Biomedical subjects

Albert Scherpbier

Publications and source records attributed to Albert Scherpbier.

17 recordsLinked to original sources

PubMed2007

Experience-based learning: a model linking the processes and outcomes of medical students' workplace learning.

OBJECTIVE: To develop a model linking the processes and outcomes of workplace learning. METHODS: We synthesised a model from grounded theory analysis of group discussions before and after experimental strengthening of medical students' workplace learning. The research was conducted within a problem-based clinical curriculum with little early workplace experience, involving 24 junior and 12 senior medical students. RESULTS: To reach their ultimate goal of helping patients, medical students must develop 2 qualities. One is practical competence; the other is a state of mind that includes confidence, motivation and a sense of professional identity. These 2 qualities reinforce one another. The core process of clinical workplace learning involves 'participation in practice', which evolves along a spectrum from passive observation to performance. Practitioners help students participate by being both supportive and challenging. The presentation of clear learning objectives and continuous periods of attachment that are as personal to the student(s) and practitioner(s) as possible promote workplace learning. CONCLUSIONS: The core condition for clinical workplace learning is 'supported participation', the various outcomes of which are mutually reinforcing and also reinforce students' ability to participate in further practice. This synthesis has 2 important implications for contemporary medical education: any reduction in medical students' participation in clinical practice that results from the patient safety agenda and expanded numbers of medical students is likely to have an adverse effect on learning, and the construct of 'self-directed learning', which our respondents too often found synonymous with 'lack of support', should be applied with very great caution to medical students' learning in clinical workplaces.

Attitude of Health Personnel↗

PubMed2006

BEME systematic review: predictive values of measurements obtained in medical schools and future performance in medical practice.

BACKGROUND: Effectiveness of medical education programs is most meaningfully measured as performance of its graduates. OBJECTIVES: To assess the value of measurements obtained in medical schools in predicting future performance in medical practice. METHODS SEARCH STRATEGY: The English literature from 1955 to 2004 was searched using MEDLINE, Embase, Cochrane's EPOC (Effective Practice and Organization of Care Group), Controlled Trial databases, ERIC, British Education Index, Psych Info, Timelit, Web of Science and hand searching of medical education journals. INCLUSION & EXCLUSIONS: Selected studies included students assessed or followed up to internship, residency and/or practice after postgraduate training. Assessment systems and instruments studied (Predictors) were the National Board Medical Examinations (NBME) I and II, preclinical and clerkship grade-point average, Observed Standardized Clinical Examination scores and Undergraduate Dean's rankings and honors society. Outcome measures were residency supervisor ratings, NBME III, residency in-training examinations, American Specialty Board examination scores, and on-the-job practice performance. DATA EXTRACTION: Data were extracted by using a modification of the BEME data extraction form study objectives, design, sample variables, statistical analysis and results. All included studies are summarized in a tabular form. DATA ANALYSIS AND SYNTHESIS: Quantitative meta-analysis and qualitative approaches were used for data analysis and synthesis including the methodological quality of the studies included. RESULTS: Of 569 studies retrieved with our search strategy, 175 full text studies were reviewed. A total of 38 studies met our inclusion criteria and 19 had sufficient data to be included in a meta-analysis of correlation coefficients. The highest correlation between predictor and outcome was NBME Part II and NBME Part III, r = 0.72, 95% CI 0.30-0.49 and the lowest between NBME I and supervisor rating during residency, r = 0.22, 95% CI 0.13-0.30. The approach to studying the predictive value of assessment tools varied widely between studies and no consistent approach could be identified. Overall, undergraduate grades and rankings were moderately correlated with internship and residency performance. Performance on similar instruments was more closely correlated. Studies assessing practice performance beyond postgraduate training programs were few. CONCLUSIONS: There is a need for a more consistent and systematic approach to studies of the effectiveness of undergraduate assessment systems and tools and their predictive value. Although existing tools do appear to have low to moderate correlation with postgraduate training performance, little is known about their relationship to longer-term practice patterns and outcomes.

Clinical Competence↗

PubMed2006

Student evaluation of the clinical 'curriculum in action'.

