Biomedical subjects

A J J A Scherpbier

Publications and source records attributed to A J J A Scherpbier.

At least 19 recordsLinked to original sources

PubMed2007

Psychometric properties of an instrument to measure the clinical learning environment.

OBJECTIVES: The clinical learning environment is an influential factor in work-based learning. Evaluation of this environment gives insight into the educational functioning of clinical departments. The Postgraduate Hospital Educational Environment Measure (PHEEM) is an evaluation tool consisting of a validated questionnaire with 3 subscales. In this paper we further investigate the psychometric properties of the PHEEM. We set out to validate the 3 subscales and test the reliability of the PHEEM for both clerks (clinical medical students) and registrars (specialists in training). METHODS: Clerks and registrars from different hospitals and specialties filled out the PHEEM. To investigate the construct validity of the 3 subscales, we used an exploratory factor analysis followed by varimax rotation, and a cluster analysis known as Mokken scale analysis. We estimated the reliability of the questionnaire by means of variance components according to generalisability theory. RESULTS: A total of 256 clerks and 339 registrars filled out the questionnaire. The exploratory factor analysis plus varimax rotation suggested a 1-dimensional scale. The Mokken scale analysis confirmed this result. The reliability analysis showed a reliable outcome for 1 department with 14 clerks or 11 registrars. For multiple departments 3 respondents combined with 10 departments provide a reliable outcome for both groups. DISCUSSION: The PHEEM is a questionnaire measuring 1 dimension instead of the hypothesised 3 dimensions. The sample size required to achieve a reliable outcome is feasible. The instrument can be used to evaluate both single and multiple departments for both clerks and registrars.

Clinical Clerkship↗

PubMed2006

[In the consultation room, knowledge that must be looked up is more important than ready knowledge].

In the consultation room, it is better to have a doctor that looks something up than one who thinks that he has (or should have) everything at his fingertips. Doctors require ready knowledge, but the rapid changes make it impossible to keep all knowledge at the ready. Training courses must pay attention to the retrieval, assessment and maintenance of (new) professional knowledge. A positive attitude and helpful aids are essential here.

Health Knowledge, Attitudes, Practice↗

PubMed2006

Internationalization of medical education in the Netherlands: state of affairs.

In the framework of the Bologna Process, internationalization co-ordinators of seven (out of eight) Dutch medical schools completed an electronic survey about internationalization-related aspects of the curriculum. Common features of internationalization in Dutch medical schools were: the numbers of outgoing students exceeded the numbers of incoming students, and most international programmes involved clinical training and research projects. We recommend that Dutch medical schools should pay more attention to 'Internationalization at Home' and focus on conditions that are conducive to participation by foreign students.

Curriculum↗

PubMed2006

The learning processes of international students through the eyes of foreign supervisors.

Semi-structured interviews were conducted with external supervisors of international electives undertaken by Dutch undergraduate students, in order to gain insight into student learning processes during these electives. The interviews served to triangulate information on these learning processes that was obtained from students' self-reports. The results of the case study reported in this paper were largely consistent with findings from prior studies of international electives in which learning processes and sociocultural differences were examined: experiential learning processes appeared to dominate and sociocultural differences occasionally seemed to blur productive learning, especially when the differences between the national cultures of host country and student home country were substantial. It is recommended that students' experiential learning from international electives should be supplemented with 'guided' and 'self-directed' learning with a focus on the sociocultural dimension.

Australia↗

PubMed2006

In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation.

