Showing papers in "Academic Medicine in 2010"
TL;DR: The authors trace the seeds of these themes in Flexner's work and describe their own conceptions of them, addressing the prior and current challenges to medical education as well as recommendations for achieving excellence.
Abstract: The Carnegie Foundation for the Advancement of Teaching, which in 1910 helped stimulate the transformation of North American medical education with the publication of the Flexner Report, has a venerated place in the history of American medical education. Within a decade following Flexner's r
684 citations
TL;DR: The authors argue that the approach to designing and evaluating the success of translational training programs must be flexible enough to accommodate the needs of individual institutions and individual trainees within the institutions but that it must also be rigorous enough to document that the program is meeting its short-, intermediate-, and long-term objectives and that its trainees are meeting preestablished competency requirements.
Abstract: Because translational research is not clearly defined, developers of translational research programs are struggling to articulate specific program objectives, delineate the knowledge and skills (competencies) that trainees are expected to develop, create an appropriate curriculum, and track outcomes to assess whether program objectives and competency requirements are being met. Members of the Evaluation Committee of the Association for Clinical Research Training (ACRT) reviewed current definitions of translational research and proposed an operational definition to use in the educational framework. In this article, the authors posit that translational research fosters the multidirectional and multidisciplinary integration of basic research, patient-oriented research, and population-based research, with the long-term aim of improving the health of the public. The authors argue that the approach to designing and evaluating the success of translational training programs must therefore be flexible enough to accommodate the needs of individual institutions and individual trainees within the institutions but that it must also be rigorous enough to document that the program is meeting its short-, intermediate-, and long-term objectives and that its trainees are meeting preestablished competency requirements. A logic model is proposed for the evaluation of translational research programs.
534 citations
TL;DR: Interactivity, practice exercises, repetition, and feedback seem to be associated with improved learning outcomes, although inconsistency across studies tempers conclusions.
Abstract: PurposeA recent systematic review (2008) described the effectiveness of Internet-based learning (IBL) in health professions education. A comprehensive synthesis of research investigating how to improve IBL is needed. This systematic review sought to provide such a synthesis.MethodThe authors
468 citations
TL;DR: Comparisons of different virtual patient designs suggest that repetition until demonstration of mastery, advance organizers, enhanced feedback, and explicitly contrasting cases can improve learning outcomes.
Abstract: PurposeEducators increasingly use virtual patients (computerized clinical case simulations) in health professions training. The authors summarize the effect of virtual patients compared with no intervention and alternate instructional methods, and elucidate features of effective virtual pati
421 citations
TL;DR: QI and PS curricula that target trainees usually improve learners' knowledge and frequently result in changes in clinical processes, however, successfully implementing such curricula requires attention to a number of learner, faculty, and organizational factors.
Abstract: PurposeTo systematically review published quality improvement (QI) and patient safety (PS) curricula for medical students and/or residents to (1) determine educational content and teaching methods, (2) assess learning outcomes achieved, and (3) identify factors promoting or hindering curricu
405 citations
TL;DR: Medical students' higher performance on examination questions related to course content learned through TBL suggests that TBL enhances mastery of course content.
Abstract: Purpose Since team-based learning (TBL) was introduced as a medical education strategy in 2001, few studies have explored its impact on learning outcomes, particularly as measured by performance on examinations. Educators considering implementing TBL need evidence of its effectiveness. This study was conducted to determine whether student performance on examinations is affected by participation in TBL and whether TBL benefits lower- or higherperforming students. Method The authors analyzed the performance of second-year medical students on 28 comprehensive course examinations over two consecutive academic years (2003– 2004, 2004–2005) at the Boonshoft School of Medicine. Results The 178 students (86 men, 92 women) included in the study achieved 5.9% (standard deviation [SD] 5.5) higher mean scores on examination questions that assessed their knowledge of pathology-based content learned using the TBL strategy compared with questions assessing pathology-based content learned via other methods (P .001, t test). Students whose overall academic performance placed them in the lowest quartile of the class benefited more from TBL than did those in the highest quartile. Lowest-quartile students’ mean scores were 7.9% (SD 6.0) higher on examination questions related to TBL modules than examination questions not related to TBL modules, whereas highest-quartile students’ mean scores were 3.8% (SD 5.4) higher (P .001, two-way analysis of variance). Conclusions Medical students’ higher performance on examination questions related to course content learned through TBL suggests that TBL enhances mastery of course content. Students in the lowest academic quartile may benefit more than highestquartile students from the TBL strategy.