AIM: To examine how students' evaluations of the environment, process and outcome of clinical learning interrelated and correlated with assessment results. METHOD: A post hoc study in the 3rd of 5 years in a student-centred, horizontally integrated, objective-based medical curriculum. In the last week of each module, students evaluated what they had learned and how they had learned it using a previously validated, web-based scale. The interrelationships between scale variables and their relationships with summative assessment results were tested using factor analysis, correlation analysis and stepwise multiple regression analysis. RESULTS: Student evaluation yielded 4 summary measures: 2 reflected learning outcomes ('real patient learning' and 'curriculum coverage'), 1 reflected process ('quality of instruction') and 1 reflected environment ('conditions for learning'). They fitted a causal model according to which instruction, conditions for learning and curriculum coverage favoured real patient learning. Real patient learning was rated higher in women than men, and the measures were associated more strongly in women. Performance in end-of-year summative assessments was predicted strongly by mid-year performance but by no other measure. CONCLUSIONS: Students' evaluations of their learning environment and instructional processes correlated with their assessments of 2 outcomes of the curriculum in action: curriculum coverage and real patient learning. There was little shared variance between those measures and students' performance in summative assessments. Given its formative potential, students' evaluation of their curriculum in action could play a useful part in learner-centred clinical education. There is a possibility, which needs further research, that women's evaluations have greater predictive validity than men's. Assessment performance should be regarded not as a solitary gold standard but as just 1 measure of educational outcome.

Attitude of Health Personnel↗

PubMed2006

Are some of the challenging aspects of the CanMEDS roles valid outside Canada?

CONTEXT: Many countries have adopted the CanMEDS roles. However, there is limited information on how these apply in an international context and in different specialties. OBJECTIVES: To survey trainee and specialist ratings of the importance of the CanMEDS roles and perceived ability to perform tasks within the roles. METHODS: We surveyed 8749 doctors within a defined region (eastern Denmark) via a single-issue, mailed questionnaire. Each of the 7 roles was represented by 3 questionnaire items to be rated for perceived importance and confidence in ability to perform the role. RESULTS: Responses were received from 3476 doctors (42.8%), including 190 interns, 201 doctors in the introductory year of specialist training, 529 residents and 2152 specialists. The overall mean rating of importance (on a scale of 1-5) of the aspects of competence described in the CanMEDS roles was 4.2 (standard deviation 0.6) and did not differ between trainee groups and specialists. Mean ratings of confidence were lower than ratings of importance and increased across the groups from interns to specialists. Differences between specialty groups were evident in both importance and confidence for many of the roles. For laboratory, technical and, to a lesser extent, cognitive specialties, the role of Health Advocate scored the lowest in importance. For general medicine specialties, the roles of Medical Expert, Collaborator, Manager and Scholar all scored lower for importance and confidence. CONCLUSIONS: This study provides a sketch of the content and construct validity of the CanMEDS roles in a non-Canadian setting. More research is needed in how these aspects of competence can be best taught and applied across specialties in different jurisdictions.

Adult↗

PubMed2006

Chronic patients in undergraduate education: didactic value as perceived by students.

OBJECTIVES: Medical education should prepare students for future clinical practice. However, this preparation is inadequate for the most prevalent problem in health care: chronic disease. This applies to the continuous aspect of chronic disease. Within the context of a newly developed programme, we investigated what makes a chronic patient interesting in the eyes of medical students, what they learned from a specific programme in which each student had contact with a chronic patient 4 times in 8 months, and what they learned from their patients. METHODS: A total of 240 Year 3 students were enrolled in the programme, 89 of whom filled in questionnaires at both the start and end of the programme. Topics included the characteristics of the ideal and the actual patient, the Ideal Physician Questionnaire, and several questions on the expected and actual amount of knowledge gained from the patient. RESULTS: Students preferred patients who demonstrated clear symptoms and had frequent contacts with health care professionals during the programme to 'well adapted' patients. The perceived knowledge obtained from the patient was less than they had expected at the start of the programme. A didactic gain perceived as low was mainly due to low expectations of gaining knowledge at the start of the programme, a doctor-centred attitude and a high level of discrepancy between the student's ideal patient and the actual patient. CONCLUSIONS: Programmes that aim to present chronic patients to medical students focus on patient selection so that patients who differ only very slightly from healthy persons are eliminated. In addition, realistic information on the types of patients with whom students can expect to have contact may help students appreciate the knowledge to be gained from these patients.

Adolescent↗

PubMed2005

Early practical experience and the social responsiveness of clinical education: systematic review.

