need for more research to establish non-educational criteria for success in the implementation of CRM in healthcare organisations

Can clinical case discussions foster clinical reasoning skills in undergraduate medical education? A randomised controlled trial

OBJECTIVE Fostering clinical reasoning is a mainstay of medical education. Based on the clinicopathological conferences, we propose a case-based peer teaching approach called clinical case discussions (CCDs) to promote the respective skills in medical students. This study compares the effectiveness of different CCD formats with varying degrees of social interaction in fostering clinical reasoning. DESIGN, SETTING, PARTICIPANTS A single-centre randomised controlled trial with a parallel design was conducted at a German university. Study participants (N=106) were stratified and tested regarding their clinical reasoning skills right after CCD participation and 2 weeks later. INTERVENTION Participants worked within a live discussion group (Live-CCD), a group watching recordings of the live discussions (Video-CCD) or a group working with printed cases (Paper-Cases). The presentation of case information followed an admission-discussion-summary sequence. PRIMARY AND SECONDARY OUTCOME MEASURES Clinical reasoning skills were measured with a knowledge application test addressing the students' conceptual, strategic and conditional knowledge. Additionally, subjective learning outcomes were assessed. RESULTS With respect to learning outcomes, the Live-CCD group displayed the best results, followed by Video-CCD and Paper-Cases, F(2,87)=27.07, p<0.001, partial η2=0.384. No difference was found between Live-CCD and Video-CCD groups in the delayed post-test; however, both outperformed the Paper-Cases group, F(2,87)=30.91, p<0.001, partial η2=0.415. Regarding subjective learning outcomes, the Live-CCD received significantly better ratings than the other formats, F(2,85)=13.16, p<0.001, partial η2=0.236. CONCLUSIONS This study demonstrates that the CCD approach is an effective and sustainable clinical reasoning teaching resource for medical students. Subjective learning outcomes underline the importance of learner (inter)activity in the acquisition of clinical reasoning skills in the context of case-based learning. Higher efficacy of more interactive formats can be attributed to positive effects of collaborative learning. Future research should investigate how the Live-CCD format can further be improved and how video-based CCDs can be enhanced through instructional support

FAMULUS: interactive annotation and feedback generation for teaching diagnostic reasoning

Our proposed system FAMULUS helps students learn to diagnose based on automatic feedback in virtual patient simulations, and it supports instructors in labeling training data. Diagnosing is an exceptionally difficult skill to obtain but vital for many different professions (e.g., medical doctors, teachers). Previous case simulation systems are limited to multiple-choice questions and thus cannot give constructive individualized feedback on a student’s diagnostic reasoning process. Given initially only limited data, we leverage a (replaceable) NLP model to both support experts in their further data annotation with automatic suggestions, and we provide automatic feedback for students. We argue that because the central model consistently improves, our interactive approach encourages both students and instructors to recurrently use the tool, and thus accelerate the speed of data creation and annotation. We show results from two user studies on diagnostic reasoning in medicine and teacher education and outline how our system can be extended to further use cases

Getting immersed in teacher and student perspectives?: facilitating analytical competence using video cases in teacher education

The ability to analyze and understand classroom situations through the eyes of not only teachers but also students can be seen as a crucial aspect of teachers’ professional competence. Even though video case-based learning is considered to have great potential for the promotion of analytical competence of teachers (i.e., becoming immersed in student and teacher perspectives as well as applying conceptual knowledge to better understand classroom situations), only a few studies have investigated the effects of corresponding instructional support. This empirical field study examines the effects on analytical competence of two types of instructional support—hyperlinks to multiple perspectives and hyperlinks to conceptual knowledge—by using a 2 × 2 factorial design in a computer-supported video case-based learning environment inspired by cognitive flexibility theory and participatory design. The study examines collaborative learning processes to discover what specific kind of instruction may help to counteract some of the known deficits of case-based learning and teacher thinking, such as limited perspective-taking. From a participatory design point of view, training novices to become immersed in teacher and student perspectives can be considered as an alternative for direct involvement of teachers and students in the design process. The study was realized as a four-day university course for pre-service teachers (N = 100). ANCOVAs of learning processes (small-group discussions) and outcomes (written case analyses) provide evidence that both types of instructional support (i.e., hyperlinks to multiple perspectives and conceptual knowledge) are beneficial. In particular, hyperlinks to multiple perspectives affected small-group case discussions and written post-tests as they led to increased immersion (i.e., perspective-taking). Hyperlinks to conceptual knowledge furthered the application of this knowledge, especially in the written post-tests. Implications for teacher education, participatory design, and further research are discussed

