New Measures to Establish the Evidence Base for Medical Education: Identifying Educationally Sensitive Patient Outcomes

Kalet, Adina; Gillespie, Colleen; Schwartz, Mark D.; Holmboe, Eric S.; Ark, Tavinder K.; Jay, Melanie; Paik, Steve; Truncali, Andrea; Bruno, Julia Hyland; Zabar, Sondra; Gourevitch, Marc N.

doi:10.1097/acm.0b013e3181d734a5

Cited by 64 publications

(54 citation statements)

References 33 publications

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“…Our synthesis of evidence across 50 studies complements and expands upon proposed conceptual models for educationally-relevant patient outcomes. 22,87,88 The reporting of validity evidence in this sample was even less frequent than in previous reviews in medical education. 6,9,13,[18][19][20][21] We discuss this below.…”

Section: Integration With Other Literaturementioning

confidence: 82%

“…22 Studies in which multiple patients contribute data for each trainee (patients clustered in trainees) require statistical techniques that account for such clustering. 23 Clinical research suggests that such unit of analysis errors are relatively common, ranging from 22 to 71 %, [24][25][26][27][28][29] and generally inflate the power of the analysis.…”

Section: Methodological Issues In Patient Outcomes Studiesmentioning

confidence: 99%

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Patient Outcomes in Simulation-Based Medical Education: A Systematic Review

et al. 2013

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OBJECTIVES:Evaluating the patient impact of health professions education is a societal priority with many challenges. Researchers would benefit from a summary of topics studied and potential methodological problems. We sought to summarize key information on patient outcomes identified in a comprehensive systematic review of simulation-based instruction. DATA SOURCES: Systematic search of MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, key journals, and bibliographies of previous reviews through May 2011. STUDY ELIGIBILITY: Original research in any language measuring the direct effects on patients of simulationbased instruction for health professionals, in comparison with no intervention or other instruction. APPRAISAL AND SYNTHESIS: Two reviewers independently abstracted information on learners, topics, study quality including unit of analysis, and validity evidence. We pooled outcomes using random effects. RESULTS: From 10,903 articles screened, we identified 50 studies reporting patient outcomes for at least 3,221 trainees and 16,742 patients. Clinical topics included airway management (14 studies), gastrointestinal endoscopy (12), and central venous catheter insertion (8). There were 31 studies involving postgraduate physicians and seven studies each involving practicing physicians, nurses, and emergency medicine technicians. Fourteen studies (28 %) used an appropriate unit of analysis. Measurement validity was supported in seven studies reporting content evidence, three reporting internal structure, and three reporting relations with other variables. The pooled Hedges' g effect size for 33 comparisons with no intervention was 0.47 (95 % confidence interval [CI], 0.31-0.63); and for nine comparisons with non-simulation instruction, it was 0.36 (95 % CI, −0.06 to 0.78). LIMITATIONS: Focused field in education; high inconsistency (I 2 >50 % in most analyses). CONCLUSIONS: Simulation-based education was associated with small-moderate patient benefits in comparison with no intervention and non-simulation instruction, although the latter did not reach statistical significance. Unit of analysis errors were common, and validity evidence was infrequently reported.

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Section: Integration With Other Literaturementioning

confidence: 82%

Section: Methodological Issues In Patient Outcomes Studiesmentioning

confidence: 99%

Patient Outcomes in Simulation-Based Medical Education: A Systematic Review

et al. 2013

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“…1 We have proposed that by identifying a set of Educationally Sensitive Patient Outcomes (ESPOs), medical education outcomes research becomes more feasible and likely to provide meaningful guidance for medical education policy and practice. 2 ESPOs are patient outcomes that are sensitive to provider education, can be measured, and are in the pathway linking medical education interventions to patient outcomes. As others have pointed out, conducting a series of studies which demonstrate these links can overcome many of the methodological complexities associated with attempting to directly link provider education to patient outcomes in a single study.…”

Section: Introductionmentioning

confidence: 99%

Health Literacy: An Educationally Sensitive Patient Outcome

et al. 2015

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We have previously proposed that by identifying a set of Educationally Sensitive Patient Outcomes (ESPOs), medical education outcomes research becomes more feasible and likely to provide meaningful guidance for medical education policy and practice. ESPOs are proximal outcomes that are sensitive to provider education, measurable, and linked to more distal health outcomes. Our previous model included Patient Activation and Clinical Microsystem Activation as ESPOs. In this paper, we discuss how Health Literacy, defined as Bthe degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,^is another important ESPO. Between one-third and one-half of all US adults have limited health literacy skills. Providers can be trained to adopt a Buniversal precautions approach^to addressing patient health literacy, through the acquisition of specific skills (e.g., teachback, Bchunking^infor-mation, use of plain language written materials) and by learning how to take action to improve the Bhealth literacy environment.^While there are several ways to measure health literacy, identifying which measurement tools are most sensitive to provider education is important, but challenging and complex. Further research is needed to test this model and identify additional ESPOs.

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“…Interesting work at the interface of medical education and delivery of ambulatory care suggests a focus on ''educationally sensitive'' outcomes that may advance the assessment of the effectiveness of educational innovation to domains that truly make them relevant, i.e., the impact on patients and the clinical system in which residents practice. 101 There are recent examples that show the value of the competencies in anesthesiology. [53][54][55][56][57][58] Future research could build on this beginning to develop and validate explicit ''milestones'' of expected learning achievements modelled on the competencies or the CanMEDS roles.…”

Section: Scientific Theory In Medical Education Researchmentioning

confidence: 99%

Review article: Closing the research gap at the interface of learning and clinical practice

Philibert

2011

Can J Anesth/J Can Anesth

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Purpose The dialogue at the interface of education and clinical practice highlights areas of critical importance to the development of new approaches for educating anesthesiologists. The purpose of this article is to examine the literature on education and acquisition of competence in three areas relevant to the interface of learning and clinical practice, with the aim to suggest a research agenda that adds to the evidence on preparing physicians for independent practice. The three areas are: 1) transitions across the continuum of education; 2) the effect of reductions in hours of clinical training on competence; and 3) efforts to incorporate the competencies and CanMEDS roles into teaching and evaluation. Principal findings Fifty-six articles relevant to one or more of the themes were identified in the review, including 21 studies of transitions (in, during, and after residency education), 19 studies on the effects of duty hour limits on residents' acquisition of competence, and 16 articles that assessed competency-based teaching and assessment in anesthesiology. Overall, the findings suggested a relative paucity of scientific evidence and a need for research and the development of new scientific theory. Studies generally treated one of the themes in isolation, while in actuality they interact to produce optimal as well as suboptimal learning situations, while medical education research often is limited by small samples, brief follow-up, and threats to validity. This suggests a ''research gap'' where editorials and commentaries have moved ahead of an evidence base for education. Promising areas for research include preparation for care deemed important by society, work to apply knowledge about the development of expertise in other disciplines to medicine, and ways to embed the competencies in teaching and evaluation more effectively. Conclusion Closing the research gap in medical education will require clear direction for future work. The starting point, at an institution or nationally, is dialogue within the specialty to achieve consensus on some of the most pressing questions.

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New Measures to Establish the Evidence Base for Medical Education: Identifying Educationally Sensitive Patient Outcomes

Cited by 64 publications

References 33 publications

Patient Outcomes in Simulation-Based Medical Education: A Systematic Review

Patient Outcomes in Simulation-Based Medical Education: A Systematic Review

Health Literacy: An Educationally Sensitive Patient Outcome

Review article: Closing the research gap at the interface of learning and clinical practice

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