Biomedical subjects

A Scherpbier

Publications and source records attributed to A Scherpbier.

12 recordsLinked to original sources

PubMed2006

How can experience in clinical and community settings contribute to early medical education? A BEME systematic review.

REVIEW DATE: Review period January 1992-December 2001. Final analysis July 2004-January 2005. BACKGROUND AND REVIEW CONTEXT: There has been no rigorous systematic review of the outcomes of early exposure to clinical and community settings in medical education. OBJECTIVES OF REVIEW: Identify published empirical evidence of the effects of early experience in medical education, analyse it, and synthesize conclusions from it. Identify the strengths and limitations of the research effort to date, and identify objectives for future research. SEARCH STRATEGY: Ovid search of: BEI, ERIC, Medline, CINAHL and EMBASE Additional electronic searches of: Psychinfo, Timelit, EBM reviews, SIGLE, and the Cochrane databases. Hand-searches of:Medical Education, Medical Teacher, Academic Medicine, Teaching and Learning in Medicine, Advances in Health Sciences Education, Journal of Educational Psychology. CRITERIA DEFINITIONS EXPERIENCE: Authentic (real as opposed to simulated) human contact in a social or clinical context that enhances learning of health, illness and/or disease, and the role of the health professional. Early: What would traditionally have been regarded as the preclinical phase, usually the first 2 years. Inclusions: All empirical studies (verifiable, observational data) of early experience in the basic education of health professionals, whatever their design or methodology, including papers not in English. Evidence from other health care professions that could be applied to medicine was included. EXCLUSIONS: Not empirical; not early; post-basic; simulated rather than 'authentic' experience. DATA COLLECTION: Careful validation of selection processes. Coding by two reviewers onto an extensively modified version of the standard BEME coding sheet. Accumulation into an Access database. Secondary coding and synthesis of an interpretation. HEADLINE RESULTS: A total of 73 studies met the selection criteria and yielded 277 educational outcomes; 116 of those outcomes (from 38 studies) were rated strong and important enough to include in a narrative synthesis of results; 76% of those outcomes were from descriptive studies and 24% from comparative studies. Early experience motivated and satisfied students of the health professions and helped them acclimatize to clinical environments, develop professionally, interact with patients with more confidence and less stress, develop self-reflection and appraisal skill, and develop a professional identity. It strengthened their learning and made it more real and relevant to clinical practice. It helped students learn about the structure and function of the healthcare system, and about preventive care and the role of health professionals. It supported the learning of both biomedical and behavioural/social sciences and helped students acquire communication and basic clinical skills. There were outcomes for beneficiaries other than students, including teachers, patients, populations, organizations and specialties. Early experience increased recruitment to primary care/rural medical practice, though mainly in US studies which introduced it for that specific purpose as part of a complex intervention. CONCLUSIONS: Early experience helps medical students socialize to their chosen profession. It helps them acquire a range of subject matter and makes their learning more real and relevant. It has potential benefits for other stakeholders, notably teachers and patients. It can influence career choices.

Attitude of Health Personnel↗

PubMed2005

The role of a computerised case-based testing procedure in practice performance assessment.

INTRODUCTION: For postgraduate training of doctors there is a need for valid and reliable instruments to assess their daily performance. Various instruments have been suggested, some of which use incognito simulated patients (SPs). These methods are resource intensive. Computerised Case-based testing (CCT) is logistically simpler and may still predict performance well. The research question was to evaluate the predictive validity of CCT for performance. METHODS: Seventeen rheumatologists were each visited by eight incognito SPs presenting various rheumatological complaints, and scoring the performance of the rheumatologists using a predefined checklist. From this checklist a panel of experts identified essential items. In addition the rheumatologists sat a CCT test containing 55 cases with a total of 121 items. RESULTS: Negative correlations were found between the SP scores and the CCT scores. This was unexpected. Therefore, background variables on experience were used to compare both methods. The correlation between these and CCT were high and positive and with the SP scores high and negative. This pattern did not differ when using the essential items of the checklist. Reliabilities of the SP scores were markedly high. DISCUSSION: Although CCT was not predictive of SP scores, it was related to working experience. There are good reasons to assume that although SP-scores were more authentic, they were less valid than CCT scores, mainly because they focussed more on thoroughness than on efficiency in data gathering. The results underpin the assumption that for valid performance assessment the most important issue is what information about the candidate is collected and now how authentic the method is.

