Incorporating TBL into the pre-clinical pediatrics curriculum led to large gains in knowledge over the short-term, but these gains did not persist. Further research should focus on extending the impact of TBL on long-term knowledge retention.

PurposeReflection is a key element in learning from experience, but the impact of most programmes of reflection on daily practice remains unclear. We investigated students’ perceptions of adding a daily written reflection assignment to a clinical rotation.MethodsThird-year medical students on a single two-week rotation completed daily reflections analyzing their performance. Programme evaluation used a 33-question anonymized survey. Quantitative data were summarized and qualitative responses coded for recurring themes.ResultsTwenty-six students completed the survey (90 % response rate). Eighty-five percent of students felt that the daily reflections had a positive impact on their learning from clinical experience. Seventy-seven percent of students reported that the programme changed their awareness of their thoughts and actions, and 80 % felt that it improved their recall of experiences. A greater sense of mindfulness and focus on self-improvement were major themes that emerge from students’ descriptions of the role of daily reflections in their learning.ConclusionOverall, daily reflections demonstrated a positive learning influence. This exploratory study suggests students may benefit from more frequent, short reflections as opposed to more typically spaced reflective assignments.Electronic Supplementary MaterialThe online version of this article (doi:10.1007/s40037-016-0293-1) contains survey questions that are available to authorized users.

Spearman correlation demonstrated moderate to strong correlation between self-assessments completed alone (no simultaneous peer assessment) and self-assessments completed at the time of peer assessments (ρ = .59, p < .0001) but weak correlation between the two self-assessments and peer assessments (alone: ρ = .13, p < .013; at time of peer: ρ = .21, p < .0001). Generalized estimating equation models revealed that self-assessments done alone (p < .0001) were a significant predictor of self-assessments done at the time of peer. Course was also a significant predictor (p = .01) of self-assessment scores done at the time of peer. Peer assessment score was not a significant predictor. Bhapkar's test revealed subgroup membership based on the relationship between self- and peer ratings was relatively stable across Time 1 and Time 2 assessments (χ = 0.83, p = .84) for all but one subgroup; members of the subgroup with initially high self-assessment and low peer assessment were significantly more likely to move to a new classification at the second measurement. A missing data analysis revealed that students who completed all self-assessments had significantly higher average peer assessment ratings compared to students who completed one or no self-assessments with a difference of -0.32, 95% confidence interval [-0.48, -0.15]. Insights: Multiple measurements of simultaneous self- and peer assessment identified a subgroup of students who consistently rated themselves higher on professionalism attributes relative to the low ratings given by their peers. This subgroup of preclinical students, along with those who elected to not complete self-assessments, may be at risk for professionalism concerns. Use of this multisource feedback tool to measure perceptual stability of professionalism behaviors is a new approach that may assist with early identification of at-risk students during preclinical years.

Background Workplace-based assessment (WBA) is critical to graduating competent physicians. Developing assessment tools that combine the needs of faculty, trainees, and governing bodies is challenging but imperative. Entrustable professional activities (EPAs) are emerging as a clinically oriented framework for trainee assessment.Objective We sought to develop an EPA-based WBA tool for pediatric critical care medicine (PCCM) fellows. The goals of the tool were to promote learning through benchmarking and tracking entrustment.Methods A single PCCM EPA was iteratively subdivided into observable practice activities (OPAs) based on national and local data. Using a mixed-methods approach following van der Vleuten's conceptual model for assessment tool utility and Messick's unified validity framework, we sought validity evidence for acceptability, content, internal structure, relation to other variables, response process, and consequences.Results Evidence was gathered after 1 year of use. Items for assessment were based on correlation between the number of times each item was assessed and the frequency professional activity occurred. Phi-coefficient reliability was 0.65. Narrative comments demonstrated all factors influencing trust, identified by current literature, were cited when determining level of entrustment granted. Mean entrustment levels increased significantly between fellow training years (P ¼ .001). Compliance for once-and twiceweekly tool completion was 50% and 100%, respectively. Average time spent completing the assessment was less than 5 minutes.Conclusions Using an EPA-OPA framework, we demonstrated utility and validity evidence supporting the tool's outcomes. In addition, narrative comments about entrustment decisions provide important insights for the training program to improve individual fellow advancement toward autonomy.

Objectives Communication and professionalism are often challenging to teach, and the impact of employing a given approach is not known. We undertook this investigation to establish PCCM trainee perception of education in professionalism and communication and to compare their responses from those obtained from Pediatric Critical Care Medicine (PCCM) fellowship program directors. Methods The Education in Pediatric Intensive Care (E.P.I.C.) Investigators used the modified Delphi technique to develop a survey examining teaching of professionalism and communication. After piloting, the survey was sent to all 283 PCCM fellows in training in the United States. Results Survey response rate was 47% (133/283). Despite high rates of teaching overall, deficiencies were noted in all areas of communication and professionalism assessed. The largest areas included not being specifically taught how to communicate: as a member of a non-clinical group (reported in 24%), across a broad range of socioeconomic and cultural backgrounds (19%) or how to provide consultation outside of the ICU (17%). Only 50% of fellows rated education in communication as ‘very good/excellent.’ but most felt confident in their communication abilities. For professionalism, fellows reported not being taught: accountability (12%), conducting a peer review (12%), and handling potential conflict between personal beliefs, circumstances, and professional values (10%). 57% of fellows felt that their professionalism education was ‘very good/excellent,’ but nearly all expressed confidence in these skills. Compared with program directors, fellows reported more deficiencies in both communication and professionalism. Conclusions There are numerous components of communication and professionalism that PCCM fellows perceive as not being specifically taught. Despite these deficiencies, fellow confidence remains high. Substantial opportunities exist to improve teaching in these areas. What’s New This investigation provides insight into the trainee perspective on both the effectiveness and areas of deficiency in teaching the domains of professionalism and communication in pediatric critical care medicine.

When used as a professionalism assessment within team-based learning, stand-alone and simultaneous peer and self-assessments are highly correlated within individuals across different courses. However, although self-assessment alone is a significant predictor of self-assessment made at the time of assessing one's peers, average peer assessment does not predict self-assessment. To explore this lack of predictive power, we classified students into four subgroups based on relative deviation from median peer and self-assessment scores. Group membership was found to be stable for all groups except for those initially sorted into the high self-assessment/low peer assessment subgroup. Members of this subgroup tended to move into the low self-assessment/low peer assessment group at T2, suggesting they became more accurate at self-assessing over time. A small group of individuals remained in the group that consistently rated themselves highly while their peers rated them poorly. Future studies will track these students to see if similar deviations from accurate professional self-assessment persist into the clinical years. In addition, given that students who fail to perform self-assessments had significantly lower peer assessment scores than their counterparts who completed self-assessments in this study, these students may also be at risk for similar professionalism concerns in the clinical years; follow-up studies will examine this possibility.

Background Pediatric critical care medicine requires the acquisition of procedural skills, but to date no criteria exist for assessing trainee competence in central venous catheter (CVC) insertion.

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