Can case-based discussions in a group setting be used to assess residents' clinical skills?
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ABSTRACT: Objectives
The purpose of this study was to explore residents' and assessors' perception of a new group assessment concept.Methods
This qualitative study consists of observations of four group assessment sessions, followed by semi-structured interviews with six residents and four assessors (specialists in internal medicine), who all volunteered to be interviewed. All residents at a medical department (eleven to fifteen each time) and four assessors participated in four group assessments, where the residents' clinical skills were assessed through case-based discussions. An external consultant (an anthropologist) performed the observations and the interviews. Notes from the observations and the interviews were analyzed using an inductive approach.Results
Eight of the ten interviewed participants preferred group assessment to individual assessment. Results from the interviews suggested that the group assessments were more consistent and that the level of discussion was perceived to be higher in the group discussions compared to the one-to-one discussions. All residents indicated that they had acquired new knowledge during their assessment and reported having learned from listening to the assessment of their peers. Assessors similarly reported gaining new knowledge.Conclusions
The residents and assessors expressed very favourable attitudes toward the new group assessment concept. The assessment process was perceived to be higher in quality and more consistent, contributing to learning for all participating doctors in the department. Group assessment is feasible and acceptable, and provides a promising tool for assessment of clinical skills in the future.
SUBMITTER: Johansen RF
PROVIDER: S-EPMC8411343 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:OBJECTIVE:Fostering clinical reasoning is a mainstay of medical education. Based on the clinicopathological conferences, we propose a case-based peer teaching approach called clinical case discussions (CCDs) to promote the respective skills in medical students. This study compares the effectiveness of different CCD formats with varying degrees of social interaction in fostering clinical reasoning. DESIGN, SETTING, PARTICIPANTS:A single-centre randomised controlled trial with a parallel design was conducted at a German university. Study participants (N=106) were stratified and tested regarding their clinical reasoning skills right after CCD participation and 2 weeks later. INTERVENTION:Participants worked within a live discussion group (Live-CCD), a group watching recordings of the live discussions (Video-CCD) or a group working with printed cases (Paper-Cases). The presentation of case information followed an admission-discussion-summary sequence. PRIMARY AND SECONDARY OUTCOME MEASURES:Clinical reasoning skills were measured with a knowledge application test addressing the students' conceptual, strategic and conditional knowledge. Additionally, subjective learning outcomes were assessed. RESULTS:With respect to learning outcomes, the Live-CCD group displayed the best results, followed by Video-CCD and Paper-Cases, F(2,87)=27.07, p<0.001, partial η2=0.384. No difference was found between Live-CCD and Video-CCD groups in the delayed post-test; however, both outperformed the Paper-Cases group, F(2,87)=30.91, p<0.001, partial η2=0.415. Regarding subjective learning outcomes, the Live-CCD received significantly better ratings than the other formats, F(2,85)=13.16, p<0.001, partial η2=0.236. CONCLUSIONS:This study demonstrates that the CCD approach is an effective and sustainable clinical reasoning teaching resource for medical students. Subjective learning outcomes underline the importance of learner (inter)activity in the acquisition of clinical reasoning skills in the context of case-based learning. Higher efficacy of more interactive formats can be attributed to positive effects of collaborative learning. Future research should investigate how the Live-CCD format can further be improved and how video-based CCDs can be enhanced through instructional support.
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Project description:Past research on group work has primarily focused on promoting change through implementation of interventions designed to increase performance. Recently, however, education researchers have called for more descriptive analyses of group interactions. Through detailed qualitative analysis of recorded discussions, we studied the natural interactions of students during group work in the context of a biology laboratory course. We analyzed multiple interactions of 30 different groups as well as data from each of the 91 individual participants to characterize the ways students engage in discussion and how group dynamics promote or prevent meaningful discussion. Using a set of codes describing 15 unique behaviors, we determined that the most common behavior seen in student dialogue was analyzing data, followed by recalling information and repeating ideas. We also classified students into one of 10 different roles for each discussion, determined by their most common behaviors. We found that, although students cooperated with one another by exchanging information, they less frequently fully collaborated to explain their conclusions through the exchange of reasoning. Within this context, these findings show that students working in groups generally choose specific roles during discussions and focus on data analysis rather than constructing logical reasoning chains to explain their conclusions.
