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The Consultation Observed Simulated Clinical Experience: Training, Assessment, and Feedback for Incoming Interns on Requesting Consultations.

ABSTRACT: PROBLEM:Formal education in requesting consultations is inconsistent in medical education. To address this gap, the authors developed the Consultation Observed Simulated Clinical Experience (COSCE), a simulation-based curriculum for interns using Kessler and colleagues' 5Cs of Consultation model to teach and assess consultation communication skills. APPROACH:In June 2016, 127 interns entering 12 University of Chicago Medicine residency programs participated in the COSCE pilot. The COSCE featured an online training module on the 5Cs and an in-person simulated consultation. Using specialty-specific patient cases, interns requested telephone consultations from faculty, who evaluated their performance using validated checklists. Interns were surveyed on their preparedness to request consultations before and after the module and after the simulation. Subspecialty fellows serving as consultants were surveyed regarding consultation quality before and after the COSCE. OUTCOMES:After completing the online module, 84% of interns (103/122) were prepared to request consultations compared with 52% (63/122) at baseline (P < .01). After the COSCE, 96% (122/127) were prepared to request consultations (P < .01). Neither preparedness nor simulation performance differed by prior experience or training. Over 90% (115/127) indicated they would recommend the COSCE for future interns. More consultants described residents as prepared to request consultations after the COSCE (54%; 21/39) than before (27%; 11/41, P = .01). NEXT STEPS:The COSCE was well received and effective for preparing entering interns with varying experience and training to request consultations. Future work will emphasize consultation communication specific to training environments and evaluate skills via direct observation of clinical performance.

SUBMITTER: Martin SK

PROVIDER: S-EPMC6265083 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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The Consultation Observed Simulated Clinical Experience: Training, Assessment, and Feedback for Incoming Interns on Requesting Consultations.

Martin Shannon K SK Carter Keme K Hellermann Noah N Glick Laura R LR Ngooi Samantha S Kachman Marika M Farnan Jeanne M JM Arora Vineet M VM

Academic medicine : journal of the Association of American Medical Colleges 20181201 12

<h4>Problem</h4>Formal education in requesting consultations is inconsistent in medical education. To address this gap, the authors developed the Consultation Observed Simulated Clinical Experience (COSCE), a simulation-based curriculum for interns using Kessler and colleagues' 5Cs of Consultation model to teach and assess consultation communication skills.<h4>Approach</h4>In June 2016, 127 interns entering 12 University of Chicago Medicine residency programs participated in the COSCE pilot. The ...[more]

PMID: 29923893

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Project description:PURPOSE:According to the entrustable professional activities (EPA) for entering residency by the Association of American Medical Colleges, incoming residents are expected to independently obtain informed consent for procedures they are likely to perform. This requires residents to not only inform their patients but to ensure comprehension of that information. We assessed the communication skills demonstrated by 372 incoming pediatric interns between 2007 and 2018 at the University of Texas Health Science Center at Houston, obtaining informed consent for a lumbar puncture. METHODS:During a simulated case in which interns were tasked with obtaining informed consent for a lumbar puncture, a standardized patient evaluated interns by rating 7 communication-based survey items using 5-point Likert scale from “poor” to “excellent.” We then converted the scale to a numerical system and calculated intern proficiency scores (sum of ratings for each resident) and average item performance (average item rating across all interns). RESULTS:Interns received an average rating of 21.6 per 28 maximum score, of which 227 interns (61.0%) achieved proficiency by scoring 21 or better. Notable differences were observed when comparing groups before and after EPA implementation (76.97% vs. 47.0% proficient, respectively). Item-level analysis showed that interns struggled most to conduct the encounter in a warm and friendly manner and encourage patients to ask questions (average ratings of 2.97/4 and 2.98/4, respectively). Interns excelled at treating the patient with respect and actively listening to questions (average ratings of 3.16, each). Both average intern proficiency scores and each average item ratings were significantly lower following EPA implementation (P<0.001). CONCLUSION:Interns demonstrated moderate proficiency in communicating informed consent, though clear opportunities for improvement exist such as demonstrating warmth and encouraging questions.

Project description:Introduction:Emergency Medicine is a medical specialty based on knowledge and skills required for the prevention, diagnosis and management of the acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. Addis Ababa University School of Medicine started its Emergency Medicine Residency in 2010 and Emergency Medicine training for fourth-year medical students started in 2013. This study aims to assess attitudes of fifth year medical students towards Emergency Medicine training and its contribution to their final year of medical school training. Methods:Two hundred fifth year medical students participated in the study by convenience sampling. Self-administered questionnaires and Likert scales were used for data collection. Descriptive frequencies and chi-square analysis were done for categorical data. Ethical oversight was provided by the Institutional Review Board of the Addis Ababa University College of Health Sciences. Results:Of the 200 participants, 150 were male and 50 were female. 80% agreed its relevance for undergraduates. Relevance was significantly associated with recommendation to other medical schools (? 2 = 8.34, Pr = 0.004). 72% of respondents agreed lectures are appropriate teaching methods, 70% agreed group activity, 68.5% skill sessions, 67.5% morning discussions, 64% diagnostic session, 60% duty exposures and 45% seminars. Difficulties faced during internship are primarily attributed to lack of facilities, ranging from the setup of the emergency centre to instruments and emergency drugs. 60% of respondents agreed that Emergency Medicine training is important to future careers. 65% agreed recommending training to other medical schools. Conclusion:An Emergency Medicine rotation during the final year of medical school provides opportunities to learn about undifferentiated medical emergencies and it should be included for other medical schools in the country. Participants suggest that leadership aspects of Emergency Medicine need more emphasis as the curriculum is further developed in the future.

