Medical Education Competencies Research Articles

Remote surgical education using synthetic models combined with an augmented reality headset

ObjectiveThe objective was to investigate the use of an augmented reality headset to remotely train clinicians on medical devices using anatomic models. DesignDisease-specific phantoms were developed to train physicians in mpMRI-guided fusion prostate biopsy, brachytherapy, and rectal spacer insertion. Training was remotely demonstrated using 1-way virtual video conferencing format. Participants responded to an educational content survey. A heads-up display with software and augmented reality was used for remote 2-way training with the proctor and student using on their own phantoms. SettingThe virtual video meeting took place during a prostate cancer conference in 2020, while the augmented reality training occurred in 2021. The proctor and student wore a heads-up display containing a projector and webcam where the ultrasound image was displayed onto a see-through optic along with the physician's hands. The heads-up display allowed the proctor to teach by line-of-sight while the student watched and repeated the steps. ParticipantsFaculty with expertise with the medical devices used in these procedures provided training to urologists unfamiliar with these techniques. ResultsParticipants responded that the 1-way training on the phantoms was realistic and mimicked human tissue. A total of 70.9% requested more training or training on the phantoms. The remote training platform was successfully beta tested at the 2 locations in transperineal prostate biopsy and rectal spacer insertion. ConclusionRemote training using augmented reality eliminates the need for travel. For training programs and workshops, this technology may mitigate the risk of infectious exposures, reduce training cost, and increase proctor availability, allowing training from their own institution or clinic.This investigation qualifies for the Accreditation Council for Graduate Medical Education competency in medical knowledge.

Structural competency in emergency medical education: A scoping review and operational framework.

Existing curricula and recommendations on the incorporation of structural competency and vulnerability into medical education have not provided clear guidance on how best to do so within emergency medicine (EM). The goal of this scoping review and consensus building process was to provide a comprehensive overview of structural competency, link structural competency to educational and patient care outcomes, and identify existing gaps in the literature to inform curricular implementation and future research in EM. A scoping review focused on structural competency and vulnerability following Arksey and O'Malley's six-step framework was performed in concurrence with a multistep consensus process culminating in the 2021 SAEM Consensus Conference. Feedback was incorporated in developing a framework for a national structural competency curriculum in EM. A literature search identified 291 articles that underwent initial screening. Of these, 51 were determined to be relevant to EM education. The papers consistently conceptualized structural competency as an interdisciplinary framework that requires learners and educators to consider historical power and privilege to develop a professional commitment to justice. However, the papers varied in their operationalization, and no consensus existed on how to observe or measure the effects of structural competency on learners or patients. None of the studies examined the structural constraints of the learners studied. Findings emphasize the need for training structurally competent physicians via national structural competency curricula focusing on standardized core competency proficiencies. Moreover, the findings highlight the need to assess the impact of such curricula on patient outcomes and learners' knowledge, attitudes, and clinical care delivery. The framework aims to standardize EM education while highlighting the need for further research in how structural competency interventions would translate to an ED setting and affect patient outcomes and experiences.

Practical tips and Stepwise guide to create and implement Rubric Based Assessment in Competency Based Medical Education: No need to google, create your own Rubric!

In a technology –driven society, it is very essential to have effective communication skills as medical graduate with patients and peer members. Assessments are vital in the process of teaching and learning. Assessing oral presentation skills is considered as assessing the behavioural skills in Millers’ prism of Clinical competence in Medical Education. In alignment with the Saudi Med competency Framework, the rubric was designed keeping the core competency at the centre like Communication & Collaboration and arranging the other auxiliary competencies around, then the parameters like dimensions were derived. An evaluation rubric for grading the presentations was designed to allow faculty evaluators to objectively score student performances in the dimensions of presentation like speech elocution, eye contact along with subject content. Rubrics create clarity for students and rubric dimensions represent various outcomes for students, giving them a realistic destination for their assignment. The students are informed about plagiarism malpractices and are instructed to maintain academic integrity. In response to the COVID-19 pandemic, the rubric scoring assessment for oral presentation was used for online assessment on Zoom webinar. This assessment tool along with online conferencing tools has provided a framework for integrated and interactive evaluation that can be used to facilitate the modification of traditional assessment methods. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 521-528