394 citations
TL;DR: Burnout seems to be associated with increased likelihood of serious thoughts of dropping out, and low scores for personal accomplishment, lower mental and physical QOL, and having children were independent predictors of students having serious thoughts about dropping out during the following year.
Abstract: Purpose Little is known about students who seriously consider dropping out of medical school. The authors assessed the severity of thoughts of dropping out and explored the relationship of such thoughts with burnout and other indicators of distress. Method The authors surveyed medical students attending five medical schools in 2006 and 2007 (prospective cohort) and included two additional medical schools in 2007 (cross-sectional cohort). The survey included questions about thoughts of dropping out, life events in the previous 12 months, and validated instruments evaluating burnout, depression symptoms, and quality of life (QOL). Results Data were provided by 858 (65%) students in the prospective cohort and 2,248 (52%) in the cross-sectional cohort. Of 2,222 respondents, 243 (11%) indicated having serious thoughts of dropping out within the last year. Burnout (P .0001), QOL (P .003 each domain), and depressive symptoms (P .0001) at baseline predicted serious thoughts of dropping out during the following year. Each one-point increase in emotional exhaustion and depersonalization score and one-point decrease in personal accomplishment score at baseline was associated with a 7% increase in the odds of serious
371 citations
TL;DR: The teaching of clinical reasoning need not and should not be delayed until students gain a full understanding of anatomy and pathophysiology, and concepts such as hypothesis generation, pattern recognition, context formulation, diagnostic test interpretation, differential diagnosis, and diagnostic verification provide both the language and the methods of clinical problem solving.
Abstract: Optimal medical care is critically dependent on clinicians’ skills to make the right diagnosis and to recommend the most appropriate therapy, and acquiring such reasoning skills is a key requirement at every level of medical education. Teaching clinical reasoning is grounded in several fundamental principles of educational theory. Adult learning theory posits that learning is best accomplished by repeated, deliberate exposure to real cases, that case examples should be selected for their reflection of multiple aspects of clinical reasoning, and that the participation of a coach augments the value of an educational experience. The theory proposes that memory of clinical medicine and clinical reasoning strategies is enhanced when errors in information, judgment, and reasoning are immediately pointed out and discussed. Rather than using cases artificially constructed from memory, real cases are greatly preferred because they often reflect the false leads, the polymorphisms of actual clinical material, and the misleading test results encountered in everyday practice. These concepts foster the teaching and learning of the diagnostic process, the complex trade-offs between the benefits and risks of diagnostic tests and treatments, and cognitive errors in clinical reasoning. The teaching of clinical reasoning need not and should not be delayed until students gain a full understanding of anatomy and pathophysiology. Concepts such as hypothesis generation, pattern recognition, context formulation, diagnostic test interpretation, differential diagnosis, and diagnostic verification provide both the language and the methods of clinical problem solving. Expertise is attainable even though the precise mechanisms of achieving it are not known. Acad Med. 2010; 85:1118–1124. All teaching methods are of necessity pragmatic and context-dependent. Teaching approaches lack a firm scientific underpinning because of the paucity of scientific evidence about optimal learning. Despite substantial advances in our understanding of human cognition during the last few decades, our teaching methods are still based largely on expert opinion. If these assertions are true for elementary teaching, they are even more compelling when applied to a field as complex as clinical reasoning. Given these modest scientific underpinnings, we might just throw up our hands and give up any hope of imparting reasoning skills to students and residents, yet we know there is much to learn, that many do become expert clinical problem solvers, and that the welfare of patients depends as much on reasoning and problemsolving abilities as it does on the use of the latest technology. Clinical cognition encompasses the range of strategies that clinicians use to generate, test, and verify diagnoses, to assess the benefits and risks of tests and treatments, and to judge the prognostic significance of the outcomes of these cognitive achievements. Needless to say, clinical medicine consists of much more than clinical cognition, including meticulous gathering of data, careful examination of patients, empathy with the sick, ability to communicate with patients, and professional demeanor, among many others, but this essay is restricted to clinical cognition. Though we still have much to learn about clinical cognition, several sources can be combined to define a reasonable pragmatic approach that can be subjected to critical evaluation. These sources start with commonsense notions of learning from some of the most venerated and respected educators, from modern theories of adult learning, from research on clinical cognition, and from the experience of educators, such as myself, who have been working at it for decades.