Project description:BackgroundHigh-quality chest compression is essential for successful cardiac arrest resuscitation. High-quality cardiopulmonary resuscitation (CPR) can effectively improve the survival rate of patients with cardiopulmonary arrest. However, bystanders untrained in cardiopulmonary resuscitation may provide inadequate chest compressions. Previous studies have shown that the use of feedback devices in training alone or in simulated cardiopulmonary arrest alone can improve cardiopulmonary resuscitation. This study aims to determine whether using an audiovisual feedback (AVF) device during CPR training or a simulated cardiopulmonary arrest (CA) scenario would be more effective in improving the quality of chest compressions (CC).MethodsWe use a prospective, randomized, 2 × 2 factorial design trial. A total of 160 participants from Wuhan University and senior clinical medicine undergraduates who had not participated in any CPR training before and had no actual CPR experience are recruited. Each participant is randomized to 1 of 4 permutations, including AVF device vs. no AVF device during CPR training and AVF device vs. no AVF device during simulated CA. Main outcomes and measures are the depth, the percentage of CCs with correct depth (5-6 cm), the rate of CCs, and the percentage of CCs with the correct rate (100-120 cpm).ResultsThe use of the AVF device during simulated CA resulted in improved CC quality. In CA without AVF device, the average compression depth and the percentage of adequate depth with AVF device are 5.1 cm, 5.0 cm and 55.5%, 56.3%, respectively, which are higher than those without AVF device (4.5 cm, 4.7 cm and 32.8%, 33.6%). (p = 0.011, p = 0.000, both < 0.05).Compared with CA without AVF device, the average compression rate and the percentage of adequate rate with AVF device are 112.3 cpm, 111.2 cpm and 79.4%, 83.1%, respectively. The average compression rate and the percentage of adequate rate without using the AVF device are 112.4 cpm, 110.3 cpm and 71.5%, 68.5%, respectively. (p = 0.567 > 0.05, p = 0.017 < 0.05)Although the average compression rate in group D is slightly lower than that in group C, the percentage of suitable frequency with the feedback device is still higher than that without AVF device.ConclusionUsing a feedback device during simulated cardiopulmonary arrest is more effective in improving cardiopulmonary resuscitation than during training.

Project description:ObjectiveSince many years, teaching and training in communication skills are cornerstones in the medical education curriculum. Although video recording in a real-time consultation is expected to positively contribute to the learning process, research on this topic is scarce. This study will focus on the feasibility and acceptability of video recording during real-time patient encounters performed by general practitioner (GP) trainees.MethodThe primary research question addressed the experiences (defined as feasibility and acceptability) of GP trainees in video-recorded vocational training in a general practice. The second research question addressed the appraisal of this training. The procedure of video-recorded training is developed, refined and validated by the Academic Teaching Practice of Leuven since 1974 (Faculty of Medicine of the University of Leuven). The study is set up as a cross-sectional survey without follow-up. Outcome measures were defined as 'feasibility and acceptability' (experiences of trainees) of the video-recorded training and were approached by a structured questionnaire with the opportunity to add free text comments. The studied sample consisted of all first-phase trainees of the GP Master 2011-2012 at the University of Leuven.ResultsAlmost 70% of the trainees were positive about recording consultations. Nevertheless, over 60% believed that patients felt uncomfortable during the video-recorded encounter. Almost 90% noticed an improvement of own communication skills through the observation and evaluation of. Most students (85%) experienced the logistical issues as major barrier to perform video consultations on a regular base.ConclusionsThis study lays the foundation stone for further exploration of the video training in real-time consultations. Both students and teachers on the field acknowledge that the power of imaging is underestimated in the training of communication and vocational skills. The development of supportive material and protocols will lower thresholds.Practice implicationsTime investment for teachers could be tempered by bringing up students to peer tutors and by an accurate scheduling of the video training. The development of supportive material and protocols will lower thresholds. Further research should finally focus on long-term efficacy and efficiency in terms of learning outcomes and on the facilitation of the technical process.

Dataset Information

The Consultation Observed Simulated Clinical Experience: Training, Assessment, and Feedback for Incoming Interns on Requesting Consultations.

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The Consultation Observed Simulated Clinical Experience: Training, Assessment, and Feedback for Incoming Interns on Requesting Consultations.

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