OBJECTIVES: To find how early experience in clinical and community settings ("early experience") affects medical education, and identify strengths and limitations of the available evidence. DESIGN: A systematic review rating, by consensus, the strength and importance of outcomes reported in the decade 1992-2001. DATA SOURCES: Bibliographical databases and journals were searched for publications on the topic, reviewed under the auspices of the recently formed Best Evidence Medical Education (BEME) collaboration. SELECTION OF STUDIES: All empirical studies (verifiable, observational data) were included, whatever their design, method, or language of publication. RESULTS: Early experience was most commonly provided in community settings, aiming to recruit primary care practitioners for underserved populations. It increased the popularity of primary care residencies, albeit among self selected students. It fostered self awareness and empathic attitudes towards ill people, boosted students' confidence, motivated them, gave them satisfaction, and helped them develop a professional identity. By helping develop interpersonal skills, it made entering clerkships a less stressful experience. Early experience helped students learn about professional roles and responsibilities, healthcare systems, and health needs of a population. It made biomedical, behavioural, and social sciences more relevant and easier to learn. It motivated and rewarded teachers and patients and enriched curriculums. In some countries, junior students provided preventive health care directly to underserved populations. CONCLUSION: Early experience helps medical students learn, helps them develop appropriate attitudes towards their studies and future practice, and orientates medical curriculums towards society's needs. Experimental evidence of its benefit is unlikely to be forthcoming and yet more medical schools are likely to provide it. Effort could usefully be concentrated on evaluating the methods and outcomes of early experience provided within non-experimental research designs, and using that evaluation to improve the quality of curriculums.

Attitude of Health Personnel↗

PubMed2005

Gender-related differences in general practice preferences: longitudinal evidence from the Netherlands 1982-2001.

The proportion of female doctors is increasing. Yet, there is little evidence that demonstrates changing career preferences over a long period, nor do we know the long-term impact of changing male-female ratios in medicine. We explored this within the GP profession. By means of a longitudinal cohort study (postal questionnaires) among all graduated GPs in the Netherlands between 1982 and 2001 we explored trends in career preferences and investigated whether practice preferences of men and women differ over the years. Preference of becoming a GP has significantly decreased among men. GPs prefer group practice more than solo practice. Female doctors were more likely to prefer a small practice and to associate. Men prefer to take over an established practice. Main reasons to abstain from practicing as a GP for men were having found another job or not having found a practice according to their preferences. Main reasons for women were having decided for another job and family life. We conclude that male and female GPs select differently on practice setting. Preferences change through the years but tend to converge. Gender differences are likely due to the circumstance that career choices for men are more influenced by fluctuating labour markets, while female choices are more based on family circumstances. We expect that as more women will become a GP the demand for small group practices will increase. Also, as many female GPs abstain from practicing after having finished a vocational GP training program it will be essential to create work facilities to keep them available for the GP labour market.

Adult↗

PubMed2005

Clinical teachers and problem-based learning: a phenomenological study.

AIM: To explore how clinicians perceive their roles in problem-based medical education, and how closely those perceptions link to the curriculum they teach. METHOD: All 14 general physicians in a teaching hospital took part in 6 semistructured discussions, which were analysed phenomenologically. RESULTS: Third year clinical teaching was described in terms that bore little relation to problem-based learning (PBL). Teachers placed great importance on the social dimension of professional learning. They expressed strongly positive affects towards learners and their learning that they found hard to express as PBL tutors. Their narratives of education were remarkably divorced from modern day clinical practice. CONCLUSIONS: Problem-based method lacked some important conditions for professional teaching and learning. Traditional apprenticeship is unsustainable under present day conditions of practice. There is a need for new educational methods that help the learner to build a professional identity through social interaction with practitioners.

Curriculum↗

PubMed2005

How can medical students learn in a self-directed way in the clinical environment? Design-based research.

AIM: This study aimed to establish whether and under what conditions medical students can learn in a self-directed manner in the clinical environment. METHOD: A web-based learning management system brought 66 placement students, in a problem-based learning (PBL) medical curriculum, into closer touch with their clinical learning objectives and ways of achieving them. Free response comments from 16 of them during the 7 weeks they used it, transcripts of group discussions before and after the period of use, and responses from all 66 students to a questionnaire were analysed qualitatively. RESULTS: Students were rarely fully autonomous or subservient. They valued affective and pedagogic support, and relied on teachers to manage their learning environment. With support, they were motivated and able to choose how and when to meet their learning needs. The new system was a useful adjunct. CONCLUSIONS: Self-direction, interpreted literally, was a method of learning that students defaulted to when support and guidance were lacking. They found "supported participation" more valuable. Learning in the clinical environment was a social process with as many differences from, as similarities to, PBL.

Computer-Assisted Instruction↗

PubMed2004

Junior doctors' opinions about the transition from medical school to clinical practice: a change of environment.

