scholarly journals Development and evaluation of a simulation-based transition to clerkship course

2020 ◽  
Vol 9 (6) ◽  
pp. 379-384
Author(s):  
Jared P. Austin ◽  
Mark Baskerville ◽  
Tracy Bumsted ◽  
Leslie Haedinger ◽  
Stephanie Nonas ◽  
...  
Keyword(s):  
Focus Group ◽  
Learning Environment ◽  
Medical Training ◽  
Clinical Skills ◽  
Professional Activities ◽  
Main Challenge ◽  
Simulation Based ◽  
Competency Based ◽  
Curricular Transformation ◽  
Development Structure

Abstract Background Transition to clerkship courses bridge the curricular gap between preclinical and clinical medical education. However, despite the use of simulation-based teaching techniques in other aspects of medical training, these techniques have not been adequately described in transition courses. We describe the development, structure and evaluation of a simulation-based transition to clerkship course. Approach Beginning in 2012, our institution embarked upon an extensive curricular transformation geared toward competency-based education. As part of this effort, a group of 12 educators designed, developed and implemented a simulation-based transition course. The course curriculum involved seven goals, centered around the 13 Association of American Medical Colleges Core Entrustable Professional Activities for entering residency. Instructional techniques included high-fidelity simulation, and small and large group didactics. Student competency was determined through a simulation-based inpatient-outpatient objective structured clinical examination, with real-time feedback and remediation. The effectiveness of the course was assessed through a mixed methods approach involving pre- and post-course surveys and a focus group. Evaluation Of 166 students, 152 (91.6%) completed both pre- and post-course surveys, and nine students participated in the focus group. Students reported significant improvements in 21 out of 22 course objectives. Qualitative analysis revealed three key themes: learning environment, faculty engagement and collegiality. The main challenge to executing the course was procuring adequate faculty, material and facility resources. Reflection This simulation-based, resource-heavy transition course achieved its educational objectives and provided a safe, supportive learning environment for practicing and refining clinical skills.

scholarly journals Simulation-based otolaryngology – head and neck surgery boot camp: ‘how I do it’

2016 ◽  
Vol 130 (3) ◽  
pp. 284-290 ◽  
Author(s):  
C J Chin ◽  
C A Chin ◽  
K Roth ◽  
B W Rotenberg ◽  
K Fung
Keyword(s):  
Medical Training ◽  
Panel Discussion ◽  
Opportunity To Learn ◽  
Neck Surgery ◽  
Boot Camp ◽  
Simulation Based ◽  
Before And After ◽  
Competency Based ◽  
Set Up ◽  
Main Components

AbstractBackground:In otolaryngology, surgical emergencies can occur at any time. An annual surgical training camp (or ‘boot camp’) offers junior residents from across North America the opportunity to learn and practice these skills in a safe environment. The goals of this study were to describe the set-up and execution of a simulation-based otolaryngology boot camp and to determine participants' confidence in performing routine and emergency on-call procedures in stressful situations before and after the boot camp.Methods:There were three main components of the boot camp: task trainers, simulations and an interactive panel discussion. Surveys were given to participants before and after the boot camp, and their confidence in performing the different tasks was assessed via multiple t-tests.Results:Participants comprised 22 residents from 12 different universities; 10 of these completed both boot camp surveys. Of the nine tasks, the residents reported a significant improvement in confidence levels for six, including surgical airway and orbital haematoma management.Conclusion:An otolaryngology boot camp gives residents the chance to learn and practice emergency skills before encountering the emergencies in everyday practice. Their confidence in multiple skillsets was significantly improved after the boot camp. Given the shift towards competency-based learning in medical training, this study has implications for all surgical and procedural specialties.

scholarly journals Could Entrustable Professional Activities mediate teaching-care integration services in the community?

