Dataset Information

Measuring faculty reflection on adverse patient events: development and initial validation of a case-based learning system.

ABSTRACT:

Background

Critical reflection by faculty physicians on adverse patient events is important for changing physician's behaviors. However, there is little research regarding physician reflection on quality improvement (QI).

Objective

To develop and validate a computerized case-based learning system (CBLS) to measure faculty physicians' reflections on adverse patient events.

Design

Prospective validation study.

Participants

Staff physicians in the Department of Medicine at Mayo Clinic Rochester.

Main measures

The CBLS was developed by Mayo Clinic information technology, medical education, and QI specialists. The reflection questionnaire, adapted from a previously validated instrument, contained eight items structured on five-point scales. Three cases, representing actual adverse events, were developed based on the most common error types: systems, medication, and diagnostic. In 2009, all Mayo Clinic hospital medicine, non-interventional cardiology, and pulmonary faculty were invited to participate. Faculty reviewed each case, determined the next management step, rated case generalizability and relevance, and completed the reflection questionnaire. Factor analysis and internal consistency reliability were calculated. Associations between reflection scores and characteristics of faculty and patient cases were determined.

Key results

Forty-four faculty completed 107 case reflections. The CBLS was rated as average to excellent in 95 of 104 (91.3%) completed satisfaction surveys. Factor analysis revealed two levels of reflection: Minimal and High. Internal consistency reliability was very good (overall Cronbach's ?=0.77). Item mean scores ranged from 2.89 to 3.73 on a five-point scale. The overall reflection score was 3.41 (standard deviation 0.64). Reflection scores were positively associated with case generalizability (p=0.001), and case relevance (p=0.02).

Conclusions

The CBLS is a valid method for stratifying faculty physicians' levels of reflection on adverse patient events. Reflection scores are associated with case generalizability and relevance, indicating that reflection improves with pertinent patient encounters. We anticipate that this instrument will be useful in future research on QI among low versus high-reflecting physicians.

SUBMITTER: Wittich CM

PROVIDER: S-EPMC3043183 | biostudies-literature | 2011 Mar

REPOSITORIES: biostudies-literature

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Publications

Measuring faculty reflection on adverse patient events: development and initial validation of a case-based learning system.

Wittich Christopher M CM Lopez-Jimenez Francisco F Decker Lindsay K LK Szostek Jason H JH Mandrekar Jayawant N JN Morgenthaler Timothy I TI Beckman Thomas J TJ

Journal of general internal medicine 20101027 3

<h4>Background</h4>Critical reflection by faculty physicians on adverse patient events is important for changing physician's behaviors. However, there is little research regarding physician reflection on quality improvement (QI).<h4>Objective</h4>To develop and validate a computerized case-based learning system (CBLS) to measure faculty physicians' reflections on adverse patient events.<h4>Design</h4>Prospective validation study.<h4>Participants</h4>Staff physicians in the Department of Medicine ...[more]

PMID: 20978863

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Project description:BACKGROUND:Existing studies have explored many aspects of medical students' experiences of patient death and propose the importance of faculty support for coping. However, UK-based literature on this subject and research concerning learning through reflection as part of coping are relatively limited. This study, through the lens of reflection, aims to explore students' experiences with patient death in a UK context. These include coping strategies, support from faculty following patient death and the relationship between these experiences and learning. Our research questions were: How do medical students cope with and learn from their experiences?How does support from ward staff and the medical school help them cope with and learn from these experiences?How can students best be supported following patient death? METHODS:We employed narrative inquiry to explore how medical students made sense of their experiences of patient death. Twelve students participated in our study via an online narrative questionnaire. Thematic analysis and complementary narrative analysis of an exemplar were applied to address our research aim. RESULTS:Coping strategies comprised internal and external strategies. Internal strategies included (1) re-interpretation of the death into a meaningful experience including lessons learned; (2) normalization; (3) staying busy and (4) enduring negative emotions. External strategies included speaking to someone, which was found to influence normalization, and lessons learned. Both satisfactory and unsatisfactory support from ward staff was identified. Satisfactory support was characterized by the inclusion of emotional and professional support. Unsatisfactory support was often characterized by a lack of emotional support. Narrative analysis further demonstrated how the experience with patient death was re-interpreted meaningfully. Students suggested that support should be structured, active, sensitive, and include peers and near-peers. CONCLUSION:Many coping strategies, internal and external, were employed in students' experiences with patient death. Student reflections, enhanced by support from ward staff, were shown to be important for learning from patient death. We encourage faculty to have regular sessions in which medical students can reflect on the death incident and discuss appropriately with others, including peers and near-peers.

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Dataset Information

Measuring faculty reflection on adverse patient events: development and initial validation of a case-based learning system.

Background

Objective

Design

Participants

Main measures

Key results

Conclusions

Publications

Measuring faculty reflection on adverse patient events: development and initial validation of a case-based learning system.

Similar Datasets

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