Comparison of expectations and beliefs about good teaching in an academic day release medical education program: a qualitative study

BACKGROUND In a professional learner-centered(ness) educational environment, communication and alignment of expectations about teaching are indispensable. Professional education of residents could benefit from an analysis and comparison of teachers' and residents' educational expectations and beliefs. Our purpose is to identify success factors and barriers related to aligning expectations and beliefs and building a supportive professional learner-centered educational environment. METHODS We conducted semi-structured individual interviews with teachers and semi-structured focus groups with residents. A single interview format was used to make it possible to compare the results. Data were analysed using a qualitative software package (AtlasTi). Data analysis steps were followed by the author team, which identified four domains of good teaching: personal traits, knowledge, relationships and teaching qualities. RESULTS Teachers and residents agreed about the importance of personal professional characteristics like being a role model and having an open and enthusiastic attitude. They all thought that having a specific knowledge base was essential for teaching. Approaching residents as adult learners was found to be an important element of the learner-centred environment and it was agreed that teachers should take practical experiences to a higher level. However, teachers and residents had different expectations about the practical consequences of being a role model, adult learning, coaching and openness, and the type of knowledge that was needed in the professional development program. Communication about different expectations appeared to be difficult. CONCLUSIONS Teachers and residents agreed on a conceptual level about expectations and beliefs regarding good teaching, but disagreed on an executive level. According to the residents, the disagreement about good teaching was not the biggest barrier to creating alignment and a supportive professional relationship; instead, it was the absence of a proper dialogue regarding issues about expectations and beliefs

The role of deliberate practice in the acquisition of clinical skills

<p>Abstract</p> <p>Background</p> <p>The role of deliberate practice in medical students' development from novice to expert was examined for preclinical skill training.</p> <p>Methods</p> <p>Students in years 1-3 completed 34 Likert type items, adapted from a questionnaire about the use of deliberate practice in cognitive learning. Exploratory factor analysis and reliability analysis were used to validate the questionnaire. Analysis of variance examined differences between years and regression analysis the relationship between deliberate practice and skill test results.</p> <p>Results</p> <p>875 students participated (90%). Factor analysis yielded four factors: planning, concentration/dedication, repetition/revision, study style/self reflection. Student scores on 'Planning' increased over time, score on sub-scale 'repetition/revision' decreased. Student results on the clinical skill test correlated positively with scores on subscales 'planning' and 'concentration/dedication' in years 1 and 3, and with scores on subscale 'repetition/revision' in year 1.</p> <p>Conclusions</p> <p>The positive effects on test results suggest that the role of deliberate practice in medical education merits further study. The cross-sectional design is a limitation, the large representative sample a strength of the study. The vanishing effect of repetition/revision may be attributable to inadequate feedback. Deliberate practice advocates sustained practice to address weaknesses, identified by (self-)assessment and stimulated by feedback. Further studies should use a longitudinal prospective design and extend the scope to expertise development during residency and beyond.</p

Reducing errors in health care: cost-effectiveness of multidisciplinary team training in obstetric emergencies (TOSTI study); a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>There are many avoidable deaths in hospitals because the care team is not well attuned. Training in emergency situations is generally followed on an individual basis. In practice, however, hospital patients are treated by a team composed of various disciplines. To prevent communication errors, it is important to focus the training on the team as a whole, rather than on the individual. Team training appears to be important in contributing toward preventing these errors. Obstetrics lends itself to multidisciplinary team training. It is a field in which nurses, midwives, obstetricians and paediatricians work together and where decisions must be made and actions must be carried out under extreme time pressure.</p> <p>It is attractive to belief that multidisciplinary team training will reduce the number of errors in obstetrics. The other side of the medal is that many hospitals are buying expensive patient simulators without proper evaluation of the training method. In the Netherlands many hospitals have 1,000 or less annual deliveries. In our small country it might therefore be more cost-effective to train obstetric teams in medical simulation centres with well trained personnel, high fidelity patient simulators, and well defined training programmes.</p> <p>Methods/design</p> <p>The aim of the present study is to evaluate the cost-effectiveness of multidisciplinary team training in a medical simulation centre in the Netherlands to reduce the number of medical errors in obstetric emergency situations. We plan a multicentre randomised study with the centre as unit of analysis. Obstetric departments will be randomly assigned to receive multidisciplinary team training in a medical simulation centre or to a control arm without any team training.</p> <p>The composite measure of poor perinatal and maternal outcome in the non training group was thought to be 15%, on the basis of data obtained from the National Dutch Perinatal Registry and the guidelines of the Dutch Society of Obstetrics and Gynaecology (NVOG). We anticipated that multidisciplinary team training would reduce this risk to 5%. A sample size of 24 centres with a cluster size of each at least 200 deliveries, each 12 centres per group, was needed for 80% power and a 5% type 1 error probability (two-sided). We assumed an Intraclass Correlation Coefficient (ICC) value of maximum 0.08.</p> <p>The analysis will be performed according to the intention-to-treat principle and stratified for teaching or non-teaching hospitals.</p> <p>Primary outcome is the number of obstetric complications throughout the first year period after the intervention. If multidisciplinary team training appears to be effective a cost-effective analysis will be performed.</p> <p>Discussion</p> <p>If multidisciplinary team training appears to be cost-effective, this training should be implemented in extra training for gynaecologists.</p> <p>Trial Registration</p> <p>The protocol is registered in the clinical trial register number NTR1859</p