2020 ◽  
Vol 69 (2) ◽  
Author(s):  
Ieda Francischetti ◽  
José Bitu Moreno ◽  
Harm Peters
Keyword(s):  
Health Care ◽  
Medical Education ◽  
Primary Health Care ◽  
Medical Training ◽  
Entrustable Professional Activities ◽  
Professional Activities ◽  
Care Integration ◽  
Primary Health ◽  
Teaching Community ◽  
Competency Based

Currently, competency-based medical education (CBME) is the most common type of curriculum used worldwide. However, its limitations include fragmented learning and difficulties to use properly the knowledge, skills, and attitudes acquired using this educational model. Having this in mind, Entrustable Professional Activities (EPA) emerge as a tool to mediate the transposition of the competency-based curriculum into physicians’ professional practice in graduate medical education. Therefore, based on a narrative review of the existing literature on EPA and the authors’ experience in teaching community-based healthcare integration services, the aim of this paper is to reflect on the possible use of these activities in undergraduate medical education for the development of a CBME model integrated with primary health care and community medicine. The reflections made here allow suggesting that, although it is a challenging process, the adoption of EPA in undergraduate medical training is appropriate to achieve a better provision of primary health care to individuals, families, and communities in general.

scholarly journals An Updated Primer on Entrustable Professional Activities (EPAs)

2019 ◽  
Vol 43 (1 suppl 1) ◽  
pp. 712-720
Author(s):  
Olle ten Cate
Keyword(s):  
Undergraduate Students ◽  
Medical Training ◽  
Specific Activity ◽  
Two Dimensions ◽  
Entrustable Professional Activities ◽  
Turn Of The Millennium ◽  
Professional Activities ◽  
Competency Based ◽  
Almost All ◽  
Indirect Supervision

ABSTRACT Since the turn of the millennium, competency-based medical education (CBME) has become a new standard for medical training in many countries. CBME has been operationalized in detailed frameworks of competencies that every physician should demonstrate at graduation, and similar frameworks have been created for specialties. However, the competencies, describing qualities that physicians should possess, do not directly translate into everyday activities of physicians. For that reason, the Entrustable Professional Activities (EPAs) were introduced. EPAs are units of professional practice that may be entrusted to undergraduate students, once they show the competencies needed to perform them without supervision. EPAs have become a popular topic within CBME programs in many countries and hundreds of publications within only a few years. This paper was written to introduce the strengths and weaknesses of EPAs. After a brief historical overview, the reason why EPAs are a bridge between a competency framework and daily clinical practice is explained. While competencies are qualities of individuals, EPAs are units of work. The two can be seen as two dimensions of a matrix, showing that almost all activities in health care are based on multiple competencies, such as communication skill, collaboration, professional behavior, content knowledge. Next, entrustment decision-making as a form of assessment is created and a framework of levels of supervision is presented. Entrustment decisions focus on the level of supervision a student requires for a specific activity, divided into five levels (1: allowed to observe; 2; allowed to perform under direct supervision; 3: allowed to perform under indirect supervision; 4: allowed to perform the activity unsupervised; 5: allowed to supervise the activity performed by more junior learners). For readers interested in applying the concept to practice, a stepwise approach to the curriculum development is proposed. The paper concludes with an overview of the state-of-the-art of working with EPAs across disciplines, professions and countries.

scholarly journals Identifying Entrustable Professional Activities in Internal Medicine Training

2013 ◽  
Vol 5 (1) ◽  
pp. 54-59 ◽  
Author(s):  
Karen E. Hauer ◽  
Jeffrey Kohlwes ◽  
Patricia Cornett ◽  
Harry Hollander ◽  
Olle ten Cate ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Content Validity ◽  
Medical Training ◽  
Entrustable Professional Activities ◽  
Internal Medicine Training ◽  
Professional Activities ◽  
Delphi Approach ◽  
Validity Indices ◽  
Competency Based ◽  
Competency Based Assessment

