Orientation of medical trainees to a new clinical environment (the ready-steady-go model): a constructivist grounded theory study

Background High-quality orientation of trainees entering a new clinical workplace is essential to support education and patient safety. However, few consultants receive extensive formal training to support new trainees and must create their own ways of integrating newcomers into their clinical team and work environment. We aim to conceptualise the strategies consultants use in the early stages of working with new trainees that will be useful for future faculty development in this area. Methods We used constructivist grounded theory (CGT) methodology by interviewing fifteen consultants in three medical specialties, to explore how trainees are integrated into a new clinical environment. We used CGT principles and procedures (iteration, constant comparison, and theoretical sampling) to analyse and construct a conceptual interpretation of the empirical data. Results Consultants’ central concern when introduced to a new cohort of trainees was that they had the required knowledge and skills (ready), were adapted and integrated into the new workplace and clinical team (steady), and safely participating in practice (go). Consultants used two broad strategies: formal orientation and informal orientation. Both these approaches had the common goal of intensifying interaction between consultants and trainees to get trainees to a position where they were ready, adapted, integrated, and participating safely and efficiently in practice. Several disruptors were identified by participants that delayed and sometimes completely inhibited the orientation process. Conclusions The model of orientation constructed through this research could be a valuable tool to support faculty development initiatives, the reflective learning practice of clinical supervisors, and curriculum design. The disruptors were identified as valid priorities for improving trainee orientation in postgraduate medical education. Future research should involve a longitudinal approach to explore trainee engagement with orientation upon entering a new clinical workplace.

PROS AND CONS OF DISTANCE LEARNING FOR MEDICAL STUDENTS UNDER QUARANTINE CONDITIONS

The pandemic of coronavirus disease (COVID-19) had a significant impact on the social life of medical students, which contributed to the active use of distance learning technologies. Distance learning – “a synthetic, integrated humanistic form of learning based on the use of a wide range of traditional and new information technologies and their technical means, which are used to present educational material, its independent study, dialogue between a lecturer and a student, and the learning process, in the general case, is uncritical to their location in space and time, as well as to a specific educational institution. Existing technologies of distance learning through the use of modern digital platforms, high-quality content of educational web resources, the introduction of an effective know­ledge quality control system give us the opportunity to adapt to new realities of the educational process and ensure consistently high quality of postgraduate medical education. This article presents a system of scientific ideas, mechanisms, advantages and disadvantages of distance (remote) learning in medical institution.

Differential attainment: how can we close the gap in paediatrics?

Differential attainment is the gap in attainment between different demographic groups undertaking the same assessment. Across the UK, we see differences in outcome in undergraduate and postgraduate medical education on the basis of gender, age, ethnicity and country of primary medical qualification which cannot be explained by a difference in ability. The largest gaps appear when we look at the variation in outcome between UK and international medical graduates (IMGs) and between white British and black, Asian and minority ethnic (BAME) doctors in postgraduate medical education. If we look to postgraduate medical examinations, the differences in attainment are stark and occur across all medical specialties, with paediatrics being no exception. The differences are also seen in the rates of relative success in recruitment to training posts and in a trainee’s likelihood of getting a satisfactory outcome at the Annual Review of Competence Progression. Ensuring all doctors reach their full potential is undoubtedly an issue of fairness that is of particular significance to paediatrics as IMGs make up 47% of our medical workforce and 36% of the paediatric workforce identifies as being from a BAME group. It is clear that if we fail to close the gap in differential attainment, there will be both a personal cost to affected individuals, but also a cost to the wider paediatric profession and the children they serve. This paper hopes to summarise the background and causes to differential attainment and look towards possible interventions that might tackle this issue.

A modified Delphi approach to enhance nurturing of professionalism in postgraduate medical education in Singapore

Introduction: Nurturing professional identities instils behavioural standards of physicians, in turn facilitating consistent professional attitudes, practice, and patient care. Identities are socioculturally constructed efforts, thus we must account for the social, cultural, and local healthcare factors that shape physicians’ roles, responsibilities and expectations. This study aims to forward a program to nurture professionalism amongst physicians in Singapore. Methods: A 3-phased-evidenced-based-approach was used. First, a systematic scoping review (SSR) was conducted to identify professionalism elements. Second, a questionnaire was created drawing from the SS’s findings. Third, a modified Delphi involving local experts identifying socioculturally appropriate elements to nurture professionalism was conducted. Results: The 124 included articles in the SSR revealed definitions, knowledge, skills, and approaches to nurturing professionalism. The modified Delphi identified professional traits, virtues, communication, ethical, self-care, teaching and assessment methods, and support mechanisms. Conclusion: Results formed the basis to a holistic and longitudinal program focused on instilling professional traits and competencies over time through personalised and holistic support of physicians. Findings will be of interest to medical communities in the region and beyond.