INTRODUCTION: Concerns have been growing about the effects of the working environment on junior doctors and the learning opportunities available to them. In order to identify problems and opportunities for improvement, we explored junior doctors' opinions about the transition from student to practitioner. METHOD: Seventeen recent graduates in four focus groups discussed the transition. DATA ANALYSIS: Related comments were combined in the report of the discussions, which was approved by the participants. RESULTS: The transition was perceived as a major change, particularly the increased responsibility and workload and contacts with other health care workers and patients. Preparation during undergraduate training was adequate as regards knowledge, communication, history taking and physical examination skills but not for pharmacological knowledge and patient management skills. Problems were connected with practical procedures and feelings of uncertainty. There was little formal education. Proposals to ease the transition were earlier patient contacts, more involvement in patient management and growing responsibility during clerkships. DISCUSSION: Although the sample was small, the uniform opinion in all groups supports the validity of the findings. Junior doctors felt confident with regard to knowledge and skills, but experienced difficulties with patient management, practical matters and their role on the team. Contrary to the idea of an educational continuum, formal learning appeared to be very limited in the hospital environment. CONCLUSIONS: Preparation for medical practice may benefit from active involvement of clerks in patient management decisions and a gradual increase in responsibilities. An effective medical education continuum would require more attention for house officers' learning.

Attitude of Health Personnel↗

PubMed2004

The effect of in-training assessment on clinical confidence in postgraduate education.

INTRODUCTION: The literature on how in-training assessment (ITA) works in practice and what educational outcomes can actually be achieved is limited. One of the aims of introducing ITA is to increase trainees' clinical confidence; this relies on the assumption that assessment drives learning through its content, format and programming. The aim of this study was to investigate the effect of introducing a structured ITA programme on junior doctors' clinical confidence. The programme was aimed at first year trainees in anaesthesiology. METHODS: The study involved a nationwide survey of junior doctors' self-confidence in clinical performance before (in 2001) and 2 years after (in 2003) the introduction of an ITA programme. Respondents indicated confidence on a 155-item questionnaire related to performance of clinical skills and tasks reflecting broad aspects of competence. A total of 23 of these items related to the ITA programme. RESULTS: The response rate was 377/531 (71%) in 2001 and 344/521 (66%) in 2003. There were no statistically significant differences in mean levels of confidence before and 2 years after the introduction of the ITA programme - neither in aspects that were related to the programme nor in those that were unrelated to the programme. DISCUSSION: This study demonstrates that the introduction of a structured ITA programme did not have any significant effect on trainees' mean level of confidence on a broad range of aspects of clinical competence. The importance of timeliness and rigorousness in the application of ITA is discussed.

Anesthesiology↗

PubMed2003

Towards valid measures of self-directed clinical learning.

AIM: To compare the validity of different measures of self-directed clinical learning. METHODS: We used a quasi-experimental study design. The measures were: (1) a 23-item quantitative instrument measuring satisfaction with the learning process and environment; (2) free text responses to 2 open questions about the quality of students' learning experiences; (3) a quantitative, self-report measure of real patient learning, and (4) objective structured clinical examination (OSCE) and progress test results. Thirty-three students attached to a single firm during 1 curriculum year in Phase 2 of a problem-based medical curriculum formed an experimental group. Thirty-one students attached to the same firm in the previous year served as historical controls and 33 students attached to other firms within the same module served as contemporary controls. After the historical control period, experimental group students were exposed to a complex curriculum intervention that set out to maximise appropriate real patient learning through increased use of the outpatient setting, briefing and supported, reflective debriefing. RESULTS: The quantitative satisfaction instrument was insensitive to the intervention. In contrast, the qualitative measure recorded a significantly increased number of positive statements about the appropriateness of real patient learning. Moreover, the quantitative self-report measure of real patient learning found high levels of appropriate learning activity. Regarding outpatient learning, the qualitative and quantitative real patient learning instruments were again concordant and changed in the expected direction, whereas the satisfaction measure did not. An incidental finding was that, despite all attempts to achieve horizontal integration through simultaneously providing community attachments and opening up the hospital for self-directed clinical learning, real patient learning was strongly bounded by the specialty interest of the hospital firm to which students were attached. Assessment results did not correlate with real patient learning. CONCLUSIONS: Both free text responses and students' quantitative self-reports of real patient learning were more valid than a satisfaction instrument. One explanation is that students had no benchmark against which to rate their satisfaction and curriculum change altered their tacit benchmarks. Perhaps the stronger emphasis on self-directed learning demanded more of students and dissatisfied those who were less self-directed. Results of objective, standardised assessments were not sensitive to the level of self-directed, real patient learning. Despite an integrated curriculum design that set out to override disciplinary boundaries, students' learning remained strongly influenced by the specialty of their hospital firm.

Clinical Competence↗

PubMed2003

Consultation by the United Kingdom to South Africa to develop human diversity teaching.