Abstract Background Entrustable professional activities (EPAs) can form the foundation of competency-based assessment in medical training, focused on performance of discipline-specific core clinical activities. Objective To identify EPAs for the Internal Medicine (IM) Educational Milestones to operationalize competency-based assessment of residents using EPAs. Methods We used a modified Delphi approach to conduct a 2-step cross-sectional survey of IM educators at a 3-hospital IM residency program; residents also completed a survey. Participants rated the importance and appropriate year of training to reach competence for 30 proposed IM EPAs. Content validity indices identified essential EPAs. We conducted independent sample t tests to determine IM educator-resident agreement and calculated effect sizes. Finally, we determined the effect of different physician roles on ratings. Results Thirty-six IM educators participated; 22 completed both surveys. Twelve residents participated. Seventeen EPAs had a content validity index of 100%; 10 additional EPAs exceeded 80%. Educators and residents rated the importance of 27 of 30 EPAs similarly. Residents felt that 10 EPAs could be met at least 1 year earlier than educators had specified. Conclusions Internal medicine educators had a stable opinion of EPAs developed through this study, and residents generally agreed. Using this approach, programs could identify EPAs for resident evaluation, building on the initial list created via our study.

scholarly journals Surgery Goes EPA (Entrusted Professional Activity) – How a Strikingly Easy to use App Revolutionizes Assessments of Clinical Skills in Surgical Training

2021 ◽  
Author(s):  
Nadine Diwersi ◽  
Jörn-Markus Gass ◽  
Henning Fischer ◽  
Jürg Metzger ◽  
Matthias Knobe ◽  
...  
Keyword(s):  
Medical Education ◽  
Clinical Skills ◽  
Total Duration ◽  
Professional Activity ◽  
User Friendliness ◽  
Aggregated Data ◽  
Professional Activities ◽  
Competency Based ◽  
User Friendly

Abstract ObjectiveEntrusted Professional Activities (EPAs) are increasingly being used in competency-based medical education approaches. A general lack of time in clinical settings, however, prevents supervisors from providing their trainees with adequate feedback. With a willingness for more administrative tasks being low in both trainees and educators, the authors developed a radical user-friendly mobile application based on the EPA concept called “Surg-prEPAred”.DesignSurg-prEPAred is designed to collect micro-assessment data for building competency profiles for surgical residents according to their curriculum. The goal of Surg-prEPAred is to facilitate the performance and documentation of workplace-based assessments. Through aggregated data the app generates a personalized competency profile for every trainee. During a pilot run of 4 months, followed by ongoing usage of the application with a total duration of 9 months (August 2019 to April 2020), 32 residents and 33 consultants made daily use of the application as a rating tool. Every rating included knowledge, skills and professional attitudes of the trainees. Before the initiation of the App and after the 9-month trial period trainees and supervisors where both sent questionnaires to evaluate the user friendliness and effectiveness of the App. Results510 App based assessments were generated. Out of 40 pre-defined EPAs, 36 were assessed. 15 trainees and 16 supervisors returned the questionnaires and stated the surg-prEPAred App as very valuable, effective and feasible to evaluate trainees in a clinical setting providing residents with an individual competence portfolio to receive precision medical education. ConclusionsThe authors expectation is that the Surg-prEPAred App will contribute to an improvement of quality of medical education and thus to the quality of patient care and safety. In the future the goal is to have the App become an integral part of the official Swiss surgical curriculum accepted by the Swiss professional surgical society.

scholarly journals Detached Concern?: Emotional Socialization in Twenty-First Century Medical Education

2017 ◽  
Author(s):  
Kelly Underman ◽  
Laura Ellen Hirshfield
Keyword(s):  
Medical Education ◽  
Cultural Change ◽  
Medical Training ◽  
Clinical Skills ◽  
Interesting Case ◽  
First Century ◽  
Emotional Socialization ◽  
Patient Health ◽  
Detached Concern ◽  
Curricular Transformation

Early works in medical sociology have been pivotal in the development of scholarly knowledge about emotions, emotional socialization, and empathy within medical training, medical education, and medical contexts. Yet despite major shifts in both medical education and in medicine writ-large, medical sociologists' focus on emotions has largely disappeared. In this paper, we argue that due to recent radical transformations in the medical arena, emotional socialization within medical education should be of renewed interest for sociologists. Developments in medical education such as increased diversity among enrollees, the rise of patient health movements, and curricular transformation have made this context a particularly interesting case for sociologists working on a variety of questions related to structural, organizational, and cultural change. We offer three areas of debate within studies in medical education that sociologists may be interested in studying: 1) gendered and racialized differences in the performance of clinical skills related to emotion, 2) differences in self-reported empathy among subspecialties, and 3) loss of empathy during the third year or clinical year of medical school.

