Maastricht Clinical Teaching Questionnaire Research Articles

Investigating the role of clinical exposure on motivational self-regulation skills in medical students based on cognitive apprenticeship model

BackgroundThe importance of motivation regulation in medical students is highly significant due to their unique educational circumstances, such as clinical exposure. However, the role of clinical exposure in learning motivational self-regulation skills in students has not been explored thus far. This current study aims to investigate the role of clinical exposure on motivational self-regulation skills in medical students based on cognitive apprenticeship model.MethodThis study was descriptive-analytical research conducted in 2022 on medical students. Data collection involved two questionnaires including Meta motivational Strategies in Medical Students Questionnaire and Maastricht Clinical Teaching Questionnaire. The research comprised two stages including measuring motivational self-regulation strategies in students before entering the clinical exposure phase, and simultaneous measurement of clinical exposure based on the student’s viewpoint and their motivational self-regulation strategies at the end of the first term of clinical exposure.ResultsThe results revealed a significant relationship between six dimensions of the cognitive apprenticeship model, including modeling, coaching, scaffolding, reflection, exploration, and learning environment, with motivational self-regulation strategies. However, there was no significant relationship between the articulation dimension of the cognitive apprenticeship model and motivational self-regulation strategies.ConclusionClinical exposure indirectly enhances students’ metacognitive skills. Observing the behavior of clinical faculty in the clinical exposure setting leads to the improvement of motivational self-regulation strategies in medical students.

Psychometric evaluation of Maastricht clinical teaching questionnaire based on the cognitive apprenticeship model.

The Maastricht Clinical Teaching Questionnaire is a valid and reliable instrument for measuring the quality of clinical teaching. This study was aimed at translation and psychometric evaluation of the Persian version of this questionnaire to evaluate clinical teaching based on the cognitive apprenticeship model. The translation of the questionnaire was performed according to Guillemins framework. Reliability was examined by calculating Cronbach's alpha coefficient. Confirmatory factor analysis was studied among 120 medical students. Content validity was assessed by calculating the content validity index and content validity ratio. Face validity was evaluated by conducting interviews with students using concurrent verbal probing and thinking aloud. Cronbach's alpha coefficient for the whole scale was 0.95. The content validity index was 0.92, and the content validity ratio was 0.82. Confirmatory factor analysis resulted in a seven-factor model and demonstrated an adequate fit with the data. The Persian version of the Maastricht Clinical Teaching Questionnaire with seven factors including modeling, coaching, scaffolding, articulation, reflection, exploration, and learning environment appears to be a valid and reliable instrument for the evaluation of clinical teaching in Iranian universities of medical sciences.

Psychometric Properties Evaluation of Persian Version of the Maastricht Clinical Teaching Questionnaire.

Students are a significant source of data for the evaluation of clinical instructors' performance. This study was undertaken with the aim of adaptation and validation of the Persian version of the Maastricht Clinical Teaching Questionnaire (MCTQ). The main objective of the researchers in this study was to evaluation the psychometric properties of the Persian version of the Maastricht Clinical Training Questionnaire (P-MCTQ) in Iran, considering cultural and social differences. This methodological study was conducted from 2019 to 2021 at four teaching hospitals affiliated with Sabzevar University of Medical Sciences, Iran. Qualitative and quantitative face and content validity, and construct validity methods were used for the validity evaluation. Stability and internal consistency methods were used, respectively, for the reliability evaluation of the questionnaire. Exploratory Factor Analysis (EFA) stage, 264 students studying in the fields of nursing, midwifery, anesthesiology, operating room, emergency medicine, and laboratory sciences completed the P-MCTQ. The value of scale-content validity index (0.92) is indicative of the overall content validity of the questionnaire. EFA extracted a single-factor structure that could explain the overall variance of the clinical education structure at about 76.61%. The alfa and intraclass correlation values were equal to 0.98 and 0.82, respectively, indicating the excellent internal consistency and high overall stability of the questionnaire. The P-MCTQ is a valid and reliable tool for the evaluation of the teaching performance of clinical instructors.