Learning with Simulations in Medical Education. Validity and Design of Learning Settings in Particular Contexts.

peer reviewedThe aim of this symposium is to initiate the discussion on learning with simulations in the medical sector. Indeed, this domain represents a very complex and dynamic environment dealing with a great variety of knowledge (declarative, pragmatic, procedural, gestural, etc.) that can be learned under diverse pedagogical forms. The four presentations describe various forms of computer-based technology, which aim to enhance the teaching and learning capabilities of doctors mostly in the form of 3D visualisation, full-scale simulation and haptic technology. They focus on research conducted in the area of anaesthesia and surgery. These studies emphasize on the necessity to adapt the learning environment to the objective of the training (validity of the learning situations). If the presentations are specific to the medical domain, their methodological and theoretical approaches can be generalized and used in other learning situations

Computer-supported collaborative learning with digital video cases in teacher education: the impact of teaching experience on knowledge convergence

Case-based learning is ascribed high potential with respect to the education of pre-service teachers as well as the further education of experienced in-service teachers, as it can provide opportunities for the application of professional knowledge to authentic classroom situations. In addition to the application and acquisition of knowledge, the aspect of knowledge convergence (i.e., increasing similarity of collaborative learners with respect to their knowledge) should be taken into account when homogeneous benefits are desired for all participants of a case-based training. A field study with 29 pre-service teachers and 24 in-service teachers from adult education was conducted to examine effects of different levels of teaching experience on knowledge application, knowledge acquisition, and knowledge convergence in a computer-supported collaborative case-based learning environment. An innovative approach to measuring knowledge convergence was introduced, using the positions of annotations (i.e., flags placed on the timeline of the case video) made by learners during their case analyses as an indicator of their shared focus of attention. This measure was found to positively correlate with the application and acquisition of professional knowledge. Teaching experience affected both processes and outcomes of case-based learning, suggesting different means of instructional support for pre-service and in-service teachers

Forschendes Lernen: Wissenschaftsforschung Jahrbuch 2016

Peer Reviewe

Diagnostic Activities and Diagnostic Practices in Medical Education and Teacher Education

In this article, we investigate diagnostic activities and diagnostic practices in medical education and teacher education. Previous studies have tended to focus on comparing knowledge between disciplines, but such an approach is complicated due to the content specificity of knowledge. We compared 142 learners from medical education and 122 learners from teacher education who were asked to (a) diagnose eight simulated cases from their respective discipline in a simulation-based learning environment and (b) write a justificatory report for each simulated case. We coded all justificatory reports regarding four diagnostic activities: generating hypotheses, generating evidence, evaluating evidence, and drawing conclusions. Moreover, using the method of Epistemic Network Analysis, we operationalized diagnostic practices as the relative frequencies of co-occurring diagnostic activities. We found significant differences between learners from medical education and teacher education with respect to both their diagnostic activities and diagnostic practices. Learners from medical education put relatively more emphasis on generating hypotheses and drawing conclusions, therefore applying a more hypothesis-driven approach. By contrast, learners in teacher education had a stronger focus on generating and evaluating evidence, indicating a more data-driven approach. The results may be explained by different epistemic ideals and standards taught in higher education. Further research on the issue of epistemic ideals and standards in diagnosing is needed. Moreover, we recommend that educators think beyond individuals’ knowledge and implement measures to systematically teach and increase the awareness of disciplinary standards