Showing papers by "Albert J. J. A. Scherpbier published in 2006"

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

Abstract: 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 exp...

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

Abstract: 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 ...

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

Abstract: 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.

Design of integrated practice for learning professional competences.

Abstract: To acquire professional competences that entail performance of complex skills, an authentic learning environment is required focused on the integration of all aspects of competences. However, most educational programmes offer separate building blocks, such as separate modules for knowledge and skills. Students accumulate what they have learned in these modules as they progress through the curriculum. In this paper the authors advocate the Four-Component Instructional Design model (4C/ID), which offers a whole-task approach to course design for programmes in which students learn complex skills. The four core components of this approach are: learning tasks, supportive information, just-in-time information and part-task practice. A concrete example from medical education will be presented to clarify both the general ideas behind this approach and the differences between the whole-task approach and conventional educational designs.

A Two-Day Teacher-Training Programme for Medical Residents: Investigating the Impact on Teaching Ability.

Abstract: Introduction: Many of the residents who supervise medical students in clinical practice are unfamiliar with the principles of effective supervision. Training in teaching skills is therefore seen as an effective strategy to improve the quality of clinical supervision. Method: Twenty seven medical residents were matched and assigned to an experimental group (n = 14) and a control group (n = 13). The experimental group participated in a two-day workshop on teaching skills. Using standardized questionnaires, the teaching abilities of all participants were assessed anonymously by medical students, before and after the workshop, to determine for any effect of the intervention. Results: A significant improvement in the teaching abilities of the medical residents in the experimental group was observed following the workshop (t=−2.68, p=0.02). The effect size within the experimental group was large (d=1.17), indicating that the workshop led to a measurable positive change in the medical residents’ teaching abilities. The effect size estimated from the post intervention scores on teaching ability of the two groups showed a moderate improvement (d=0.57) in the experimental group compared with the control group. Discussion: Medical students rated the teaching abilities of the workshop participants after the training more highly than those of the residents in the control group. The ability to adjust teaching to the needs of the students and teach effective communication and diagnostic clinical skills were among the features that characterized effective teaching. Properly designed, teacher-training workshops could be effective and feasible methods to improve the quality of teaching by medical residents.

In‐training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation

Abstract: BACKGROUND Supervision and feedback are essential factors that contribute to the learning environment in the context of workplace learning and their frequency and quality can be improved. Assessment is a powerful tool with which to influence students' learning and supervisors' teaching and thus the learning environment. OBJECTIVE To investigate an in-training assessment (ITA) programme in action and to explore its effects on supervision and feedback. DESIGN A qualitative study using individual, semistructured interviews. SUBJECTS AND SETTING Eight students and 17 assessors (9 members of staff and 8 residents) in the internal medicine undergraduate clerkship at Vrije Universiteit Medical Centre, Amsterdam, the Netherlands. RESULTS The ITA programme in action differed from the intended programme. Assessors provided hardly any follow-up on supervision and feedback given during assessments. Although students wanted more supervision and feedback, they rarely asked for it. Students and assessors failed to integrate the whole range of competencies included in the ITA programme into their respective learning and supervision and feedback. When giving feedback, assessors rarely gave borderline or fail judgements. DISCUSSION AND CONCLUSION If an ITA programme in action is to be congruent with the intended programme, the implementation of the programme must be monitored. It is also necessary to provide full information about the programme and to ensure this information is given repeatedly. Introducing an ITA programme that includes the assessment of several competencies does not automatically lead to more attention being paid to these competencies in terms of supervision and feedback. Measures that facilitate change in the learning environment seem to be a prerequisite for enabling the assessment programme to steer the learning environment.

Student evaluation of the clinical 'curriculum in action'.

Abstract: 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.

Internationalization of medical education in the Netherlands: state of affairs.

Abstract: In the framework of the Bologna Process, internationalization co-ordinators of seven (out of eight) Dutch medical schools completed an electronic survey about internationalization-related aspects of the curriculum. Common features of internationalization in Dutch medical schools were: the numbers of outgoing students exceeded the numbers of incoming students, and most international programmes involved clinical training and research projects. We recommend that Dutch medical schools should pay more attention to 'Internationalization at Home' and focus on conditions that are conducive to participation by foreign students.

The learning processes of international students through the eyes of foreign supervisors.