This paper describes consultation provided by the University of Leicester to the Medical University of Southern Africa (Medunsa) funded through British Council and the Department for International Development to develop a course addressing issues of diversity at Medunsa. The aims of the link were essentially for Leicester to provide support and guidance on the development of aspecific module. This inevitably included the provision of training in key areas such as teaching skills and evaluation of teaching. This paper focuses on the potential difficulties of such a link, which included cultural differences, issues of hierarchy and student influence. The project outcomes have been the development of a coherent module on human diversity which is assessed in such a way as to support the development of student writing skills, increased staff teaching skills and a joint conference to disseminate the learning that has taken place from the project.

Consultants↗

PubMed2002

Reproducibility of clinical performance assessment in practice using incognito standardized patients.

BACKGROUND: The reproducibility of authentic assessment methods has been investigated for objective structured clinical examinations (OSCEs) and video assessment in general practice, but not for assessment with incognito standardized patients. PURPOSE: To investigate the reproducibility of assessment with incognito standardized patients. METHODS: A total of 27 Dutch rheumatologists in 16 hospitals were each visited by 8 incognito standardized patients presenting with different rheumatological disorders. After each visit, the standardized patient completed a case-specific checklist containing items on medical history, physical examination and management. Over a 20-month period, 254 incognito visits took place, of which 201 were first visits. The standardized patient was detected by the rheumatologist in 2 cases only. These encounters were not included in the analysis. Generalizability theory was used to investigate the reproducibility of the assessment. RESULTS: One fifth of the variance can be attributed to variation between rheumatologists. The largest variance is due to the variation in difficulty among cases. A reproducible assessment requires 3 hours of testing time (6 cases) if it is obtained through a norm-referenced interpretation of scores and 7 hours of testing time (14 cases) if it is obtained through an absolute interpretation of scores. CONCLUSION: The reproducibility of performance assessment in clinical practice by incognito standardized patients is similar to that of other authentic measurements for the assessment of clinical competence and performance.

Analysis of Variance↗

PubMed2002

Doctor-patient interaction: standardized patients' reflections from inside the rheumatological office.

OBJECTIVE: To assess appreciation and quality of doctor-patient interaction by exploring standardized patients' (SP) opinions on aspects of the interaction between doctors and standardized patients. METHODS: A focus group interview was organized with SP who had completed 254 incognito visits to 26 Dutch rheumatologists in a study assessing rheumatologists' daily practice performance; 13 of 16 SP attended the interview. Patients discussed aspects of interaction with the physicians. The interview was audiotaped and transcribed literally. Recurring themes were identified. RESULTS: Participants were on the whole very satisfied with the rheumatological care received. Factors contributing to satisfaction included "being approached as a person," "being treated respectfully," and "being given enough room to mention all complaints." On the other hand, SP were struck by the variation in performance among the rheumatologists. CONCLUSION: Physicians may not be aware of the influence of their behavior on patients. Most critical comments from patients regarding communication and behavior were on small things, which should not be too difficult to change in daily practice.

Aged↗

PubMed2001

Correlation of a written test of skills and a performance based test: a study in two traditional medical schools.

Studies in innovative curricula have shown that a written test of skills is potentially able to predict OSCE scores. In this study we verified the potential of a written test of skills as an alternative to an OSCE in two traditional medical schools. A 12 station OSCE was scored using detailed checklists and global rating scales. The written test of skills consisted of 132 true-false questions. Students were assessed immediately before graduation in 1997. The size of the reported correlations confirms that the written test of skills can be used to predict performance-based test scores in traditional medical schools to some extent. For research purposes, particularly for outcome research to compare curricula of medical schools, a written test of skills is a viable alternative to performance-based testing. A written test of skills is unable to replace the OSCE for assessment of individual students.

Journal Article↗

PubMed2001

Medical students' experience in practical skills is far from stakeholders' expectations.

This study compares medical graduates' experience in practical skills with a range of stakeholders' expectations. A questionnaire listing 58 practical skills was sent out to a group of graduating medical students. The medical students were asked to indicate their experience in each skill during medical school. A similar questionnaire was sent out to five groups of stakeholders asking for their expectations regarding graduates' experience. The stakeholders were: faculty members; consultants at clinical departments with interns in training; general practitioners; nurses; recently graduated junior doctors. A total of 472 questionnaires were sent out and 315 (67%) were returned. Medical graduates showed substantial variation in level of experience, and their experience was substantially lower than the expectations of the stakeholders. Nurses and junior doctors tended to have higher expectations compared with faculty members and consultants. Differences between our results and reports in the literature from elsewhere emphasize the importance of performing local needs assessments, and in this process stakeholders apart from faculty members should be involved.

Journal Article↗