The Impact of Clinical Teacher: The Dental Students' Perception

Aims: This study aims to evaluate the impact of the clinical teachers and the effectiveness of their supervisory skills in clinical settings from the dental students’ perception using the cognitive apprenticeship model. Materials and Methods: A total of 273 undergraduate clinical dental students, from Faculty of Dentistry UiTM, were asked to complete the modified and validated Maastricht Clinical Teaching Questionnaire (MCTQ) which consists of twenty-seven questions distributed on seven domains: Modelling, Coaching, Scaffolding, Articulation, Reflection, Exploration and General Learning Environment. The responses were descriptively analysed. Results: The clinical experience of 162 dental students, who responded, was evaluated. Overall, the students conveyed positive and neutral perceptions of their clinical experience in all criteria of the seven domains. Articulation domain showed the highest positive feedback (93.5%) while the general learning environment domain showed the highest negative feedback (28.1%). Conclusions: The clinical experience and the impact of the clinical teachers were mostly satisfactory. Further improvements of the clinical environment can be achieved regarding the areas of concern.

Clinical supervision: What do the supervisors and residents think?

Objectives: To assess the clinical supervisors’ performance in the workplace as perceived by themselves and their trainees to determine their educational needs. Study Design: Multisite Descriptive Cross-sectional. Setting: Department of Medicine, Surgery and Dentistry at Nine Public and Private Teaching Hospitals of Rawalpindi/Islamabad. Period: 1st March 2018 till 31st January 2019. Material & Methods: Data were collected from clinical supervisors and their trainees using modified Maastricht Clinical Teaching Questionnaire (mMCTQ) to assess clinical supervisors’ modelling, coaching, scaffolding, articulation, Reflection, exploration, and learning climate for trainees’ clinical practice. Descriptive and inferential statistics were calculated using SPSS v.23. Results: A total of 37 supervisors and 135 trainees participated in the study. The overall agreement was low on observing multiple trainee-patient encounters (Mean=3.64±1.17; 3.24±1.10), delivering effective feedback (Mean=3.89±0.91; 3.60±1.04), discussing rationale for trainees’ actions (Mean=3.92±0.69; 3.65±0.97) and consistently demonstrating clinical tasks (Mean=3.97±0.87; 3.46±0.79). The trainees significantly (p<0.05) differed from their supervisors’ perceptions in their supervisors’ abilities to help them become aware of the gaps in their knowledge and skills, ask and also encourage questions, and adjust teaching activities to reach the trainees level of experience. Conclusion: The study highlighted multiple issues with supervision regarding observation of trainee-patient encounters, deliver effective feedback, and demonstrate clinical tasks. The agreement of trainees on their supervisors’ educational abilities is lower than that of supervisors. There is a need for structured training with protected time for clinical supervision.

Improved cognitive apprenticeship clinical teaching after a faculty development program.

While it is well known that the cognitive apprenticeship is an effective workplace-based teaching approach for clinical teachers, the effects of faculty development (FD) have not been analyzed from that perspective. The purpose of this study was to investigate self-assessment by clinical teachers of their educational perceptions and behaviors after a FD program using the cognitive apprenticeship model. Board-certified pediatricians who participated in a 3-day FD program on practical clinical teaching were asked to complete questionnaires. Fifty participants completed two questionnaires prior to and 3 and 6months after the FD program: the first was on the participants' general perceptions and behaviors in relation to their own clinical education and the second was a self-assessment using the Maastricht Clinical Teaching Questionnaire (MCTQ) that was developed based on the cognitive apprenticeship model. The general survey demonstrated that 78% of the participants experienced positive changes in their educational perceptions 6months after FD. Self-assessment using the MCTQ showed that the scores in the categories of "articulation," "exploration," and "safe learning environment" remained significantly improved 6months after the FD program. The participants' self-perceived improvement in behaviors was sustainable for 6months after participation the FD program. The results of the MCTQ show that through their experiences in the FD program, the participants seemingly transformed their clinical teaching to become interactive facilitators, encouraging self-directed learning. Our results also suggest that the MCTQ can be used for self-assessment of clinical teachers and to enhance the effectiveness of the FD program.