Clinical Competence↗

PubMed2004

Evaluation of self-directed clinical education: validation of an instrument.

AIM: To explore the evaluation of self-directed, integrated clinical education. METHODS: We delivered a quantitative and qualitative, self-report questionnaire to students through their web-based learning management system. The questionnaire was distributed 4 times over 1 year, each time in 2 parts. A generic part evaluated boundary conditions for learning, teaching activities and "real patient learning". Factor analysis with varimax rotation was used to validate the constructs that made up the scale and to stimulate hypotheses about how they interrelated. A module-specific part evaluated real patient learning of the subject matter in the curriculum. RESULTS: A total of 101 students gave 380 of a possible 404 responses (94%). The generic data loaded onto 4 factors, corresponding to: firm quality; hospital-based teaching and learning; community and out-patient learning, and problem-based learning (PBL). A 5-item quality index had content, construct and criterion validity. Quality differed greatly between firms. Self-evaluation of module-specific, real patient learning was also valid. It was strongly influenced by the specialty interests of hospital firms. CONCLUSIONS: Quality is a multidimensional construct. Self-report evaluation of real patient learning is feasible, and could be capitalised on to promote reflective self-direction. The social and material context of learning is an important dimension of educational quality.

Clinical Competence↗

PubMed2004

Growth of knowledge in psychiatry and behavioural sciences in a problem-based learning curriculum.

PURPOSE: To evaluate the effectiveness of undergraduate medical education in the domains of psychiatry and behavioural sciences, we examined the growth of knowledge in those disciplines in a 6-year, problem-based learning (PBL) curriculum. Psychiatry and behavioural sciences are taught in the 4 preclinical years and in the psychiatric clerkship. The integrative nature of this PBL curriculum led us to hypothesise that the knowledge growth curves for these disciplines are similar and show a steady upward trend throughout the curriculum. METHODS: All items pertaining to psychiatry and behavioural sciences in the progress tests administered in the period from September 1993 through May 2001 were identified. For those items, the percentage of correct scores in the 6 year groups were considered a multivariate observation reflecting knowledge growth across the 6-year programme. RESULTS: Knowledge growth for psychiatry and behavioural sciences increased significantly, from 12% to 59% and from 28% to 60%, respectively, between Year 1 and the end of Year 6. Apparently, students know more about behavioural sciences than about psychiatry when they enter medical school, but this difference vanishes in the last 2 years of training. Moreover, the growth curves for psychiatry and behavioural sciences started to level off after Years 3 and 4, respectively, with no additional significant growth in any of the later years. CONCLUSIONS: Psychiatry and behavioural sciences showed different patterns of knowledge growth and the 2 growth curves levelled off in Years 5 through 6. Because a student-centred, horizontally and vertically integrated PBL curriculum is aimed at effecting steady growth in knowledge in all disciplines, the slowdown in growth in the later years was among the reasons for initiating a major curricular innovation in 2001.

Behavioral Sciences↗

PubMed2003

Embracing the new paradigm of assessment in residency training: an assessment programme for first-year residency training in anaesthesiology.

Assessment of clinical competence is facing a paradigm shift in more than one sense. The shift relates to test content, which increasingly covers a broader spectrum of competences than mere medical expertise, and to test methods, with an increasing focus on testing performance in realistic settings. Also there is a shift in the concept of assessment in that instruction and assessment are no longer seen as being separate in time and purpose, but as integral parts of the learning process. The nature of the new paradigm for assessment is well described but the challenge to programme directors is to specify the evaluation situations and develop appropriate methods. This paper describes the intrinsic rational validation process in outlining an assessment programme for first-year anaesthesiology residency training according to the new paradigm. The applicability to other residency programmes and higher-level training in anaesthesiology is discussed.

Anesthesiology↗

PubMed2002

Consultants' opinion on a new practice-based assessment programme for first-year residents in anaesthesiology.