Effects of an internationalization at home (IAH) programme on cultural awareness among medical and nursing students in Hong Kong and Indonesia during the COVID-19 pandemic: a mixed-methods study

BackgroundThe COVID-19 pandemic has severely impacted the learning experience of students by limiting their opportunities for face-to-face intercultural exchanges. Given the importance of cultural competence in medical education, there is a need to develop a programme that promotes cultural awareness, but that offers more flexibility in terms of outbound mobility. This study aims to evaluate the effectiveness of an internationalization at home programme and to explore the learning experiences of medical and nursing students from Hong Kong and Indonesia.MethodsStudents were recruited from two universities in Hong Kong and Indonesia. They attended an online internationalization at home programme designed by members of the research team from both countries. A mixed-methods study was conducted using a concurrent triangulation approach.A pre-test post-test design was used to evaluate the effects of the programme on cultural awareness, and four focus groups were conducted to explore the students’ experiences in the programme. Quantitative and qualitative data were analysed by T-test and reflexive thematic analysis, respectively. Data were integrated and triangulated using joint displays by comparing findings from both sources.ResultsOne hundred and forty-eight students from Hong Kong and Indonesia participated in the study. After the programme, there was a significant improvement in cultural awareness. Three themes were identified: (1) learning process: enjoyable, but a desire remains for face-to-face cross-cultural communication; (2) learning outcomes: gained cultural awareness, developed cultural sensitivity, had an opportunity to practice language and learn about new learning styles; (3) factors influencing learning outcomes: facilitators (micro-movie and active communication) and barriers (language barrier, inappropriate time arrangement, insufficient prior briefing).ConclusionThis programme achieved the learning outcomes by successfully enhancing the cultural awareness of students during a time of pandemic when outbound student exchanges were not possible. Further adaptations of the programme are required to enhance different learning outcomes.

A Synchronous Hybrid Team-Based Learning Class: Why and How to Do It?

COVID-19 pandemic has transformed much of the medical curriculum delivery from in person to online. Given that interpersonal interaction facilitates team cohesion and professional identity formation, prolonged online learning with minimal social interaction might impact these competencies in medical education. To mitigate the impact of prolonged social isolation, we conducted synchronous team-based learning (TBL) classes, where half the class is physically present and the other is connected via an online platform, termed hybrid TBL. We present practical tips in implementing hybrid TBL for educators teaching in large-sized classes, should conditions exist where not all students can attend in person.

Telehealth Competencies in Medical Education: New Frontiers in Faculty Development and Learner Assessments.

Telehealth visits have become an integral model of healthcare delivery since the COVID-19 pandemic. This rapid expansion of telehealthcare delivery has forced faculty development and trainee education in telehealth to occur simultaneously. In response, academic medical institutions have quickly implemented clinical training to teach digital health skills to providers across the medical education continuum. Yet, learners of all levels must still receive continual assessment and feedback on their skills to align with the telehealth competencies and milestones set forth by the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME). This paper discusses key educational needs and emerging areas for faculty development in telehealth teaching and assessment of telehealth competencies. It proposes strategies for the successful integration of the AAMC telehealth competencies and ACGME milestones into medical education, including skills in communication, data gathering, and patient safety with appropriate telehealth use. Direct observation tools in the paper offer educators novel instruments to assess telehealth competencies in medical students, residents, and peer faculty. The integration of AAMC and ACGME telehealth competencies and the new assessment tools in this paper provide a unique perspective to advance clinical practice and teaching skills in telehealthcare delivery.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07564-8.