Perceptions of Clinical Supervision in Ambulatory Settings: Do Supervisee and Supervisors See Eye to Eye?

Introduction: Given the shortage of primary care physicians, faculties of medicine have been seeking ways to encourage medical students to opt for family medicine as their career choice. The Faculty of Medicine in Geneva decided to incorporate a mandatory one-month rotation during clerkship in a primary care physician’s private office. Such a learning environment offers a privileged opportunity for the student but represents a considerable challenge for clinical teachers. With the goal of identifying training priorities, we sought to investigate the differences in perception of clinical supervision held by clinical teachers and by students. Methods: Cognitive apprenticeship is a well-established theoretical framework for studies on clinical supervision. The Maastricht Clinical Teaching Questionnaire, based on this theory, measures five dimensions of clinical supervision. We used this validated questionnaire to compare student assessment and supervisor self-assessment of the clinical supervision. A total of 275 students over two years assessed their clinical supervision experience provided by a group of 128 clinical supervisors. This hierarchical configuration of the collected data (students were grouped according to the supervisor they had assessed) implied using a linear mixed-effects model approach to assess the significance of observed scores. Results: The results clearly show that students consistently scored their supervisor higher on all five dimensions than the supervisors did themselves. Although it appears that students and supervisors do not focus on the same issues pertaining to clinical supervision, and student expectations might not coincide with supervisors’, the fact remains that they both experience the tasks described in each of the five dimensions together. Conclusion: The results of our study point to some improvements to the training of clinical supervisors.

Evaluating the Reliability and Validity of the Maastricht Clinical Teaching Questionnaire in Bahrain.

ObjectivesThe Maastricht Clinical Teaching Questionnaire (MCTQ) was developed to evaluate clinical teachers’ supervisory skills during undergraduate clinical rotations. Evidence exists supporting the reliability and validity of this questionnaire. Our study sought to examine the reliability and validity of the MCTQ in a Middle Eastern context.MethodsBetween 2016 and 2017, we evaluated a total of 549 medical students in their final year who were undergoing clinical rotations using the MCTQ. The construct validity was assessed using exploratory and confirmatory factor analysis. Internal consistency reliability was measured using Cronbach’s alpha. Factor scores were compared with other outcomes to explore the relationship with other relevant variables.ResultsA four-factor model demonstrated an adequate fit with the data. The findings showed good internal consistency reliability. The following results were obtained for the four-factor model: chi-square divided by degrees of freedom was 5.026, and the comparative index, goodness of fit index, normalized fit index, and non-normalized fit index were all above 0.800 (0.955, 0.858, 0.950, and 0.952, respectively). The standardized root mean square residual was 0.016, and the root mean square error of approximation score was 0.086. Acceptable reliability was achieved with 10 evaluations per teacher. We observed a strong correlation between factors and overall judgment.ConclusionsOur study suggests that the MCTQ is a valid and reliable instrument to evaluate teachers’ performance during clinical rotations in Bahrain.

Transcultural validation of the Maastricht Clinical Teaching Questionnaire.

The evaluation of the clinical teacher's performance provides feedback to motivate them to improve their teaching skills. To perform the cross-cultural adaptation of the Maastricht Clinical Teaching Questionnaire, the International Guide for the Adaptation of the Questionnaires was followed. The validity of content, response process, construct and reliability were investigated. After cross-cultural adaption, residents of two University hospitals evaluated 187 clinical teachers. Content and answering process were validated. In the confirmatory factor analysis, all indexes and criteria for a good fit suited the 5 factors and 14 items model. The Cronbach's alpha coefficient was 0.80. The G coefficient was > 0.70, with low variance of the absolute error. Every clinical teacher should receive at least 6 evaluations to achieve a reliable evaluation of every domain and of their global performance. The Spanish version of the questionnaire is a valid, reliable instrument for medical residents to evaluate teachers.