343 citations
TL;DR: Relationships between medical student burnout, empathy, and professionalism climate are observed and may have implications for the design of curriculum interventions to promote student well-being and professionalism.
Abstract: BackgroundMedical student burnout is prevalent, and there has been much discussion about burnout and professionalism in medical education and the clinical learning environment. Yet, few studies have attempted to explore relationships between those issues using validated instruments.MethodMed
331 citations
TL;DR: Students' reflections on thehidden curriculum are a rich resource for gaining a deeper understanding of how the hidden curriculum shapes medical trainees, and medical educators may use these results to inform, revise, and humanize clinical medical education.
Abstract: To probe medical students' narrative essays as a rich source of data on the hidden curriculum, a powerful influence shaping the values, roles, and identity of medical trainees.
In 2008, the authors used grounded theory to conduct a thematic analysis of third-year Harvard Medical School students' reflection papers on the hidden curriculum.
Four overarching concepts were apparent in almost all of the papers: medicine as culture (with distinct subcultures, rules, vocabulary, and customs); the importance of haphazard interactions to learning; role modeling; and the tension between real medicine and prior idealized notions. The authors identified nine discrete “core themes” and coded each paper with up to four core themes based on predominant content. Of the 30 students (91% of essay writers, 20% of class) who consented to the study, 50% focused on power–hierarchy issues in training and patient care; 30% described patient dehumanization; 27%, respectively, detailed some “hidden assessment” of their performance, discussed the suppression of normal emotional responses, mentioned struggling with the limits of medicine, and recognized personal emerging accountability in their medical training; 23% wrote about the elusive search for personal/professional balance and contemplated the sense of “faking it” as a young doctor; and 20% relayed experiences derived from the positive power of human connection.
Students' reflections on the hidden curriculum are a rich resource for gaining a deeper understanding of how the hidden curriculum shapes medical trainees. Ultimately, medical educators may use these results to inform, revise, and humanize clinical medical education.
317 citations
TL;DR: Findings suggest the need for attention to the varied influencing conditions and inherent tensions to progress in understanding self-assessment, how it is informed, and its role in self-directed learning and professional self-regulation.
Abstract: PurposeTo determine how learners and physicians engaged in various structured interventions to inform self-assessment, how they perceived and used self-assessment in clinical learning and practice, and the components and processes comprising informed self-assessment and factors that influenc
TL;DR: The findings strongly suggest that students' reflective narratives are a rich source of information about the elements of both the informal and hidden curricula, in which medical students learn to become physicians.
Abstract: PurposeThe aim of this study was to use medical students' critical incident narratives to deepen understanding of the informal and hidden curricula.MethodThe authors conducted a thematic analysis of 272 stories of events recorded by 135 third-year medical students that “taught them something
TL;DR: The amount of nutrition education that medical students receive continues to be inadequate and needs to be improved.
Abstract: Purpose To quantify the number of required hours of nutrition education at U.S. medical schools and the types of courses in which the instruction was offered, and to compare these results with results from previous surveys.
TL;DR: Investigating factors guiding clinical supervisors' decisions to trust residents with critical patient-care tasks found residents' and attendings' opinions and impressions differ regarding what is expected from residents, what residents actually do, and what residents think they can do safely.
