Qualitative case study methodology provides tools for researchers to study complex phenomena within their contexts. When the approach is applied correctly, it becomes a valuable method for health science research to develop theory, evaluate programs, and develop interventions. The purpose of this paper is to guide the novice researcher in identifying the key elements for designing and implementing qualitative case study research projects. An overview of the types of case study designs is provided along with general recommendations for writing the research questions, developing propositions, determining the “case” under study, binding the case and a discussion of data sources and triangulation. To facilitate application of these principles, clear examples of research questions, study propositions and the different types of case study designs

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Qualitative Case Study Methodology: Study Design and Implementation for Novice Researchers

The factors that cause large individual differences in professional achievement are only partially understood. Nobody becomes an outstanding professional without experience, but extensive experience does not invariably lead people to become experts. When individuals are first introduced to a professional domain after completing their education, they are often overwhelmed and rely on help from others to accomplish their responsibilities. After months or years of experience, they attain an acceptable level of proficiency and are able to work independently. Although everyone in a given domain tends to improve with experience initially, some develop faster than others and continue to improve during ensuing years. These individuals are eventually recognized as experts and masters. In contrast, most professionals reach a stable, average level of performance within a relatively short time frame and maintain this mediocre status for the rest of their careers. The nature of the individual differences that cause the large variability in attained performance is still debated. The most common explanation is that achievement in a given domain is limited by innate factors that cannot be changed through experience and training; hence, limits of attainable performance are determined by one’s basic endowments, such as abilities, mental capacities, and innate talents. Educators with this widely held view of professional development have focused on identifying and selecting students who possess the necessary innate talents that would allow them to reach expert levels with adequate experience. Therefore, the best schools and professional organizations nearly always rely on extensive testing and interviews to find the most talented applicants. This general view also explains age-related declines in professional achievement in terms of the inevitable reductions in general abilities and capacities believed to result from aging. In this article, I propose an alternative framework to account for individual differences in attained professional development, as well as many aspects of age-related decline. This framework is based on the assumption that acquisition of expert performance requires engagement in deliberate practice and that continued deliberate practice is necessary for maintenance of many types of professional performance. In order to contrast this alternative framework with the traditional view, I first describe the account based on innate talent. I then provide a brief review of the evidence on deliberate practice in the acquisition of expert performance in several performance domains, including music, chess, and sports. Finally, I review evidence from the acquisition and maintenance of expert performance in medicine and examine the role of deliberate practice in this domain.

http://edianas.com/portfolio/proj_EricssonInterview/articles/2004_Academic_Medicine_Vol_10,_S70-S81.pdf

Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains.

Background: Research into adverse events (AEs) has highlighted the need to improve patient safety. AEs are unintended injuries or complications resulting in death, disability or prolonged hospital stay that arise from health care management. We estimated the incidence of AEs among patients in Canadian acute care hospitals. Methods: We randomly selected 1 teaching, 1 large community and 2 small community hospitals in each of 5 provinces (British Columbia, Alberta, Ontario, Quebec and Nova Scotia) and reviewed a random sample of charts for nonpsychiatric, nonobstetric adult patients in each hospital for the fiscal year 2000. Trained reviewers screened all eligible charts, and physicians reviewed the positively screened charts to identify AEs and determine their preventability. Results: At least 1 screening criterion was identified in 1527 (40.8%) of 3745 charts. The physician reviewers identified AEs in 255 of the charts. After adjustment for the sampling strategy, the AE rate was 7.5 per 100 hospital admissions (95% confidence interval [CI] 5.7– 9.3). Among the patients with AEs, events judged to be preventable occurred in 36.9% (95% CI 32.0%–41.8%) and death in 20.8% (95% CI 7.8%–33.8%). Physician reviewers estimated that 1521 additional hospital days were associated with AEs. Although men and women experienced equal rates of AEs, patients who had AEs were significantly older than those who did not (mean age [and standard deviation] 64.9 [16.7] v. 62.0 [18.4] years; p = 0.016). Interpretation: The overall incidence rate of AEs of 7.5% in our study suggests that, of the almost 2.5 million annual hospital admissions in Canada similar to the type studied, about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable.

/pdf/the-canadian-adverse-events-study-the-incidence-of-adverse-4ip66k5tbq.pdf

The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada

Traditionally, surgeons have been trained and evaluated on the basis of their performance of surgical procedures in live patients. This article in the Medical Education series explores the use of mechanical devices for the teaching and evaluation of surgical skills.

Teaching Surgical Skills — Changes in the Wind

https://coloradocap.com/wp-content/uploads/2011/11/Book-Review-The-Checklist-Manifesto.pdf

The Checklist Manifesto: How to Get Things Right

Training in surgery has historically been considered an apprenticeship. Traditionally, the early training experiences of junior surgical residents are in real operative settings, on real patients. Several factors suggest that the operating theater may no longer provide the ideal atmosphere to foster the skills of a novice surgeon. First, as pressures intensify to use operating room time and resources efficiently, less time is available for teaching and practice of fundamental technical skills.1,2 Second, ethical concerns about teaching and learning basic surgical techniques on live human patients have been voiced.3 Third, the movement toward increased specialization in academic teaching hospitals has resulted in more highly complex and challenging surgical problems, which demand greater surgical expertise. Finally, technical evolution in surgery has created new skill sets and techniques that must be mastered by both practicing surgeons and trainees prior to clinical application.

Reacting to this situation, many academic health centers have turned toward laboratory-based training programs to foster the development of technical skills in both junior and senior surgeons.4–6 While the need for laboratory-based technical skills training courses has been identified,4 there remains debate regarding the educational effectiveness of such initiatives as they currently exist. Few studies have evaluated the impact of a focused laboratory-based training program using valid and objective assessments of surgical performance. Moreover, several authors have argued that short technical skills training courses are insufficient to provide adequate knowledge and skill and should not be used as a substitute for hands-on experience.7,8

As surrogates for human anatomy, surgical skills training laboratories rely on a variety of bench model simulations. These models vary widely with respect to their level of fidelity or “realism” to living human patients. Live animal and fresh human cadaver models, considered to be of high-fidelity, are limited by availability, high costs, potential for transmission of infectious disease, and ethical concerns.6,9 Lower-fidelity synthetic bench models sacrifice realism for portability, lower costs, and the potential for repetitive use.6,9 Despite the intuitive belief that “the more realistic, the better,” few studies have directly compared the relative attributes and educational effectiveness of live animal models versus synthetic training models on the acquisition and maintenance of surgical skill. Using microsurgery as the research platform, the current initiative was designed to evaluate the significance of bench model fidelity on the acquisition of technical skill among surgical trainees using clinically relevant outcome measures.

The educational impact of bench model fidelity on the acquisition of technical skill: the use of clinically relevant outcome measures.

https://www.thelancet.com/pdfs/journals/lancet/PIIS014067360207441X.pdf

Effect of visual-spatial ability on learning of spatially-complex surgical skills

Teaching the surgical craft: From selection to certification

Visual-spatial ability correlates with efficiency of hand motion and successful surgical performance

Laboratory based training in urological microsurgery with bench model simulators: a randomized controlled trial evaluating the durability of technical skill.

Kyle R. Wanzel

Papers

The educational impact of bench model fidelity on the acquisition of technical skill: the use of clinically relevant outcome measures.

Effect of visual-spatial ability on learning of spatially-complex surgical skills

Teaching the surgical craft: From selection to certification

Visual-spatial ability correlates with efficiency of hand motion and successful surgical performance

Laboratory based training in urological microsurgery with bench model simulators: a randomized controlled trial evaluating the durability of technical skill.