Assessing Preceptor Use of Cognitive Apprenticeship: Is the Maastricht Clinical Teaching Questionnaire (MCTQ) a Useful Approach?

Construct: The authors investigated the utility of the Maastricht Clinical Teaching Questionnaire (MCTQ) to assess preceptor use of cognitive apprenticeship teaching methods. Background: The MCTQ is an instrument first studied in medical and veterinary education; it was shown to produce valid and reliable data when evaluating how well preceptors engage in cognitive apprenticeship. Additional validity evidence, however, is needed to determine if the MCTQ is useful and applicable in other healthcare professions, such as pharmacy. Approach: Student pharmacists and pharmacy residents at a large academic medical center completed the MCTQ to evaluate pharmacist preceptors. A confirmatory factor analysis (CFA) was used to determine how consistent the data were with the 5-factor structure of the cognitive apprenticeship teaching methods (e.g., modeling, coaching, articulation, exploration, and safe learning environment). A structural equation model (SEM) was used to evaluate the relationship between the 5 factors. Preceptor and student perceptions were also collected to evaluate the response process and potential consequences of using the instrument. Results: Thirty-eight learners (2nd-year and 4th-year student pharmacists and pharmacy residents) submitted 157 evaluations. The CFA showed appreciable fit with the 5-factor structure of the cognitive apprenticeship framework after 2 modifications (removal of 1 item and moving 1 item to a different factor). The SEM had poor model fit compared to previous studies, and an exploratory analysis suggests that there is a complex relationship between the various teaching methods. Preceptors and students highly agreed that the instrument was valuable for providing feedback. Conclusion: The MCTQ has additional validity evidence that supports it as a viable instrument to assess preceptor engagement in teaching methods consistent with the cognitive apprenticeship framework. Additional research is warranted to explore the relationship between components in the cognitive apprenticeship framework to determine how preceptors can best focus their efforts to improve clinical teaching.

RESIDENT AS TEACHER IN CLERKSHIP: STUDENTS’ AND RESIDENTS’ PERCEPTION

Background: Resident has a significant role and time allocation as a clinical teacher in the learning process of medical students at the clerkship stage in clinical settings. Unfortunately, residents were often not formally asked to be involved in the teaching process. Residents’ role in medical students’ learning process in clerkship is still ill defined. The aim of this study was to explore the perceptions of resident and medical students on residents’ role as a teacher in clerkship using cognitive apprenticeship model.Methods: This study used quantitative descriptive, cross sectional design. Samples taken with total sampling were 153 students (68.3%) and 214 resident (60.6%) of the total population. Respondents were asked to fill The Maastricht Clinical Teaching Questionnaire (MCTQ), and the results were analyzed using ANOVA and independent t-test.Results: Results of quantitative analysis showed a difference of perception between students and residents in modeling (p = 0.008) and overall performance (p = 0.002) factor, in which students placed a higher point than the resident. These results were consistently found in three departments. While in three other, students gave a lower point than the resident. In addition, differences also found in the exploration factor based on residents’ study period and residents’ preferences for teaching.Conclusion: Residents’ role as a clinical teacher in clerkship is very important, especially as a role model for students. Taking into account of time allocations spent between students and the residents, improvement and optimalization of residents’ role as a clinical teacher appears to be an important requirement.

What should we teach the teachers? Identifying the learning priorities of clinical supervisors.