Abstract: PurposePatient-care responsibilities stimulate trainee learning but training may compromise patient safety. The authors investigated factors guiding clinical supervisors' decisions to trust residents with critical patient-care tasks.MethodIn a mixed quantitative and qualitative descriptive s
TL;DR: The authors propose a definition and, using the biographies of actual physician advocates, describe the spectrum of physician advocacy, as first steps toward building a model for competency-based physician advocacy training and delineating physician advocacy in common practice.
Abstract: Many medical authors and organizations have called for physician advocacy as a core component of medical professionalism. Despite widespread acceptance of advocacy as a professional obligation, the concept remains problematic within the profession of medicine because it remains undefined in concept, scope, and practice. If advocacy is to be a professional imperative, then medical schools and graduate education programs must deliberately train physicians as advocates. Accrediting bodies must clearly define advocacy competencies, and all physicians must meet them at some basic level. Sustaining and fostering physician advocacy will require modest changes to both undergraduate and graduate medical education. Developing advocacy training and practice opportunities for practicing physicians will also be necessary. In this article, as first steps toward building a model for competency-based physician advocacy training and delineating physician advocacy in common practice, the authors propose a definition and, using the biographies of actual physician advocates, describe the spectrum of physician advocacy.
TL;DR: The impact on measured outcomes increased with the number of Rounds attended, and the more Rounds one attended, the greater the impact on postsurvey insights into psychosocial aspects of care and teamwork.
Abstract: Purpose To assess the impact of Schwartz Center Rounds, an interdisciplinary forum where attendees discuss psychosocial and emotional aspects of patient care. The authors investigated changes in attendees' self-reported behaviors and beliefs about patient care, sense of teamwork, stress, and personal support. Results Most of the retrospective survey respondents indicated that attending Rounds enhanced their likelihood of attending to psychosocial and emotional aspects of care and enhanced their beliefs about the importance of empathy. Respondents reported better teamwork, including heightened appreciation of the roles and contributions of colleagues. There were significant decreases in perceived stress (P.001) and improvements in the ability to cope with the psychosocial demands of care (P.05). In the prospective study, after control for presurvey differences, the more Rounds one attended, the greater the impact on postsurvey insights into psychosocial aspects of care and teamwork (both: P
TL;DR: Reexamination revealed that the evidence does not warrant the strong, disturbing conclusion that empathy declines during medical education, and shows a very weak decline in mean ratings.
Abstract: Purpose Research is said to show that empathy declines during medical school and residency training. These studies and their results were examined to determine the extent of the decline and the plausibility of any alternative explanations. Method Eleven studies published from 2000 to 2008 which reported empathy at various stages of physician training were reexamined. Their results were transformed back to the original units of the rating scales to make results more interpretable by reporting them in the metric of the original anchors. Next, the relationship between empathy ratings and response rates were examined to see whether response bias was a plausible threat to the validity of the empathy decline conclusion. Results The changes in mean empathy ranged across the 11 studies from a 0.1-point increase in empathy to a 0.5-point decrease, with an average of a 0.2-point decline for the 11 studies (ratings were on 5-point, 7-point, and 9-point scales). Mean ratings were similar in medical school and residency. Response rates were low and-where reported-declined on average about 26 percentage points. Conclusions Reexamination revealed that the evidence does not warrant the strong, disturbing conclusion that empathy declines during medical education. Results show a very weak decline in mean ratings, and even the weak decline is questionable because of the low and varying response rates. Moreover, the empathy instruments are self-reports, and it isn't clear what they measure-or whether what they measure is indicative of patients' perceptions and the effectiveness of patient care.
TL;DR: Evidence on the positive long-term impacts of integrating humanities into undergraduatemedical education is sparse and may pose a threat to the continued development of humanities-related activities in undergraduate medical education in the context of current demands for evidence to demonstrate educational effectiveness.
Abstract: PurposeHumanities form an integral part of undergraduate medical curricula at numerous medical schools all over the world, and medical journals publish a considerable quantity of articles in this field. The aim of this study was to determine the extent to which the literature on humanities i
TL;DR: Despite concerted efforts to create standardized, objective, competency-based evaluations, the assessment of residents' clinical performance still has a strong subjective influence.
