Clinical Education: Origins and Outcomes

McGaghie, William C.; Wayne, Diane B.

doi:10.1007/978-3-030-34811-3_1

Cited by 9 publications

(9 citation statements)

References 70 publications

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“…Hemodynamics are typically learned from evaluating patients while on clinical service and through independent study. However, many trainees are not exposed to all basic clinical scenarios depending on individual experience 17 . Furthermore, there are trainees who require extra hemodynamic interpretation training despite clinical exposure.…”

Section: Discussionmentioning

confidence: 99%

Improving cardiology fellow education of right heart catheterization using a simulation based curriculum

Davidson

Chow

Jivan

et al. 2020

Cathet Cardio Intervent

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Background Medical procedures are traditionally taught informally at patients' bedside through observation and practice using the adage “see one, do one, teach one.” This lack of formalized training can cause trainees to be unprepared to perform procedures independently. Simulation based education (SBE) increases competence, reduces complications, and decreases costs. We developed, implemented, and evaluated the efficacy of a right heart catheterization (RHC) SBE curriculum. Methods The RHC curriculum consisted of a pretest, video didactics, deliberate practice, and a posttest. Pre‐and posttest skills examinations consisted of a dichotomous 43‐item checklist on RHC skills and a 14‐item hemodynamic waveform quiz. We enrolled two groups of fellows: 6 first‐year, novice cardiology fellows at Northwestern University in their first month of training, and 11 second‐ and third‐year fellows who had completed traditional required, level I training in RHC. We trained the first‐year fellows at the beginning of the 2018–2019 year using the SBE curriculum and compared them to the traditionally‐trained cardiology fellows who did not complete SBE. Results The SBE‐trained fellows significantly improved RHC skills, hemodynamic knowledge, and confidence from pre‐ to posttesting. SBE‐trained fellows performed similarly to traditionally‐trained fellows on simulated RHC skills checklists (88.4% correct vs. 89.2%, p = .84), hemodynamic quizzes (94.0% correct vs. 86.4%, p = .12), and confidence (79.4 vs. 85.9 out of 100, p = .15) despite less clinical experience. Conclusions A SBE curriculum for RHC allowed novice cardiology fellows to achieve level I skills and knowledge at the beginning of fellowship and can train cardiology fellows before patient contact.

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Section: Discussionmentioning

confidence: 99%

Improving cardiology fellow education of right heart catheterization using a simulation based curriculum

Davidson

Chow

Jivan

et al. 2020

Cathet Cardio Intervent

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“…The course began with learners completing a directly observed baseline skills pretest using the modified TUBE-iCOMPT checklist, as outlined by step 1 of the mastery learning bundle described by McGaghie. 8 This was done without prompting or teaching from instructors to allow it to be a true baseline assessment. Following the pretest, the instructors went over the results with each learner and gave direct feedback in order to review specific areas for improvement and to tailor the deliberate practice session to the needs of each individual learner.…”

Section: Methodsmentioning

confidence: 99%

“…McGaghie describes a mastery learning bundle of seven features: (1) baseline or diagnostic testing, (2) clear learning objectives, (3) educational activities, (4) minimum passing standards, (5) formative testing with actionable feedback, (6) evidence-based advancement, and (7) continued practice and assessment until the minimum passing standard is reached. 8 …”

Section: Introductionmentioning

confidence: 99%

Simulation-Based Mastery Learning Course for Tube Thoracostomy

et al. 2022

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Introduction Tube thoracostomy is a relatively infrequent, high-risk procedure that is a required competency for emergency medicine residents. Simulation-based mastery learning is the gold standard for procedure training and has been used to successfully train residents in high-risk procedures. Methods We developed a simulation-based mastery learning course for tube thoracostomy for PGY 2 emergency medicine residents. The course included (1) precourse work, (2) baseline assessment using a modified version of the TUBE-iCOMPT checklist, (3) anatomy/radiology review, (4) deliberate practice to master individual aspects of the procedure, and (5) final assessment. If a minimum passing score was not achieved, additional coaching and deliberate practice occurred until the learner was able to achieve a minimum passing score. Results After piloting the course with a cohort of seven PGY 2 emergency medicine residents, we successfully trained 24 additional PGY 2 residents in the subsequent two classes. Combining all three cohorts ( N = 31), there was a statistically significant increase in learners’ modified TUBE-iCOMPT scores (pretest M = 61.2, SD = 10.0; posttest M = 75.5, SD = 2.9; p < .001). Learners’ confidence in their ability to correctly place a chest tube increased, rated on a 10-point Likert scale (1 = not very confident , 10 = very confident ; precourse M = 5.6, SD = 1.8; postcourse M = 8.3, SD = 1.1; p < .001). Discussion This simulation-based course was well received by learners. Our assessment demonstrated that learners improved directly observed procedural skills in simulation and confidence in tube thoracostomy placement.

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“…After assessment, participants were given direct feedback, time for deliberate practice, and repeat testing until a minimum passing standard (MPS) was met using mastery learning principles. 14 The MPS for the assessment tool was set by our expert panel using the Mastery Angoff approach, with additional determination of items critical for patient safety. 15 …”

Section: The Implementation Phasementioning

confidence: 99%

The OSSE: Development and validation of an “Objective Structured Supervision Evaluation”

Pokrajac

Roszczynialski

Rider

et al. 2022

AEM Education and Training

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Background Trainee supervision and teaching are distinct skills that both require faculty physician competence to ensure patient safety. No standard approach exists to teach physician supervisory competence, resulting in variable trainee oversight and safety threats. The Objective Structured Teaching Evaluation (OSTE) does not adequately incorporate the specific skills required for effective supervision. To address this continuing medical education gap, the authors aimed to develop and identify validity evidence for an “Objective Structured Supervision Evaluation” (OSSE) for attending physicians, conceptually modeled on the historic OSTE. Methods An expert panel used an iterative process to create an OSSE instrument, which was a checklist of key supervision items to be evaluated during a simulated endotracheal intubation scenario. Three trained “standardized residents” scored faculty participants' performance using the instrument. Validity testing modeled a contemporary approach using Kane's framework. Participants underwent simulation‐based mastery learning (SBML) with deliberate practice until meeting a minimum passing standard (MPS). Results The final instrument contained 19 items, including three global rating measures. Testing domains included supervision climate , participant control of patient care , trainee evaluation , instructional skills , case‐specific measures , and overall supervisor rating . Reliability of the assessment tool was excellent (ICC range 0.84–0.89). The assessment tool had good internal consistency (Cronbach's α = 0.813). Out of 24 faculty participants, 17 (70.8%) met the MPS on initial assessment. All met the MPS after SBML and average score increased by 19.5% (95% CI of the difference 10.3%–28.8%, p = 0.002). Conclusions The OSSE is a promising tool to assess faculty supervision performance. Further study should evaluate the effect of OSSE training on supervision in the clinical environment, which may have measurable changes in patient‐centered outcomes and resident teaching.

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Clinical Education: Origins and Outcomes

Cited by 9 publications

References 70 publications

Improving cardiology fellow education of right heart catheterization using a simulation based curriculum

Improving cardiology fellow education of right heart catheterization using a simulation based curriculum

Simulation-Based Mastery Learning Course for Tube Thoracostomy

The OSSE: Development and validation of an “Objective Structured Supervision Evaluation”

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