BACKGROUND: Assessment in postgraduate education is moving towards using a broad spectrum of practice-based assessment methods. This approach was recently introduced in first-year residency in anaesthesiology in Denmark. The new assessment programme covers: clinical skills, communication skills, organizational skills and collaborative skills, scholarly proficiencies and professionalism. Eighteen out of a total of 21 assessment instruments were used for pass/fail decisions. The aim of this study was to survey consultants' opinions of the programme in terms of the representativeness of competencies tested, the suitability of the programme as a basis for pass/fail decisions and the relevance and sufficiency of the content of the different assessment instruments. METHODS: A description of the assessment programme and a questionnaire were sent to all consultants of anaesthesiology in Denmark. The questionnaire consisted of items, to be answered on a five-point scale, asking the consultants' opinions about representativeness, suitability and content of the programme. RESULTS: The response rate was 251/382 (66%). More than 75% of the respondents agreed that the assessment programme offered adequate coverage of the competencies of a first-year resident and was appropriate for making pass/fail decisions. There was strong agreement that the content of the 18 tests used for pass/fail decisions was relevant and sufficient for pass/fail decisions. CONCLUSION: Judging from the consultants' opinions, the assessment programme for first-year residency in anaesthesiology appears to be appropriate regarding the range of competencies assessed, the appropriateness as a basis for pass/fail decisions, and regarding the content of the tests used for pass/fail decisions. Further studies are needed to assess the feasibility and acceptability of the programme in practice.

Anesthesiology↗

PubMed2001

Rhemulatologists' performance in dailiy practice.

OBJECTIVE: To assess rheumatologists' performance for 8 rheumatologic conditions and to explore possible explanatory factors. METHODS: After written informed consent was obtained, 27 rheumatologists (21% of all Dutch rheumatologists) practicing in 16 outpatient departments were each visited by 8 incognito "standardized patients" (SPs). The diagnoses of these 8 cases account for about 23% of all new referred patients in the Netherlands. Results for ordered lab tests as well as real radiographs with corresponding results from a radiologist were simulated. Information from the visits was obtained from the SPs, who completed predefined case-specific checklists, and by collecting data on resource utilization. Feedback was provided. RESULTS: Altogether 254 encounters took place, of which 201 were first visits and 53 were followup visits. SPs were unmasked twice during a visit. There was considerable variation in resource utilization (lab tests and imaging) between cases and between rheumatologists. Mean costs per rheumatologist ranged from US $ 4.67 to $ 65.36 per visit for lab tests and from US $ 33.15 to $ 226.84 per visit for imaging tests. No significant correlations were seen between resource utilization costs and number of years of clinical experience or performance on checklist scores. Rheumatologists with longer experience had lower total item checklist scores (r = -0.47; P < 0.05). CONCLUSION: A considerable variation in resource utilization was found among 27 Dutch rheumatologists. The information obtained is an excellent source for discussion on the appropriateness of care.

Adult↗

PubMed2001

Effectiveness of basic clinical skills training programmes: a cross-sectional comparison of four medical schools.

OBJECTIVE: Training in physical diagnostic skills is an important part of undergraduate medical education. The objective of this study was to study the outcome of skills training at four medical schools. CONTEXT: At the time of the study, three schools had a traditional lecture-based curriculum and one school had a problem-based learning curriculum with a longitudinal skills training programme. All schools offer extended exposure to clerkships. METHOD: A cross-sectional study in four medical schools was performed, using a written test of skills that has good correlation with actual student performance. The scores attained from four student groups were compared within and between the four medical schools. A total of 859 volunteer students from the later four years at each medical school participated in the study. RESULTS: The mean scores in the traditional medical schools increased with the start of skill training and the hands-on experience offered during the clerkships. Students from the school with the longitudinal skills training programme and the problem-based learning approach had significantly higher mean scores at the start of the clerkships, and maintained their lead in the subsequent clinical years. CONCLUSIONS: Longitudinal skills training seems to offer the students a superior preparation for clerkships as well as influencing the students' learning abilities during the clerkships. The effect of the problem-based learning approach, also related to the innovative philosophy of the curriculum, could not be accounted for.

Belgium↗

PubMed2000

An evaluation study of the didactic quality of clerkships.

CONTEXT: Previous qualitative research at the University of Antwerp revealed dissatisfaction amongst medical students about clinical clerkships. OBJECTIVE: To use quantitative methods to further explore student perceptions of their clinical teaching. METHOD, SAMPLE AND SETTING: Monthly questionnaire administered to final-year medical students at the University of Antwerp, Belgium. RESULTS: The response rate was 83.9%. Many of the qualitative findings were reproduced. Educational resources were not optimally used. The junior doctor was the most important clinical teacher. Many activities were passive experiences. Coaching, feedback and supervision associated most with general satisfaction of the clerkship, however, these dimensions were often considered suboptimal. CONCLUSIONS: Clinical clerkships do not automatically provide an ideal learning environment for medical students.