Abstract: Purpose The drive toward competency-based education frameworks has created a tension between competing desires—for quantified, standardized measures on one hand, and for an authentic representation of what it means to be a good doctor on the other. The purpose of this study was to better understand the tensions that exist between competency frameworks and faculty’s real-life experiences in evaluating residents. Method Interviews were conducted with 19 experienced internal medicine attendings at two Canadian universities in 2007. Attendings each discussed a specific outstanding, average, and problematic resident they had supervised. Interviews were analyzed using grounded theory. Results Eight major themes emerged reflecting how faculty conceptualize residents’ performance: knowledge, professionalism, patient interactions, team interactions, systems, disposition, trust, and impact on staff. Attendings’ impressions of residents did not seem to result from a linear sum of dimensions; rather, domains idiosyncratically took on variable degrees of importance depending on the resident. Relative deficiencies in outstanding residents could be overlooked, whereas strengths in problematic residents could be discounted. Some constructs (e.g., impact on staff) were not competencies at all; rather, they seem to act as explanations or evidence of attendings’ opinions. Standardized evaluation forms might constrain authentic depictions of residents’ performance. Conclusions
TL;DR: A broad group of experts believes that an understanding of basic science content remains essential to clinical practice and that teaching should be accomplished across the entire undergraduate medical education experience and integrated with clinical applications.
Abstract: A central tenet of Flexner's report was the fundamental role of science in medical education. Today, there is tension between the time needed to teach an ever-expanding knowledge base in science and the time needed for increased instruction in clinical application and in the behavioral, ethical, and managerial knowledge and skills needed to prepare for clinical experiences. One result has been at least a perceived reduction in time and focus on the foundational sciences. In this context, the International Association of Medical Science Educators initiated a study to address the role and value of the basic sciences in medical education by seeking perspectives from various groups of medical educators to five questions: (1) What are the sciences that constitute the foundation for medical practice? (2) What is the value and role of the foundational sciences in medical education? (3) When and how should these foundational sciences be incorporated into the medical education curriculum? (4) What sciences should be prerequisite to entering the undergraduate medical curriculum? (5) What are examples of the best practices for incorporating the foundational sciences into the medical education curriculum? The results suggest a broad group of experts believes that an understanding of basic science content remains essential to clinical practice and that teaching should be accomplished across the entire undergraduate medical education experience and integrated with clinical applications. Learning the sciences also plays a foundational role in developing discipline and rigor in learners' thinking skills, including logical reasoning, critical appraisal, problem solving, decision making, and creativity.
TL;DR: Skills acquired from SBML were substantially retained during one year, so programs should use periodic testing and refresher training to ensure competence.
Abstract: Background Simulation-based mastery learning (SBML) of central venous catheter (CVC) insertion improves trainee skill and patient care. How long skills are retained is unknown. Method This is a prospective cohort study. Subjects completed SBML and were required to meet or exceed a minimum passing score (MPS) for CVC insertion on a posttest. Skills were retested 6 and 12 months later and compared with posttest results to assess skill retention. Results Forty-nine of 61 (80.3%) subjects completed follow-up testing. Although performance declined from posttest where 100% met the MPS for CVC insertion, 82.4% to 87.1% of trainees passed the exam and maintained their high performance up to one year after training. Conclusions Skills acquired from SBML were substantially retained during one year. Individual performance cannot be predicted, so programs should use periodic testing and refresher training to ensure competence.
TL;DR: It is maintained that cultural competence represents an important building block of clinical care, as well as a skill set that is central to professionalism and quality, and it should be held to the same standards as other educational interventions and activities.