Clinicians who teach are essential for the health workforce but require faculty development to improve their educational skills. Curricula for faculty development programs are often based on expert frameworks without consideration of the learning priorities as defined by clinical supervisors themselves. We sought to inform these curricula by highlighting clinical supervisors own requirements through answering the research question: what do clinical supervisors identify as relative strengths and areas for improvement in their teaching practice? This mixed methods study employed a modified version of the Maastricht Clinical Teaching Questionnaire (mMCTQ) which included free-text reflections. Descriptive statistics were calculated and content analysis was conducted on textual comments. 481 (49%) of 978 clinical supervisors submitted their mMCTQs and associated reflections for the research study. Clinical supervisors self-identified relatively strong capability with interpersonal skills or attributes and indicated least capability with assisting learners to explore strengths, weaknesses and learning goals. The qualitative category 'establishing relationships' was the most reported strength with 224 responses. The qualitative category 'feedback' was the most reported area for improvement, with 151 responses. Key areas for curricular focus include: improving feedback practices; stimulating reflective and agentic learning; and managing the logistics of a clinical education environment. Clinical supervisors' self-identified needs provide a foundation for designing engaging and relevant faculty development programs.

Clinical teaching and supervision in postgraduate psychiatry training: the trainee perspective.

We aimed to explore psychiatry trainees' perspectives on clinical teaching and supervision as well as how this might be improved. New Zealand trainees ( n=51) completed online the Maastricht Clinical Teaching Questionnaire (MCQT) and three open-ended questions. The majority rated 'agree' or 'strongly agree' to all items of the MCQT. Weaknesses in the feedback process including observation, feedback provision, and formulating learning goals were highlighted. College training requirements and workplace environment were identified as factors impacting on clinical teaching and supervision. A model was proposed to enhance awareness of the various factors involved in the feedback process.

Understanding how residents' preferences for supervisory methods change throughout residency training: a mixed-methods study.

BackgroundA major challenge for clinical supervisors is to encourage their residents to be independent without jeopardising patient safety. Residents’ preferences according to level of training on this regard have not been completely explored. This study has sought to investigate which teaching methods of the Cognitive Apprenticeship (CA) model junior, intermediate and senior residents preferred and why, and how these preferences differed between groups.MethodsWe invited 301 residents of all residency programmes of Javeriana University, Bogotá, Colombia, to participate. Each resident was asked to complete a Maastricht Clinical Teaching Questionnaire (MCTQ), which, being based on the teaching methods of CA, asked residents to rate the importance to their learning of each teaching method and to indicate which of these they preferred the most and why.ResultsA total of 215 residents (71 %) completed the questionnaire. All concurred that all CA teaching methods were important or very important to their learning, regardless of their level of training. However, the reasons for their preferences clearly differed between groups: junior and intermediate residents preferred teaching methods that were more supervisor-directed, such as modelling and coaching, whereas senior residents preferred teaching methods that were more resident-directed, such as exploration and articulation.ConclusionsThe results indicate that clinical supervision (CS) should accommodate to residents’ varying degrees of development by attuning the configuration of CA teaching methods to each level of residency training. This configuration should initially vest more power in the supervisor, and gradually let the resident take charge, without ever discontinuing CS.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0462-7) contains supplementary material, which is available to authorized users.

Beliefs, identities and educational practice: a Q methodology study of general practice supervisors

Quality of supervisory practices varies. According to the integrative model of behaviour prediction, supervisors' beliefs may influence practice. This study aimed to examine the belief profiles of general practice supervisors, and their potential relationship with supervisory practice. A cross-sectional study was conducted using Q-methodology to explore supervisors' beliefs and the Maastricht Clinical Teaching Questionnaire to measure self-reported supervisory practice. One-hundred and thirty-nine supervisors took part (76%). The most common belief profile (36.7%) comprised a proactive view of supervisors' roles, strong self-efficacy beliefs and awareness of university norms. It revealed merged identities as clinicians and teachers. The second profile (18.0%) included a belief that supervision essentially involved sharing one's experience, uncertainty about the impact of supervision and about university norms. This profile was consistent with a pre-eminence of supervisors' identities as clinicians. Supervisors with merged identities were more likely to have more experience as supervisors and to engage in other teaching activities. Differences in self-reported supervisory practice were observed but did not reach statistical significance (P = 0.053). Supervisors' beliefs reveal differences in the way they manage their multiple professional identities. Further research should be conducted into whether these differences are developmental and if so how development occurs.