scholarly journals A95 HOW ENDOSCOPY TEACHERS MAKE POLYPECTOMY ENTRUSTMENT DECISIONS IN CLINICAL AND SIMULATION-BASED SETTINGS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 68-70
Author(s):  
T Jeyalingam ◽  
C M Walsh ◽  
W Tavares ◽  
M Mylopoulos ◽  
K Hodwitz ◽  
...  
Keyword(s):  
Colonic Polyps ◽  
Constructivist Grounded Theory ◽  
Endoscopic Polypectomy ◽  
Real Patient ◽  
Clinical Supervisors ◽  
Professional Activities ◽  
University Of Toronto ◽  
Simulation Based ◽  
Procedural Complications ◽  
Competency Based

Abstract Background Entrustment, a central construct in competency-based medical education (CBME), represents the point at which clinical supervisors trust a trainee to perform a task independently. Many implementations of CBME involve assessing entrustment through observation of entrustable professional activities (EPAs). While EPAs are frequently assessed in both clinical and simulation-based settings, research has yet to clarify how faculty who teach endoscopy form judgments of entrustment across these two contexts. Aims We aimed to explore the features that endoscopy teachers report as influencing their entrustment decisions regarding polypectomy across clinical and simulation-based assessment settings. Methods We designed an interview-based, constructivist grounded theory-informed study involving endoscopy teachers and trainees in the University of Toronto gastroenterology residency program. Teachers completed separate EPA assessments of each trainee’s performance of an endoscopic polypectomy (colonic polyps < 1cm, Paris 0-Is or 0-Ip in morphology) in both settings. Teachers were interviewed after each assessment to explore how they made their entrustment decision within and across settings. Transcribed interview data were coded iteratively using constant comparison to generate themes. Results Based on 14 interviews with 7 endoscopy teachers, we found that they: (1) held multiple meanings of entrustment for polypectomy, both within and across participants, (2) expressed variability in how they justified their entrustment decisions, the related narrative, and numerical scoring, (3) held unique personal criteria for making decisions ‘comfortably,’ including authenticity of the task, variability in terms of polyp shape, location, and morphology, as well as the ability to assess trainee response to procedural complications (e.g., post-polypectomy bleeding), and (4) perceived a relative freedom when using simulation to make entrustment decisions due to the absence of a real patient. Conclusions We found that faculty who teach endoscopy defined polypectomy entrustment in a variety of ways, leading to variability in how they judged entrustment within and across trainees and assessment settings. The observed idiosyncrasies suggest gastroenterology competence committees cannot assume equivalence of EPA data obtained from different settings. Furthermore, educators designing faculty development for CBME will need to attend to the criteria that endoscopy teachers report they need to comfortably make entrustment decisions. Funding Agencies Royal College of Physicians and Surgeons of Canada

Assessing competency using simulation: the SimZones approach

2019 ◽  
Vol 6 (5) ◽  
pp. 262-267
Author(s):  
Christopher Roussin ◽  
Taylor Sawyer ◽  
Peter Weinstock
Keyword(s):  
Medical Education ◽  
Medical Training ◽  
System Development ◽  
Real Life ◽  
Competency Assessment ◽  
Competency Based Medical Education ◽  
Simulation Based ◽  
Competency Based ◽  
The Many ◽  
Structured Approach

IntroductionCompetency-based medical education (CBME) is a system of medical training that focuses on a structured approach to developing the clinical abilities of medical education graduates and practicing physicians. CBME requires a robust and multifaceted system of assessment in order to both measure and guide the progress of learners toward pre-established goals. Simulation has been proposed as one method for assessing competency in healthcare workers. However, a longitudinal framework for assessing competency using simulation has not been developed.MethodsConjecture mapping methodology was used to map Miller’s framework for competency assessment—‘knows’, ‘knows how’, ‘shows how’, and ‘does’—to the five SimZones described by Roussin and Weinstock. The SimZones describe a system of organising the development and delivery of simulation-based education and offer a foundation for both guiding and organising assessment in a simulation context.ResultsA conceptualised alignment of the SimZones with Miller’s pyramid of assessment was developed, as well as a detailed conjecture map. SimZone 0 (auto-feedback) and SimZone 1 (foundational instruction) mapped to ‘knows’ and ‘knows how’. SimZone 2 (acute care instruction) mapped to ‘shows how’. SimZone 3 (team and system development) mapped to ‘shows how’. SimZone 4 (real-life debriefing and development) mapped to ‘does’.ConclusionThe SimZones system of competency assessment offers a robust, flexible, and multifaceted system to guide both formative and summative assessment in CBME. The SimZones approach adds to the many methods of competency assessment available to educators. Adding SimZones to the vocabulary of CBME may be helpful for the full deployment of CBME.