BACKGROUND: Supervision and feedback are essential factors that contribute to the learning environment in the context of workplace learning and their frequency and quality can be improved. Assessment is a powerful tool with which to influence students' learning and supervisors' teaching and thus the learning environment. OBJECTIVE: To investigate an in-training assessment (ITA) programme in action and to explore its effects on supervision and feedback. DESIGN: A qualitative study using individual, semistructured interviews. SUBJECTS AND SETTING: Eight students and 17 assessors (9 members of staff and 8 residents) in the internal medicine undergraduate clerkship at Vrije Universiteit Medical Centre, Amsterdam, the Netherlands. RESULTS: The ITA programme in action differed from the intended programme. Assessors provided hardly any follow-up on supervision and feedback given during assessments. Although students wanted more supervision and feedback, they rarely asked for it. Students and assessors failed to integrate the whole range of competencies included in the ITA programme into their respective learning and supervision and feedback. When giving feedback, assessors rarely gave borderline or fail judgements. DISCUSSION AND CONCLUSION: If an ITA programme in action is to be congruent with the intended programme, the implementation of the programme must be monitored. It is also necessary to provide full information about the programme and to ensure this information is given repeatedly. Introducing an ITA programme that includes the assessment of several competencies does not automatically lead to more attention being paid to these competencies in terms of supervision and feedback. Measures that facilitate change in the learning environment seem to be a prerequisite for enabling the assessment programme to steer the learning environment.

Clinical Competence↗

PubMed2005

Effects of an in-training assessment programme on supervision of and feedback on competencies in an undergraduate Internal Medicine clerkship.

Assessment drives the educational behaviour of students and supervisors. Therefore, an assessment programme targeted at specific competencies may be expected to motivate supervisors and students to pay more attention to those competencies. In-training assessment (ITA) is regarded as a feasible method for assessing a broad range of competencies. Before and after the implementation of an ITA programme in an undergraduate Internal Medicine clerkship we surveyed students on the frequency of unobserved and observed supervision, and the quality of feedback as inferred from the seniority of the person providing it. After the implementation of the ITA programme supervision increased, but the difference was not statistically significant. The quality of feedback showed no significant change either. Inter-student variation in supervision and feedback remained invariably high after the implementation of the ITA programme. Whether these results are attributable to the way the programme was implemented or to the way the results were assessed remains to be clarified.

Clinical Clerkship↗

PubMed2005

The versatility of progress testing assessed in an international context: a start for benchmarking global standardization?

Sharing and collaboration relating to progress testing already takes place on a national level and allows for quality control and comparisons of the participating institutions. This study explores the possibilities of international sharing of the progress test after correction for cultural bias and translation problems. Three progress tests were reviewed and administered to 3043 Pretoria and 3001 Maastricht medical students. In total, 16% of the items were potentially biased and removed from the test items administered to the Pretoria students (9% due to translation problems; 7% due to cultural differences). Of the three clusters (basic, clinical and social sciences) the social sciences contained most bias (32%), basic sciences least (11%). The differences that were found, comparing the student results of both schools, seem a reflection of the deliberate accentuations that both curricula pursue. The results suggest that the progress test methodology provides a versatile instrument that can be used to assess medical schools across the world. Sharing of test material is a viable strategy and test outcomes are interesting and can be used in international quality control.

Benchmarking↗

PubMed2005

Reliability of the clinical teaching effectiveness instrument.

INTRODUCTION: The Clinical Teaching Effectiveness Instrument (CTEI) was developed to evaluate the quality of the clinical teaching of educators. Its authors reported evidence supporting content and criterion validity and found favourable reliability findings. We tested the validity and reliability of this instrument in a European context and investigated its reliability as an instrument to evaluate the quality of clinical teaching at group level rather than at the level of the individual teacher. METHODS: Students participating in a surgical clerkship were asked to fill in a questionnaire reflecting a student-teacher encounter with a staff member or a resident. We calculated variance components using the urgenova program. For individual score interpretation of the quality of clinical teaching the standard error of estimate was calculated. For group interpretation we calculated the root mean square error. RESULTS: The results did not differ statistically between staff and residents. The average score was 3.42. The largest variance component was associated with rater variance. For individual score interpretation a reliability of > 0.80 was reached with 7 ratings or more. To reach reliable outcomes at group level, 15 educators or more were needed with a single rater per educator. DISCUSSION: The required sample size for appraisal of individual teaching is easily achievable. Reliable findings can also be obtained at group level with a feasible sample size. The results provide additional evidence of the reliability of the CTEI in undergraduate medical education in a European setting. The results also showed that the instrument can be used to measure the quality of teaching at group level.