Evaluating clinical teachers with the Maastricht clinical teaching questionnaire: How much ‘teacher’ is in student ratings?

Background: Students are a popular source of data to evaluate the performance of clinical teachers. Instruments to obtain student evaluations must have proven validity. One aspect of validity that often remains underexposed is the possibility of effects of between-student differences and teacher and student characteristics not directly related to teaching performance.Aim: The authors examined the occurrence of such effects, using multilevel analysis to analyse data from the Maastricht clinical teaching questionnaire (MCTQ), a validated evaluation instrument, in a veterinary curriculum.Methods: The 15-item MCTQ covers five domains. The authors used multilevel analysis to divide the variance in the domain scores in components related to, respectively, teachers and students. They estimated subsequent models to explore how the MCTQ scores are dependent on teacher and student characteristics.Results: Significant amounts of variance in student ratings were due to between-teacher differences, particularly for learning climate, modelling and coaching. The effects of teacher and student characteristics were mostly non-significant or small.Conclusion: Large portions of variance in MCTQ scores were due to differences between teachers, while the contribution of student and teacher characteristics was negligible. The results support the validity of student ratings obtained with the MCTQ for evaluating teacher performance.

Exploring the validity and reliability of a questionnaire for evaluating veterinary clinical teachers’ supervisory skills during clinical rotations

Background: Feedback to aid teachers in improving their teaching requires validated evaluation instruments. When implementing an evaluation instrument in a different context, it is important to collect validity evidence from multiple sources.Aim: We examined the validity and reliability of the Maastricht Clinical Teaching Questionnaire (MCTQ) as an instrument to evaluate individual clinical teachers during short clinical rotations in veterinary education.Methods: We examined four sources of validity evidence: (1) Content was examined based on theory of effective learning. (2) Response process was explored in a pilot study. (3) Internal structure was assessed by confirmatory factor analysis using 1086 student evaluations and reliability was examined utilizing generalizability analysis. (4) Relations with other relevant variables were examined by comparing factor scores with other outcomes.Results: Content validity was supported by theory underlying the cognitive apprenticeship model on which the instrument is based. The pilot study resulted in an additional question about supervision time. A five-factor model showed a good fit with the data. Acceptable reliability was achievable with 10–12 questionnaires per teacher. Correlations between the factors and overall teacher judgement were strong.Conclusions: The MCTQ appears to be a valid and reliable instrument to evaluate clinical teachers’ performance during short rotations.

The Maastricht Clinical Teaching Questionnaire (MCTQ) as a Valid and Reliable Instrument for the Evaluation of Clinical Teachers

Clinical teaching's importance in the medical curriculum has led to increased interest in its evaluation. Instruments for evaluating clinical teaching must be theory based, reliable, and valid. The Maastricht Clinical Teaching Questionnaire (MCTQ), based on the theoretical constructs of cognitive apprenticeship, elicits evaluations of individual clinical teachers' performance at the workplace. The authors investigated its construct validity and reliability, and they used the underlying factors to test a causal model representing effective clinical teaching. Between March 2007 and December 2008, the authors asked students who had completed clerkship rotations in different departments of two teaching hospitals to use the MCTQ to evaluate their clinical teachers. To establish construct validity, the authors performed a confirmatory factor analysis of the evaluation data, and they estimated reliability by calculating the generalizability coefficient and standard error measurement. Finally, to test a model of the factors, they fitted a structural linear model to the data. Confirmatory factor analysis yielded a five-factor model which fit the data well. Generalizability studies indicated that 7 to 10 student ratings can produce reliable ratings of individual teachers. The hypothesized structural linear model underlined the central roles played by modeling and coaching (mediated by articulation). The MCTQ is a valid and reliable evaluation instrument, thereby demonstrating the usefulness of the cognitive apprenticeship concept for clinical teaching during clerkships. Furthermore, a valuable model of clinical teaching emerged, highlighting modeling, coaching, and stimulating students' articulation and exploration as crucial to effective teaching at the clinical workplace.