scholarly journals Nursing students’ transfer of learning outcomes from simulation-based training to clinical practice: a focus-group study

BMC Nursing ◽  
2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Jørn Hustad ◽  
Berit Johannesen ◽  
Mariann Fossum ◽  
Olav Johannes Hovland
Keyword(s):  
Nursing Education ◽  
Clinical Practice ◽  
Nursing Students ◽  
Focus Group ◽  
Learning Outcomes ◽  
Transfer Of Learning ◽  
Clinical Skills ◽  
Focus Group Interviews ◽  
Simulation Based ◽  
Group Interviews

Abstract Background Simulation-based training is used to develop nursing students’ clinical performance in assessing and managing situations in clinical placements. The use of simulation-based training has increased and become an integrated part of nursing education. The aim of this study was to explore nursing students’ experiences of simulation-based training and how the students perceived the transfer of learning to clinical practice. Methods Eight focus group interviews were conducted with a total of 32 s- and third-year nursing students who participated in a simulation-based training organized as preparation for clinical placement. The transcribed interviews were analysed with thematic analysis. Results Three major themes emerged from the focus group interviews; first, the simulation-based training promoted self-confidence; second, understanding from simulation-based training improved clinical skills and judgements in clinical practice; and third, simulation-based training emphasised the importance of communication and team collaboration. Conclusions This study revealed students’ transfer of learning outcomes from simulation-based training to clinical practice. The students’ experiences of the simulation-based training remain as enduring and conscious learning outcomes throughout their completion of clinical practice. The organisation of simulation-based training and its implementation in the curriculum are crucial for the learning outcomes and for students’ experiences of the transfer of knowledge to clinical practice.

scholarly journals P.179 An International Comparison of Neurosurgical Competence by Design Curriculum

2021 ◽  
Vol 48 (s3) ◽  
pp. S71-S71
Author(s):  
J Rabski ◽  
G Moodie
Keyword(s):  
Medical Training ◽  
Postgraduate Medical Education ◽  
The United States ◽  
Professional Activities ◽  
The United Kingdom ◽  
Competency Frameworks ◽  
Future Challenges ◽  
Regulatory Bodies ◽  
General Program ◽  
Competency Based

Background: Prior to its recent introduction into Canadian neurosurgical curriculum, Competence by Design (CBD) principles have been implemented across many international neurosurgical training programs for several years. As such, comparing other international competency-based educational frameworks and curricula can help anticipate, avoid or mitigate potential future challenges for Canadian neurosurgical trainees. Methods: A comparative web-based analysis of neurosurgical postgraduate medical education documents and resources provided by medical accreditation and regulatory bodies of Canada, the United States, the United Kingdom and Australasia, was performed. Results: All four countries varied considerably across four major curriculum-based themes: 1) general program structure; 2) overarching foundational competency frameworks; 3) types and numbers of performance assessments required and; 4) curricular learning outcomes. In particular, the expected progression and degree of competence required of neurosurgical residents when performing entrustable professional activities (EPAs) or defined tasks of neurosurgical practice, varied across all countries. Differences in types of neurosurgical EPAs and number of required assessments demonstrating a trainee’s competence achievement were also appreciated. Conclusions: This study revealed variations across competency-based neurosurgical curricula proposed by four international medical training regulatory bodies. Differences in types of EPAs and their required degree of competence achievement suggests potential disconnects between neurosurgical educational outcomes and actual medical practice.

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