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Project description:BackgroundEmotion regulation difficulties appear to play a role in the development and maintenance of several eating disorders. This pilot study aimed at examining whether a short add-on group skills training in emotion regulation for young adults with different eating disorders was feasible in a psychiatric clinical setting. We also investigated if the treatment increased knowledge of emotions, and decreased self-reported difficulties with emotion regulation, alexithymia, symptoms of eating disorder, anxiety and depression, as well as clinical impairment.MethodsSix skills training groups were piloted with a total of 29 participants (M = 21.41 years, SD = 1.92). The treatment consisted of five sessions dealing with psychoeducation about emotions and emotion regulation skills training. Paired samples t-test was used to compare differences between before-and-after measures.ResultsThe primary outcomes measures difficulties in emotion regulation (p < 0.001) and alexithymia (p < 0.001) showed significant improvement after treatment. The total eating disorder score (p = 0.009) was also significantly reduced, as was clinical impairment (p < 0.001). Acceptance/valued direction, identifying primary emotions and learning about secondary emotions was rated as especially helpful.ConclusionsThis preliminary pilot study showed that group training targeting emotion regulation skills was feasible and appreciated by participants, as well as being potentially promising as an adjunctive treatment for different eating disorders. Further controlled studies are needed.Trial registrationThe study was retrospectively registered NCT04148014 on October 30th 2019.
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Project description:Take Home Message Formal training in evidence-based medicine is lacking in most urology residency programs. Perceptions of and attitudes to evidence-based medicine are very positive among European urology residents. Background Evidence-based medicine (EBM) was introduced as a concept in the early 1990s as an integration of the best available evidence with clinical expertise and patient values. Objective To evaluate the current status of EBM training and EBM perception, attitudes, and self-perceived skills among European urology residents. Design, setting, and participants Our online open survey comprised 28 multiple-choice items, including ten questions with responses on a five-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree. The survey was distributed via the mailing lists and social media accounts of the European Society of Residents in Urology, German Society of Residents in Urology, French Society of Urologists in Training, Spanish Urology Residents Working Group, Italian Society of Residents in Urology, and the Urology Social Media Working Group in two rounds (May–July 2019 and July 2020). We excluded responses from non-European countries. Outcome measurements and statistical analysis The online open survey comprised 28 multiple-choice items. These included ten questions with answers on a five-point Likert scale with response items ranging from strongly disagree (score of 1) to strongly agree (score of 5). Results and limitations We received 210 responses, of which 181 from 23 European countries were eligible. Approximately three-quarters (73.7%) of the respondents were male, with a mean age of 31 yr. Only 28.2% reported EBM training as part of their urology curriculum and 19.3% felt that the training they received was sufficient to guide their daily practice. An overwhelming majority (91.5%) stated that they would be interested in more formalized EBM training or additional training. There was a strong level of agreement (median score 5, interquartile range 4–5) that EBM is important for daily medical and surgical practice and that it improves patient care. Overall, the mean self-perceived understanding of basic EBM concepts was good. Limitations include concerns about generalizability given its internet-based format, the inability to calculate a response rate, poor representation from some European regions, and limited sample size. Conclusions Our survey suggests that European urology residents receive a limited amount of EBM training despite considerable appreciation, interest, and self-perceived deficits for more advanced concepts. Formal integration of EBM teaching in all European residency programs should be considered. Patient summary We performed an online survey of urology residents in Europe. We found that residents have positive perceptions of and attitudes to evidence-based medicine but most programs lack formal training in this area.
| S-EPMC9637704 | biostudies-literature
Project description:BackgroundNusinersen is one of an increasing number of new, expensive orphan drugs to receive authorization. These drugs strain public healthcare budgets and challenge principles for resource allocation. Nusinersen was introduced in the Norwegian public healthcare system in 2018. A national expert group consisting of physicians was formed to oversee the introduction and continuation of treatment in light of specific start and stop criteria.MethodsWe have studied experiences within the expert group with a special emphasis on their application of the start and stop criteria, rationing of treatment, and experienced moral dilemmas. A research interview with six members of the national expert group was performed, then analysed with manifest content analysis. The analysis was supplemented with publically available sources on priority setting and the process leading up to the introduction of nusinersen and the establishment of the expert group.ResultsSixty-six patients have received treatment within the first 25 months since the national expert group's establishment. Treatment has not been discontinued for any patient. No patients under 18 years of age have been denied treatment, as those who were referred at this age were all deemed to fulfill the start criteria. The expert group has, however, increased geographical treatment equity and facilitated important cooperation at the national level. Furthermore, it has enhanced open and critical discussions of both medical issues and new ethical dilemmas.ConclusionAlthough facilitating equal access to treatment for SMA patients, the national expert group has not discontinued treatment for any patient. It is suggested that in order for clinicians to be able to ration care for individual patients, they require both adequate support and sufficient formal authority. Start and stop criteria need to be re-evaluated as more knowledge and experience are gained regarding the treatment.
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