Teachers' ideas versus experts' descriptions of 'the good teacher' in postgraduate medical education: implications for implementation. A qualitative study

Contains fulltext : 96394.pdf (publisher's version ) (Open Access)BACKGROUND: When innovations are introduced in medical education, teachers often have to adapt to a new concept of what being a good teacher includes. These new concepts do not necessarily match medical teachers' own, often strong beliefs about what it means to be a good teacher.Recently, a new competency-based description of the good teacher was developed and introduced in all the Departments of Postgraduate Medical Education for Family Physicians in the Netherlands. We compared the views reflected in the new description with the views of teachers who were required to adopt the new framework. METHODS: Qualitative study. We interviewed teachers in two Departments of Postgraduate Medical Education for Family Physicians in the Netherlands. The transcripts of the interviews were analysed independently by two researchers, who coded and categorised relevant fragments until consensus was reached on six themes. We investigated to what extent these themes matched the new description. RESULTS: Comparing the teachers' views with the concepts described in the new competency-based framework is like looking into two mirrors that reflect clearly dissimilar images. At least two of the themes we found are important in relation to the implementation of new educational methods: the teachers' identification and organisational culture. The latter plays an important role in the development of teachers' ideas about good teaching. CONCLUSIONS: The main finding of this study is the key role played by the teachers' feelings regarding their professional identity and by the local teaching culture in shaping teachers' views and expectations regarding their work. This suggests that in implementing a new teaching framework and in faculty development programmes, careful attention should be paid to teachers' existing identification model and the culture that fostered it

Students' perceptions about the transition to the clinical phase of a medical curriculum with preclinical patient contacts; a focus group study

Abstract Background Studies have shown that medical students experience the transition between preclinical and clinical training as a stressful period. They are generally frustrated by their inability to apply their knowledge to solve clinical problems in practice. Preclinical patient contacts may offer a solution to this 'shock of practice.' We studied how students who have had preclinical patient contacts perceive the transition from preclinical to clinical training and, more specifically, how they value these early patient contacts as preparation for learning in clinical practice. Methods A purposive sample of 21 students participated in three focus groups which met twice during their first weeks of clinical clerkships. The interviews were recorded and transcribed literally. Qualitative content analysis of the transcriptions was performed. Results According to the students, working in clinical practice was enjoyable, motivated them to study and helped them to develop non-analytical reasoning skills. The students experienced stress due to increased working hours and work load, uncertainty as to what was expected of them and self-perceived lack of knowledge. They did not experience a major gap between the preclinical and clinical phase and felt well prepared for the clerkships. The preclinical patient contacts were considered to be instrumental in this. Conclusions Early patient contacts seem to ameliorate the shock of practice and prepare students for clinical work. The problems mentioned by the students in this study are mainly related to the socialisation process. The results of this study have to be validated by quantitative research.</p