Attitude to Health↗

PubMed2000

Patient-oriented learning: a review of the role of the patient in the education of medical students.

AIM: To explore the contribution patients can make to medical education from both theoretical and empirical perspectives, to describe a framework for reviewing and monitoring patient involvement in specific educational situations and to generate suggestions for further research. METHODS: Literature review. RESULTS: Direct contact with patients can be seen to play a crucial role in the development of clinical reasoning, communication skills, professional attitudes and empathy. It also motivates through promoting relevance and providing context. Few studies have explored this area, including effects on the patients themselves, although there are examples of good practice in promoting more active participation. CONCLUSION: The Cambridge framework is a tool for evaluating the involvement of patients in the educational process, which could be used by curriculum planners and teachers to review and monitor the extent to which patients are actively involved. Areas for further research include looking at the 'added value' of using real, as opposed to simulated, patients; more work on outcomes for patients (other than satisfaction); the role of real patients in assessment; and the strengths and weaknesses of different models of patient involvement.

Clinical Competence↗

PubMed2000

Developing case-specific checklists for standardized-patient-based assessments in internal medicine: A review of the literature.

PURPOSE: To review the literature on the methods used in writing case-specific checklists for studies of internal medicine physicians' performances that were assessed by standardized patients. METHOD: The authors searched Medline, Embase, Psychlit, and ERIC for articles in English published between 1966 and February 1998. The following search string was used: "[(standardi(*) or simulat(*) or programm(*)) near (patient(*) or client(*) or consultati(*))] and internal medicine." The authors then searched the reference lists of papers retrieved from the database searches, as well as those from seven proceedings of the International Ottawa Conference on Medical Education and Assessment. RESULTS: The procedure yielded 29 relevant articles: database searches yielded 14 published reports dealing with case-specific checklists, 11 articles were culled from the reference lists of these papers, and the Ottawa Conference proceedings yielded four articles. Only 12 articles reported specifically on the development of checklists. In general, there were three sources used for developing checklists: panels of experts, the investigators themselves, and responses from expert physicians to written protocols. No article indicated that researchers had relied exclusively on data from the literature to compose their checklists. Only three articles indicated that literature sources had informed their checklist development. All articles except one relied on explicit criteria for the inclusion of items on the checklists. In 21 of the 29 articles, the checklists had been scored by SPs, but the scoring of specific items on the checklists varied according to the purpose of the SP-physician encounter. Only four of the articles made the checklists available or indicated that the checklists could be obtained from the authors. CONCLUSION: The development of case-specific checklists for SP examinations of physicians' performance has received little attention. To judge the validity of studies of physicians' performances that use SPs, the development processes for the checklists need to be more fully described to enable readers to evaluate the validity and reliability of the studies.

Clinical Competence↗

PubMed1999

Can medical schools rely on clerkships to train students in basic clinical skills?

OBJECTIVE: Many medical schools have drawn up lists of basic clinical skills that students are required to have mastered at the end of medical training. To determine whether undergraduate students actually perform these basic clinical skills during clerkships and whether different approaches to skills training led to different results, we surveyed 365 final-year medical students in 1996 and 1997. METHOD: A questionnaire containing items on 265 skills in eight body systems was administered to students from two conventional medical schools (Ghent and Antwerp, Belgium), and one Dutch medical school, Maastricht, which offers a problem-based curriculum and systematic skills training. RESULTS: Although quite a few skills were not performed by Maastricht students, the results of this school compared favourably to those of the Ghent and Antwerp medical schools. Significant differences between Ghent and Antwerp were found for surgery, paediatrics and gynaecology/obstetrics. In the non-obligatory clerkships in dermatology, otorhinolaryngology and ophthalmology a great percentage of skills were not performed. CONCLUSIONS: The main conclusion is that all three medical schools cannot rely on clerkship experiences alone to provide adequate basic skills training. A problem-based learning environment and training in a skills laboratory appear to result in students performing more skills during clerkships. Assessment of clinical skills, obligatory clerkships in specialties and general practice, and continuous monitoring of the quality of clerkships may also be strong determinants of the present findings.

Belgium↗