Clinical Clerkship↗

PubMed2005

Comparison of text and video cases in a postgraduate problem-based learning format.

OBJECTIVE: To investigate whether adding a brief video case instead of an equivalent written text improves the cognitive and metacognitive processes (data exploration, theory building, theory evaluation and metareasoning) of residents in problem-based learning. SUBJECTS: Paediatric residents. SETTING: Department of Paediatrics, Arhus University Hospital, Skejby, Denmark. METHODS: Eleven residents were each assigned to 1 of 2 groups. Both groups analysed an identical vignette of a patient case. Immediately after this, 1 group watched a 2.5-minute video recording and the other group read a description of the same video recording. The groups then reanalysed the case. Thinking processes were tapped by recording and analysing the verbal group interaction. The frequencies of clause categories were calculated and compared using chi-square tests. RESULTS: The verbal interaction showed statistically significant improvements in data exploration, theory building and theory evaluation after the video case. CONCLUSIONS: The greater improvement in clause frequency after the video case compared with the equivalent text suggests an improvement in data exploration, theory building and theory evaluation. The use of patient video recordings may be a valuable supplement to postgraduate paediatric training, particularly pertaining to movement disorders.

Denmark↗

PubMed2004

Effectiveness of clinical rotations as a learning environment for achieving competences.

Competences are becoming more and more prominent in undergraduate medical education. Workplace learning is regarded as crucial in competence learning. Assuming that effective learning depends on adequate supervision, feedback and assessment, the authors studied the occurrence of these three variables in relation to a set of clinical competences. They surveyed students at the end of their rotation in surgery, internal medicine or paediatrics asking them to indicate for each competence how often they had received observed and unobserved supervision, the seniority of the person who provided most of their feedback, and whether the competence was addressed in formal assessments. Supervision was found to be scarce and mostly unobserved. Senior staff did not provide much feedback, and assessment mostly targeted patient-related competences. For all variables, the variation between students exceeded that between disciplines. We conclude that conditions for adequate workplace learning are poorly met and that clerkship experiences show huge inter-student variation.

Clinical Competence↗

PubMed2004

Providing physicians with feedback on how they supervise students during patient contacts.

In this descriptive study an instrument is presented that has been developed to provide physicians with feedback about their strengths and weaknesses in facilitating student learning during patient contacts. The instrument is strongly theory based, i.e. it is based on current general theories of context-bound learning environments, and forms of facilitation promoting transfer of knowledge to actual professional practice. In addition, it has been developed in cooperation with physicians supervising students during patient contacts. The authors have shown how physicians can be provided with individualized feedback on their performance in supervising students during patient contacts.

Education, Medical, Undergraduate↗

PubMed2004

The impact of multifaceted educational structuring on learning effectiveness in a surgical clerkship.

INTRODUCTION: Various measures have been introduced to enhance learning experiences in clerkships, generally with limited success. This study evaluated the impact of a multifaceted approach on the effectiveness of learning in a surgical clerkship. In accordance with results obtained in continuing medical education, several interventions were introduced simultaneously. We compared students' evaluations of the traditional surgical clerkship with those of the restructured clerkship. METHODS: Two consecutive cohorts of students were asked to complete a questionnaire about the quality and quantity of their learning experiences. Cohort 1 (n = 28) undertook the traditional clerkship and cohort 2 (n = 72) the restructured clerkship. A Mann-Whitney test was used to compare outcomes between the 2 cohorts. RESULTS: There were few statistically significant differences between cohorts 1 and 2. Overall, quality indicators did not differ between the 2 cohorts. DISCUSSION: A short-term multifaceted intervention led to a slight increase in the performance of clinical skills and a slight decrease in time spent on activities of limited educational value. The intervention may have been too brief to produce substantial effects. Future interventions should also target teachers, including trainees, in order to assess their opinions and address their educational needs.