Locally adapting generic rubrics for the implementation of outcome-based medical education: a mixed-methods approach

BackgroundRubrics are frequently used to assess competencies in outcome-based medical education (OBE). The implementation of assessment systems using rubrics is usually realised through years of involvement in projects with various stakeholders. However, for countries or specialities new to OBE, faster and more simplified processes are required. In March 2019, Japan introduced nine competencies and generic rubrics of competencies for medical residents. We explored the local adaptation of these generic rubrics and its consequences for assessors.MethodsThe study followed three steps. First, we locally adapted the generic rubrics. This was followed by conducting mixed-method research to explore the effect of the local adaptation. In step two, we examined the correlations between the scores in the locally adapted assessment sheets for supervising doctors and generic rubrics. In step three, we conducted interviews with supervising doctors. The study was conducted in the General Internal Medicine Department of Nagoya University, Japan. In the first step, doctors in the Medical Education Center and other medical departments, clerks, and residents participated. Supervising doctors in the General Internal Medicine Department participated in the second and third steps.ResultsA locally adapted assessment system was developed and implemented in seven months. The scores of the generic rubrics and the adapted assessment tool completed by the supervising doctors showed good correlations in some items as opposed to others, assessed mainly with other tools. Participant interviews revealed that local adaptation decreased their cognitive load leading to consistent ratings, increased writing of comments, and promoting reflection on instruction.ConclusionsThis adaptation process is a feasible way to begin the implementation of OBE. Local adaptation has advantages over direct use of generic rubrics.

Interprofessional communication in medical simulation: findings from a scoping review and implications for academic medicine

BackgroundInterprofessional communication is fundamental to the delivery of healthcare and can be taught in medical school and other health professional schools through interprofessional education (IPE) activities. Simulation centers have become a predominant location for simulation IPE activities with infrastructure able to support high fidelity activities in a controlled environment. In this secondary analysis of a scoping review conducted on simulation-based IPE, we describe the characteristics of previously reported simulation IPE activities involving undergraduate medical students in a simulation center focused on interprofessional communication.MethodsElectronic searches of PubMed, CINAHL, and ERIC databases in accordance with PRISMA-ScR guidelines were conducted to isolate relevant articles from 2016–2020. In total, 165 peer-reviewed articles met inclusion criteria and data extraction linked to four research questions was applied by one individual and the accuracy was confirmed by a second individual. A secondary analysis was performed to describe what existing approaches for simulation IPE in simulation center settings have been used to explicitly achieve interprofessional communication competencies in undergraduate medical education. A sub-dataset was developed from the original scoping review and identified 21 studies describing simulation IPE activities that took place in dedicated simulation centers, targeted the IPEC interprofessional communication domain, and involved undergraduate medical students.ResultsThough diverse, the majority of simulation IPE activities described high-fidelity approaches involving standardized patients and utilized assessment tools with established validity evidence in IPE activities to measure learning outcomes. A minority of simulation IPE activities were described as hybrid and utilized more than one resource or equipment for the activity and only two were longitudinal in nature. Learning outcomes were focused predominantly on modification of attitudes/perceptions and few targeted higher levels of assessment.ConclusionsEducators charged with developing simulation IPE activities for medical students focused on interprofessional communication should incorporate assessment tools that have validity evidence from similar activities, target higher level learning outcomes, and leverage hybrid models to develop longitudinal simulation IPE activities. Though an ideal environment to achieve higher level learning outcomes, simulation centers are not required for meaningful simulation IPE activities.

The Use of Patient Simulations to Teach and Assess Clinical Competencies in Colleges of Podiatric Medicine: A Survey of US Podiatric Medical Schools.

Human and mechanical simulations are used to teach and assess clinical competencies in medical education. In 2014, the National Board of Podiatric Medical Examiners implemented the Clinical Skills Patient Encounter, an examination using standardized patients. Similar clinical skills examinations already existed as part of medical and osteopathic licensure examinations. The purpose of this study was to assess the use of simulation-based education in the nine colleges of podiatric medicine in the United States to inform podiatric clinical faculty and other stakeholders about current trends within the podiatric education system. In 2019, the Clinical Skills Patient Encounter committee of the National Board of Podiatric Medical Examiners developed a survey and contacted each podiatric school to voluntarily participate. The mailed survey instrument gathered information on patient simulation modalities, years used, clinical content application, simulation program administration, facilities and equipment available, and the role of simulation educators. All nine schools participated anonymously. The survey showed that simulation modalities were used in all of the schools during the first 3 years, although there was considerable variance in their use.