Determinants of research productivity during postgraduate medical education: a structured review

Background Although formal participation in research is an integral and often mandatory component of clinical training programs, resulting productivity is highly variable. The objective of this review was to identify determinants of successful research performance among graduate medical education trainees. Methods A structured review of the published literature was performed by searching PubMed, CINAHL, and EMBASE from inception through to 7 April, 2021. Articles examining graduate medical education trainee research productivity evidenced by publications in peer-reviewed journals were included. Results Eighty-five articles were included of which most (66; 78%) were reported from the USA or Canada (10; 12%). A wide range of disciplines were represented with the most common being general surgery, internal medicine, orthopedic surgery, and pediatrics. Themes (number of reports) included trainee characteristics (n = 24), project characteristics (n = 8), mentoring/supervision (n = 11), and programmatic aspects (n = 57). Although variable results were observed, research productivity tended to be higher with prior research experience, later years of training, male gender, and pursuit of a postgraduate degree. Few project related aspects of success were identified. Trainee publication was associated with mentors with higher rank, publication productivity, and supportive academic environments. Training programs with organised programs/curricula including protection of time for research were associated with increased productivity as were provision of incentives or rewards but not mandatory requirements. Conclusion This review identifies several trainee characteristics, project and mentor aspects, and programmatic aspects associated with increased productivity that may serve as a useful resource for trainees and graduate medical education training programs.

Evaluation of a Quality Improvement Experience for Family Medicine Clerkship Students

Background and Objectives: There is emphasis on systems-based practice competencies and quality improvement (QI) training in postgraduate medical education. However, we lack effective approaches to provide experiences in these areas during undergraduate medical education. To address this, we developed a novel approach to providing didactic and experiential learning experiences in QI during a third-year family medicine clerkship. Methods: We implemented and evaluated a QI curriculum combining self-directed learning with real-world experience to increase knowledge and confidence in the plan-do-study-act (PDSA) process for family medicine clerkship students. Students collaborated and presented their change ideas in a “Shark Tank” format for practice leaders at the end of their rotation. We used pre- and postcurriculum surveys to assess knowledge of and comfort with completing QI projects. Results: Three hundred eighty-nine students completed precurriculum surveys and 242 completed postcurriculum surveys. Pre- and postlearning evaluations revealed an increase in agreement or strong agreement with self-reported understanding of specific QI topic areas of 50%. Almost all (91.3%) reported feeling confident or reasonably confident in their ability to create change in health care after exposure to the curriculum, compared with 66.3% in the precurriculum survey. One-third of students (34%) reported intent to complete the Institute for Healthcare Improvement Open School curriculum in QI. Conclusions: Self-directed learning about QI, combined with practice observation, small-group discussion and presentation in a Shark Tank format was effective and engaging for learners. Students had limited preexisting knowledge of QI principles, suggesting a need for preclinical exposure to this topic. The family medicine clerkship provides an ideal environment for teaching QI.

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

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.

A Survey on the Impact of COVID 19 on Undergraduate and Postgraduate Medical Education in Qatar

BackgroundCOVID-19 pandemic has affected all dimensions of day to day life across the world and medical education was no exception. In Qatar, two institutions provide undergraduate medical education; Qatar University - College of medicine and Weill Cornell Medical College, Qatar and post graduate medical education is provided by tertiary care public hospitals under Hamad Medical Corporation (HMC) through Accreditation Council for Graduate Medical Education -International (ACGME-I) accredited residency and fellowship programs. With this study we aimed to understand the impact of nationwide restrictions on medical education in Qatar.MethodsWe conducted a cross sectional study utilising an online questionnaire between April and October 2020. Two questionnaires for the faculty and trainees each were designed to address the objectives. The questionnaires addressed barriers to delivery of medical education and perceptions on the models of education used.ResultsMajority of trainees (58.5%) responded that the pandemic has adversely affected medical education at both the undergraduate and postgraduate levels. Trainees (58.5%) and faculty (35.7%) reported an increased reliance on e-learning. Trainees preferred face to face education (33.5%) while the faculty (37.1%) preferred a combination of different models of education delivery. Although 52.5% of the faculty had no previous experience of delivering education using e-learning modalities, but 58.9% felt confident in using e-learning software.ConclusionsFaculty and trainees agree that the COVID-19 pandemic has had a significant impact on the provision of medical education and training in Qatar, with an increased dependence on e-learning. As trainee’s prefer face-to-face models of education, we may have to consider restructuring of medical curricula in order to ensure that optimum learning is achieved via e-learning, while at the same time enhancing our use, knowledge and understanding of the e -learning methods as they may be an essential way of delivering education in the future.

‘Exam preparedness’: Exploring non-academic predictors of postgraduate exam success

Introduction: There are certain factors in exam preparedness that are not well studied in the postgraduate medical education context. Non-academic predictors have been extensively researched but usually in isolation. Methods: The study involved a sequential explanatory mixed methods research design. The study was conducted among anaesthesia postgraduates appearing for high-stake nation-wide primary examination. Data obtained by a questionnaire assessing pre-examination attributes were compared with the students’ reflections through focus group discussions (FGD) after the formal declaration of results. The examination had an overall pass rate of 42.9% (18 out of 42). Results: The study showed that pre-examination questionnaire could identify attributes and study behaviours in the postgraduates who passed. Passers procrastinated three times lesser, pursuing a timetable-based study (conscientiousness); had higher metacognitive self-regulation (p value<0.05) applying concentrated self-directed learning & effective group study and higher self-efficacy compared to those who failed. The focus group discussions affirmed of these attributes in candidates who ‘breeze through exams’. Postgraduate success required better ‘work-study’ balance, self & cross regulation and peer and faculty support. Conclusion: Implementing a composite tool to assess ‘exam preparedness’, we propose, would help the learners and teachers to skim for non-academic factors (metacognitive self-regulation, self-efficacy, conscientiousness) that influence the chances of success. Understanding & predicting this would help educators to identify the ‘candidates with difficulty’ and delegate personalised faculty attention. This could guide the exam candidates to have a ‘reality check’ to plan and pace their effort with peer learning, consolidated study and goal orientation.