The effects of deliberate practice in undergraduate medical education

INTRODUCTION: Ericsson and colleagues introduced the term 'deliberate practice' to describe training activities that are especially designed to maximise improvement. They stressed that how much one practises is as important as how one practises. Essential aspects of deliberate practice are the presence of well defined tasks, informative feedback, repetition, self-reflection, motivation and endurance. Deliberate practice is often difficult, laborious, and even unpleasant. Previous studies in the fields of sports and music have shown a positive relation between deliberate practice and level of expertise. PURPOSE: The present study investigated the relationship between several aspects of deliberate practice and study achievements among undergraduate medical students. METHODS: A questionnaire was developed to measure important aspects of deliberate practice. It was filled out by 777 medical students at Maastricht University Medical School (response rate 90%). Scores on 3 regular tests were used to define student levels of expertise. RESULTS: Positive correlations between aspects of deliberate practice (self-study, study resources, planning, study style and motivation) and study achievements were found. Furthermore, high achieving students showed more characteristics of deliberate practice than low achieving students. CONCLUSION: Some important aspects of deliberate practice appear to contribute to the performance of medical students

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

Towards healthy learning climates in postgraduate medical education: exploring the role of hospital-wide education committees.

BackgroundPostgraduate medical education prepares residents for delivery of high quality patient care during training as well as for later practice, which makes high quality residency training programs crucial to safeguard patient care. Healthy learning climates contribute to high quality postgraduate medical education. In several countries, modernization of postgraduate medical education has resulted in hospital-wide responsibilities for monitoring learning climates. This study investigates the association between the actions undertaken by hospital-wide education committees and learning climates in postgraduate medical education.MethodsResearch conducted in December 2010 invited 57 chairs of hospital-wide education committees to complete a questionnaire on their implemented level of quality improvement policies. We merged the survey data from 21 committees that oversaw training programs and used the Dutch Residency Educational Climate Test (D-RECT) instrument in 2012 to measure their training programs' learning climate. We used descriptive statistics and linear mixed models to analyse associations between the functioning of hospital-wide education committees and corresponding learning climates.ResultsIn total, 812 resident evaluations for 99 training programs in 21 teaching hospitals were available for analysis. The implementation level of the internal quality management systems as adopted by the hospital-wide education committees varied from 1.6 to 2.6 on a 5 point Likert-scale (ranging from 1 (worst) to 5 (best)). No significant associations were found between the functioning of the committees and corresponding learning climates.ConclusionsThe contribution of hospital-wide committees to creating healthy learning climates is yet to be demonstrated. The absence of such an association could be due to the lack of a Plan-Do-Check-Act cycle guiding the policy as implemented by the committees and the lack of involvement of departmental leadership. Insight into the impact of these strategies on learning climates will benefit the quality of postgraduate medical education and, hopefully, patient care

Medical students perceive better group learning processes when large classes are made to seem small.

ObjectiveMedical schools struggle with large classes, which might interfere with the effectiveness of learning within small groups due to students being unfamiliar to fellow students. The aim of this study was to assess the effects of making a large class seem small on the students' collaborative learning processes.DesignA randomised controlled intervention study was undertaken to make a large class seem small, without the need to reduce the number of students enrolling in the medical programme. The class was divided into subsets: two small subsets (n=50) as the intervention groups; a control group (n=102) was mixed with the remaining students (the non-randomised group n∼100) to create one large subset.SettingThe undergraduate curriculum of the Maastricht Medical School, applying the Problem-Based Learning principles. In this learning context, students learn mainly in tutorial groups, composed randomly from a large class every 6-10 weeks.InterventionThe formal group learning activities were organised within the subsets. Students from the intervention groups met frequently within the formal groups, in contrast to the students from the large subset who hardly enrolled with the same students in formal activities.Main outcome measuresThree outcome measures assessed students' group learning processes over time: learning within formally organised small groups, learning with other students in the informal context and perceptions of the intervention.ResultsFormal group learning processes were perceived more positive in the intervention groups from the second study year on, with a mean increase of β=0.48. Informal group learning activities occurred almost exclusively within the subsets as defined by the intervention from the first week involved in the medical curriculum (E-I indexes&gt;-0.69). Interviews tapped mainly positive effects and negligible negative side effects of the intervention.ConclusionBetter group learning processes can be achieved in large medical schools by making large classes seem small