Abstract: Semi-structured interviews were conducted with external supervisors of international electives undertaken by Dutch undergraduate students, in order to gain insight into student learning processes during these electives. The interviews served to triangulate information on these learning processes that was obtained from students’ self-reports. The results of the case study reported in this paper were largely consistent with findings from prior studies of international electives in which learning processes and sociocultural differences were examined: experiential learning processes appeared to dominate and sociocultural differences occasionally seemed to blur productive learning, especially when the differences between the national cultures of host country and student home country were substantial. It is recommended that students’ experiential learning from international electives should be supplemented with ‘guided’ and ‘self-directed’ learning with a focus on the sociocultural dimension.

The relationship between professional behaviour grades and tutor performance ratings in problem-based learning.

Abstract: PURPOSE We investigated the influence of harsh grading by tutors on tutor performance rating by students. METHODS A total of 187 tutors assessed students' professional behaviour in tutorial groups. Students rated tutor performance after receiving their grades for professional behaviour. In addition, students were asked to indicate whether they perceived their professional behaviour grades as too positive, adequate or too negative. This was considered to reflect tutors' harshness of grading. Students also rated the quality of the feedback they received from tutors with respect to their grades. RESULTS Professional behaviour grades that students perceived as too negative, adequate or too positive were associated with tutor performance ratings of 7.4 (SD = 0.9, scale 1-10, n = 33), 7.7 (SD = 0.9, scale 1-10, n = 95) and 7.5 (SD = 0.8, scale 1-10, n = 59), respectively. Harshness of grading did not influence tutor performance ratings significantly. Tutor ratings were predicted more effectively by the quality of the feedback tutors provided on grades than by the harshness of grading. CONCLUSIONS Tutor performance ratings were not related significantly to harshness of grading. Two explanations can be given: (1) tutor performance ratings were based on rating by groups of students and (2) the percentage of tutors who rated students' professional behaviour as unsatisfactory was low. The strong relationship between tutor performance ratings and the adequacy of the feedback given by tutors suggests that the tutor performance ratings collected in this study are a valid measure of the quality of their teaching, although, for a full picture of teaching quality, more measures will be needed.

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

Abstract: 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.

First aid and basic life support of junior doctors: A prospective study in Nijmegen, the Netherlands

Abstract: According to the Dutch medical education guidelines junior doctors are expected to be able to perform first aid and basic life support. A prospective study was undertaken to assess the level of first aid and basic life support (BLS) competence of junior doctors at the Radboud University Nijmegen Medical Centre (RUNMC), the Netherlands. Fifty-four junior doctors (18%), of the medical students in their final years, were submitted to a theoretical test, composed of multiple-choice questions concerning first aid and basic life support. This test was followed by a practical test consisting of two out-of-hospital first aid and basic life support scenarios including cardiopulmonary resuscitation (CPR). In total, 19% of the junior doctors passed the theoretical test. The first scenario was performed correctly in 11%. The CPR situation was correctly performed by 30% of the students as observed by the examiners but when assessed by the checklists of Berden only 6% of the students performed correct CPR. It is concluded that the level of first aid and basic life support of the junior doctors at the RUNMC is low and does not meet the required level as stated in the guidelines for practice of medical education in the Netherlands.

Commentary: Dutch perspective

Abstract: The health service in England is experiencing a revolution.1 Dutch health care is also changing but less dramatically than in England. Medical educators can embrace this challenge as an opportunity to improve medical education and training.

A Description of a Validated Effective Teacher-Training Workshop for Medical Residents.

Abstract: A teacher-training program for residents was designed and piloted in the St. Elisabeth Hospital in Curacao, Netherlands Antilles. The program comprised of six modules namely: effective teaching, self-knowledge and teaching ability, feedback, assessing prior knowledge, trouble shooting and time management. Method: Instruction was provided during a two-day workshop with eight hours instruction time per day. Residents in the first three years of training participated, and the instructors were experienced clinicians. Lectures, group discussions, case simulations, video presentations and role-plays were the forms of instruction. Results: Using standardized questionnaires, the participants rated the quality of the workshop highly. They considered it to be a feasible and appropriate educational intervention and that it had a positive impact on their teaching skills. Conclusion: This workshop was developed based on careful analysis of medical residents’ perceived educational needs and systematically implemented and evaluated. The results show that it is a suitable and effective educational intervention.

[In the consultation room, knowledge that must be looked up is more important than ready knowledge].

Abstract: In the consultation room, it is better to have a doctor that looks something up than one who thinks that he has (or should have) everything at his fingertips. Doctors require ready knowledge, but the rapid changes make it impossible to keep all knowledge at the ready. Training courses must pay attention to the retrieval, assessment and maintenance of (new) professional knowledge. A positive attitude and helpful aids are essential here.