Digital health competencies in medical school education: a scoping review and Delphi method study

IntroductionIn order to fulfill the enormous potential of digital health in the healthcare sector, digital health must become an integrated part of medical education. We aimed to investigate which knowledge, skills and attitudes should be included in a digital health curriculum for medical students through a scoping review and Delphi method study.MethodsWe conducted a scoping review of the literature on digital health relevant for medical education. Key topics were split into three sub-categories: knowledge (facts, concepts, and information), skills (ability to carry out tasks) and attitudes (ways of thinking or feeling). Thereafter, we used a modified Delphi method where experts rated digital health topics over two rounds based on whether topics should be included in the curriculum for medical students on a scale from 1 (strongly disagree) to 5 (strongly agree). A predefined cut-off of ≥4 was used to identify topics that were critical to include in a digital health curriculum for medical students.ResultsThe scoping review resulted in a total of 113 included articles, with 65 relevant topics extracted and included in the questionnaire. The topics were rated by 18 experts, all of which completed both questionnaire rounds. A total of 40 (62%) topics across all three sub-categories met the predefined rating cut-off value of ≥4.ConclusionAn expert panel identified 40 important digital health topics within knowledge, skills, and attitudes for medical students to be taught. These can help guide medical educators in the development of future digital health curricula.

Development of an Objective Structured Clinical Examination Station for Pediatric Occupational Therapy and an Evaluation of Its Quality.

The Objective Structured Clinical Examination (OSCE) is a highly valued measure of students' clinical competencies in medical education. However, few studies have reported on the administration of the OSCE in pediatric occupational therapy education. To describe the development of a pediatric occupational therapy OSCE station to evaluate students' use of a standardized assessment and examine its standard setting, failure rates, and psychometric properties. Prospective, cross-sectional, observational study design. Three OSCE stations in a university clinical skills center. Five experienced occupational therapists, 60 examinees, 44 child standardized patients, 44 chaperones, and 15 examiners. The sum of the rating scale and the global performance scores were used. The rating scale measured the examinee's clinical competences in administering a standardized assessment. The 5-point global performance score was used to evaluate the examinee's whole performance. The OCSE station's expert validity was acceptable (item-level content validity index [CVI] = 0.8-1.0; scale-level CVI = 0.98). Passing scores according to the Angoff method (passing score = 14) and the contrasting-groups M-SD method (passing score = 13) were similar. Failure rates were high (61.7%-73.3%). Internal consistency was acceptable (Cronbach's α = .78). No significant examiner effect was found (p = .554), and interexaminer reliability was acceptable (item score = 0.58-1.00; sum of the rating scale score = 0.97; global performance score = 0.79). The OSCE station for using a standardized assessment is a reliable and valid measure of students' interpersonal communication skills and assessment skills. What This Article Adds: The OSCE for education in pediatric occupational therapy is both effective and rigorous.

Expert Consensus on the Accreditation Council for Graduate Medical Education Competencies That Align With Vascular Quality Initiative Surgical Outcomes

The policy and practice of vascular surgical education has evolved significantly since the advent of the Accreditation Council for Graduate Medical Education (ACGME) Milestones. Concomitantly, greater emphasis has been placed nationally on vascular surgery (VS) quality and outcomes as measured by the Vascular Quality Initiative (VQI) procedure registries. As such, no data have supported the association between the VS ACGME Milestones performance with patient outcomes. To investigate the associations between training and surgical outcomes, a critical first step is to determine which ACGME competencies will contribute to patient outcomes.

AAIM Recommendations to Improve Learner Transitions

xxx.