Attitude of Health Personnel↗

PubMed2004

Feasibility and reliability of an in-training assessment programme in an undergraduate clerkship.

INTRODUCTION: Structured assessment, embedded in a training programme, with systematic observation, feedback and appropriate documentation may improve the reliability of clinical assessment. This type of assessment format is referred to as in-training assessment (ITA). The feasibility and reliability of an ITA programme in an internal medicine clerkship were evaluated. The programme comprised 4 ward-based test formats and 1 outpatient clinic-based test format. Of the 4 ward-based test formats, 3 were single-sample tests, consisting of 1 student-patient encounter, 1 critical appraisal session and 1 case presentation. The other ward-based test and the outpatient-based test were multiple sample tests, consisting of 12 ward-based case write-ups and 4 long cases in the outpatient clinic. In all the ITA programme consisted of 19 assessments. METHODS: During 41 months, data were collected from 119 clerks. Feasibility was defined as over two thirds of the students obtaining 19 assessments. Reliability was estimated by performing generalisability analyses with 19 assessments as items and 5 test formats as items. RESULTS: A total of 73 students (69%) completed 19 assessments. Reliability expressed by the generalisability coefficients was 0.81 for 19 assessments and 0.55 for 5 test formats. CONCLUSIONS: The ITA programme proved to be feasible. Feasibility may be improved by scheduling protected time for assessment for both students and staff. Reliability may be improved by more frequent use of some of the test formats.

Clinical Clerkship↗

PubMed2003

The importance of active involvement in learning: a qualitative study on learning results and learning processes in different traineeships.

INTRODUCTION: In order to gain more insight into learning in different traineeships we sought students' opinions on their experiences. METHOD: 24 students of Maastricht University, the Netherlands, were interviewed: 8 medical students, and 16 students in the mental health science programme of the Faculty of Health Sciences (8 research trainees (MHS-res.) and 8 trainees in mental health care practice (MHS-prac.). Students' perceptions about instructive, difficult and less instructive learning experiences were recorded on audiotape. The literal transcripts of the interviews were analysed and categorised. RESULTS: The most frequently mentioned learning process was "learning by doing" followed by "actively overcoming gaps in knowledge and skills". These processes occurred with instructive and difficult experiences. Other processes were "learning by seeing things in practice" and "preparation and evaluation". Learning outcomes were categorised as learning about: working, professional competences and personal growth. Most frequently mentioned - in most cases with difficult experiences - were "professional knowledge and skills", "learning about personal growth" and "learning about working". The latter was mentioned most often by MHS-res. students. Medical students' responses suggested that they occasionally perceived the clerkship environment as stressful. DISCUSSION AND CONCLUSIONS: Although the small sample size precludes any firm conclusions, the overwhelming impression is that students prefer being actively involved in their learning process. In addition, traineeships appear to introduce students to professional working life the hard way. Investigating how teachers and supervisors can stimulate active learning and facilitate the introduction to professional practice might be subjects for fruitful further investigation.

Adult↗

PubMed2003

A qualitative study of constructive clinical learning experiences.

Little is known about the effectiveness of clinical education. A more educational structure is considered to be potentially beneficial. The following structured components were added to a surgical clerkship: logbooks, an observed student-patient encounter, individual appraisals, feedback on patient notes, and (case) presentations by students. The authors organized two focus-group sessions in which 19 students participated to explore their perceptions about effective clinical learning experiences and the newly introduced structured components. The analysis of the transcripts showed that observation and constructive feedback are key features of clinical training. The structured activities were appreciated and the results show the direction to be taken for further improvement. Learning experiences depended vastly on individual clinicians' educational qualities. Students experienced being on call, assisting in theatre and time for self-study as instructive elements. Recommended clerkship components are: active involvement of students, direct observation, selection of teachers, a positive learning environment and time for self-study.