Integrating geriatric competencies in the undergraduate medical education

With the advancements in science and the field of medicine, it has become a reality that people are living longer in contrast to the earlier trends of life expectancy. The current review was carried out to explore the integration of geriatric competencies in the medical education curriculum. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of five articles were selected based upon the suitability with the current review objectives and analyzed. As it is quite obvious that in the years to come all the medical doctors will encounter a large number of elderly patients with physical, psychological, and other social concerns, it becomes indispensable to expose them to different geriatric competencies during the undergraduate period of training. We must also accept that elderly population requires a different approach and the better and long-term approach will be to expose the undergraduate medical students in this domain and prepare them for their future clinical practice. This integration into the existing curriculum has to start with the formulation of geriatric competencies that need to be covered in the undergraduation period followed by curriculum mapping. In conclusion, regardless of the rise in the number of the elderly, the medical education imparted to undergraduate medical students lacks alignment. This calls for the need to expose the medical students to different learning experiences in geriatrics and prepare them to not only meet the specific needs of the elderly but also address the concern of shortage of geriatricians.

A review on cultural competency in medical education.

Cultural competency is a wide notion with a variety of academic bases and differing perspectives on how it should be implemented. While it is widely acknowledged that cultural competency should be an element of general practise, there is a paucity of literature in this area. It has been commonly claimed that cultural competency is a fundamental prerequisite for working well with persons from different cultural backgrounds. Medical students must learn how to connect successfully with patients from all walks of life, regardless of culture, gender, or financial background. Hence, National Medical Council (NMC) has included cultural competence as a course subject in the curriculum of medical education. The opportunities and concept of Competency Based Medical Education, the inclusion of cultural competency in medical course by NMC, various models and practice skill of cultural competence in medical education are discussed in this paper. This study will be useful to researchers who are looking at cultural competency as a research variable that influences study result.

Essential laboratory tests for medical education

Medical practice requires physicians to have a broad understanding of the basic sciences, have competent clinical skills, and have an ability to practice in evolving health systems in a cost-effective and evidence-based manner. Essential to the practice of medicine is an understanding of the common laboratory tests and the ability to use them effectively. The Essential Laboratory Tests for Medical Education (ELTME) is a concise document explaining the pathophysiology of common laboratory tests and clinical context for each test and was developed in response to an expressed need from medical students, residents and fellows, and medical educators. The ELTME is linked to the Pathology Competencies in Medical Education and its third competency of diagnostic medicine and therapeutic pathology. The ELTME table is a document of common laboratory tests in alphabetical listing. Laboratory tests may be easily queried by name or organ system, and with simple editing tools, new tables may be constructed to fit the needs of individual curricula or learners. Furthermore, the table may be easily expanded by educators who wish to add specific tests to complement their curricula.

Inclusion of sexual health-related competencies in undergraduate medical education

Sexual health has been recognized as an essential component of the overall health of humans. The purpose of current review is to explore the need and opportunities for the incorporation of sexual health-related competencies in the undergraduate medical curriculum. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 9 articles were selected based upon the suitability with the current review objectives and analyzed. Keywords used in the search include sexual health and medical education in the title alone only. In general, the health professionals are not ready for this role on their own, and this establishes the need that undergraduate medical students should be exposed to competencies pertaining to sexual health during their training period. In the current setup, we cannot ignore the fact that not many teaching hours are assigned to sexual health, there is absence of standard competencies, lack of plans for teaching-learning or assessment of the same, and the discomfort among both doctors and patients to openly talk about the same. The competencies for sexual health should be formulated, and subsequently, a thorough curriculum mapping should be done. In conclusion, regardless of the specialty branch which an undergraduate medical student might opt in the future, there is an indispensable need to expose them to competencies pertaining to the maintenance of sexual health and well-being.

The Impact of Global Health Experiences on the Emergency Medicine Residency Milestones.

OBJECTIVESIdentify the impact of experiences in global health (GH) on the Accreditation Council for Graduate Medical Education (ACGME) competencies in emergency medicine (EM) residents and describe the individual characteristics of EM residents with global health experience compared to those without.METHODSFrom 2015 to 2018, 117 residents from 13 nationally accredited United States EM residency training programs were surveyed. Specifically, the survey gathered demographic data and information regarding timing, type, location and duration of short term experiences in global health (STEGH). The survey collected both qualitative and quantitative data regarding resident experiences, including number of procedures performed and self-assessment of the impact on their residency milestones. ACGME milestone data from survey respondents was collected from each resident's training program coordinators. Chi-squared analysis and t-tests were conducted to assess differences between residents with STEGH and those without. A generalized linear model (GLM) was utilized to assess the effects of time and experience with interaction on achieving milestones in each of the competency domains, to compare milestone achievement over time between residents with STEGH and those without.RESULTSOut of 117 EM residents, 60 were female (44%), the mean age was 30 years (standard deviation = 3.1), and 84 (71.8%) reported STEGH in general, including prior to residency (64.5%). 33 (28.2%) reported having completed STEGH during residency. The results of the GLM analysis showed that residents with STEGH during residency had significantly higher scores compared to those without the experience or STEGH pre-residency across all six competenciesCONCLUSIONSSTEGH in EM residents was associated with higher milestone achievement in certain ACGME competency domains including medical knowledge, practice-based learning and improvement, and professionalism. Participation in STEGH during residency appeared to show the strongest effect, with higher scores across all six competencies.

Implementation of a Clinical Leadership Curriculum for Pediatric Residents.

IntroductionClinical leadership is an essential skill for physicians, empowering them to lead and coordinate teams, communicate clearly under various conditions, model positive behaviors, display emotional intelligence, and ultimately improve patient care outcomes. However, there are currently no standardized residency curricula or competency-based assessments for clinical leadership, as residents often assimilate leadership skills through trial-and-error or observation of their clinical faculty. By utilizing a comprehensive needs assessment and synthesizing evidence-based practices, we developed and implemented a longitudinal and skills-based clinical leadership curriculum for pediatric residents.MethodsWe modeled our clinical leadership curriculum after Kern's 6-step approach to curricular development and the Accreditation Council for Graduate Medical Education competency requirements for professionalism. We identified topics based on a resident needs assessment and synthesized evidence from published practices. The curriculum was implemented through both monthly facilitated group sessions and independent learning modules.Results44 postgraduate year-2 (PGY-2) and PGY-3 pediatric residents participated in at least one monthly session of the clinical leadership curriculum. 27 (61%) completed the survey to evaluate the efficacy of the curriculum. Of the respondents, 23 (85%) residents found the leadership sessions useful, 4 (15%) were neutral, and none (0%) rated the sessions as not useful. 26 (96%) residents reported that the sessions should be continued.ConclusionThe clinical leadership curriculum has been received favorably by senior pediatric residents at our institution. Our next steps are to pilot the curriculum within residency programs of different specialties at our own institution as well as with pediatric residencies at other institutions.

Assessment of individual competence

Aims: the assessment of individual competence in medical education is about finding a balance between having sufficient resources to make valid and reliable decisions and not using more resources than necessary. Sequential assessment, in which more resources are used for borderline performing candidates than for poorly or clearly satisfactorily performing candidates, can be used to achieve that balance. Although sequential assessment is commonly associated with larger groups of candidates to be assessed, in many practical settings numbers of candidates may be small.Objective: this article presents a single case design with a statistical model for the assessment of individual competence that can be used regardless of the number of candidates.Method: a worked example of a solution that can be used for an individual candidate, using simulated data in the zero-cost Open Source statistical program R version 4.0.5., is provided.Results: the aforementioned solution provides statistics that can be used to make pass/fail decisions at the level of the individual candidate as well as to make decisions regarding the length and timing of an exam (or parts thereof) for the individual candidate.Conclusion: the solution provided can help to reduce resources needed for assessment to a considerable extent while maximizing resources for borderline candidates. This facilitates both decision making and cost reduction in assessment.