Clinical Clerkship↗

PubMed2003

From quality assurance to total quality management: how can quality assurance result in continuous improvement in health professions education?

CONTEXT: Quality assurance is a hot topic in many institutes for higher education. Quality assurance is a cyclic process, consisting of three steps: measuring, judging and improving. Many institutes in higher education collect data about the quality of their educational programme on a regular basis and with proper frequency, but these evaluative data are not always used to improve the quality of the programme. PURPOSE: The aim of this article is to demonstrate which conditions need to be fulfilled to ensure that quality assurance is a cyclic process resulting in continuous improvement. CONCLUSIONS: Quality assurance can only be successful, i.e. result in continuous improvement, if three conditions are met: the evaluation activities are carried out in (1). a systematic and (2). structural fashion and (3). are integrated in the organization's regular work patterns. Parts of the system for quality assurance at the Maastricht Medical School are presented to demonstrate how the three conditions can be realized in practice.

Education, Medical↗

PubMed2002

Longitudinal and concentrated communication skills programmes: two dutch medical schools compared.

AIM OF THE STUDY: The communication skills of students of the Dutch medical schools of Maastricht and Leiden were compared, to assess the effectiveness of these schools' different approaches to communication skills training. Both schools have a six-year undergraduate medical curriculum, divided into four preclinical years and two years of clinical clerkships. The Maastricht problem-based curriculum offers an integrated clinical skills training programme, including communication skills, which runs throughout the first four years. Communication skills training in Leiden is concentrated in courses in the preclinical phase, at the beginning of the clinical phase and preceding two clerkships. METHOD: Communication skills of fourth-year and sixth-year students (N = 161) of both universities were assessed using four OSCE stations in which students did entire consultations with standardised patients. Trained observers rated these consultations, using a checklist. RESULTS: Maastricht students of both year groups obtained significantly higher checklist scores for their communication skills than their Leiden colleagues. The Leiden students' scores increase between years 4 and 6, whereas those of the Maastricht students showed no significant change. DISCUSSION: The higher scores obtained by the Maastricht students indicate a greater overall effectiveness of a longitudinal, integrated approach compared with concentrated courses. Absence of formal training in the clinical phase in Maastricht leads to stabilisation of communication skills, whereas the increase in the Leiden students' scores between years 4 and 6 offers evidence that formal communication skills training during the clinical phase does pay off. These findings suggest that the preferred approach to communication skills training would be an integrated, longitudinal programme, which continues during the clinical years.

Analysis of Variance↗

PubMed2002

Predicting communication skills with a paper-and-pencil test.

AIM: This study was conducted to investigate the value of a written knowledge test of communication skills for predicting scores on a performance test of communication skills. METHOD: A paper-and-pencil test of knowledge about communication skills and a performance test of communication skills, consisting of four stations with standardised patients, were administered to students of two classes of the medical schools of Maastricht and Leiden, the Netherlands. The results on these tests were compared. RESULTS: From the results of both instruments, the classes of the participating students could be recognised equally well: 60% correct qualifications of the classes by the knowledge test and 64% by the multiple station examination. Between the two tests an overall, disattenuated correlation of 0.60 was found (N=133, P < 0.01), suggesting moderate predictive value of the knowledge test for the performance test of communication skills. The correlation is stronger for students from Maastricht medical school than for their colleagues in Leiden. Correlation between the knowledge of communication skills test and other available test results of the participating Maastricht students is close to zero, suggesting that the test measures a distinct quality of students' competence. DISCUSSION: The paper-and-pencil test of knowledge of communication skills has predictive value for the performance of these skills, but this value seems to be less pronounced than similar findings for clinical procedural skills. The stronger relationship between 'knowing how' and 'showing' in the Maastricht student group might be indicative of an effect of the training format.

Clinical Competence↗