Abstract: The Institute of Medicine report entitled Unequal Treatment recommended that all health care professionals receive training in cross-cultural communication-also called "cultural competence"-as one potential strategy for addressing racial or ethnic disparities in health care. Although evidence shows that cultural competence training improves the attitudes, knowledge, and skills of physicians as well as patients' ratings of care, no definitive evidence has yet linked this training to improved health outcomes. Recently, there has been great interest in the field of cultural competence, including an expressed desire for a better understanding of its key principles, of effective ways of engaging clinicians in this area of instruction, and of the link between training and health outcomes. On the basis of years of experience in the field, the authors share key perspectives in all of these areas, with particular focus on a set of guidelines for measuring the impact of cultural competence training on health care outcomes. The authors maintain that cultural competence represents an important building block of clinical care, as well as a skill set that is central to professionalism and quality. Cultural competence training should be evaluated in a stepwise fashion by using the tools of health services research and the principles of quality improvement, and it should be held to the same standards as other educational interventions and activities. Just as medicine strives to meet other challenges in U.S. health care, so should it focus on developing the skills needed to care for the country's diverse population.
TL;DR: The authors propose a call to action by various professional groups and organizations to use rigorous and complex research efforts to seek answers to the larger question, “How, when, and why do physicians choose an academic career in medicine?”
Abstract: PurposeMedicine has different pathways in which physicians pursue their vocation. Clinical practice, research, and academia are common paths. The authors examined the literature to identify research-based factors influencing physicians to choose a career path in academic medicine.MethodIn th
TL;DR: Most MD-PhD program graduates follow career paths generally consistent with their training as physician-scientists, however, the range of their professional options is broad and further thought should be given to designing their training to anticipate their career choices and maximize their likelihood of success as investigators.
Abstract: Purpose MD-PhD training programs provide an integrated approach for training physician-scientists. The goal of this study was to characterize the career path taken by MD-PhD program alumni during the past 40 years and identify trends that affect their success. The concept of the MD-PhD program as an integrated approach to training physician-scientists dates back to the late 1950s. Although a long tradition exists of physicians becoming investigators as well as clinicians, MD- PhD programs were established with the realization that the standard four-year medical school curriculum is neither intended nor sufficient to train physician-investigators who are as proficient in the lab as they are in the clinic. As the term is now commonly applied, a physician-scientist or, more broadly, a physician-investigator ,i s a physician who is committed to the quest for new knowledge and new approaches to disease diagnosis, treatment, and prevention, and who devotes far more of his or her time to these activities than to routine clinical care. It was expected from the start that most graduates of MD-PhD programs would be employed by academic medical centers, universities, and research institutes such as the National Institutes of Health (NIH). It was also expected that links would exist between program graduates' medical training, clinical activities, and research interests and that each of these would inform the others in ways that could not be experienced by scientists who were not
TL;DR: The author explores the implications of both time-based and outcomes-based models for medical education reform and proposes an integration of their best features.
Abstract: One hundred years after Abraham Flexner released his report Medical Education in the United States and Canada, the spirit of reform is alive again. Reports in the United States and Canada have called for significant changes to medical education that will allow doctors to adapt to complex environments, work in teams, and meet a wide range of social needs. These reports call for clear educational outcomes but also for a flexible, individualized approach to learning. Whether or not change will result has much to do with the alignment between what is proposed and the nature of current societal discourses about how medical education should be conducted. Currently, two powerful and competing models of competence development are operating at odds with one another. The traditional one is time-based (a "tea-steeping" model, in which the student "steeps" in an educational program for a historically determined fixed time period to become a successful practitioner). This model directs attention to processes such as admission and curriculum design. The newer one is outcomes-based (an "i-Doc" model, a name suggested by the Apple i-Pod that infers that medical schools and residencies, like factories, can produce highly desirable products adapted to user needs and desires). This model focuses more on the functional capabilities of the end product (the graduate student, resident, or practicing physician). The author explores the implications of both time-based and outcomes-based models for medical education reform and proposes an integration of their best features.
TL;DR: Simulation training was associated with improved in-hospital performance of CVC insertion and Procedural simulation wasassociated with improved residents' skills and was more effective than traditional training.
Abstract: PurposeTo determine whether simulation training of ultrasound (US)-guided central venous catheter (CVC) insertion skills on a partial task trainer improves cannulation and insertion success rates in clinical practice.MethodThis prospective, randomized, controlled, single-blind study of first
TL;DR: In many respects, health care team training implementation and evaluation align with best practices suggested from the science of training, adult learning, and human performance; however, opportunities for improvement exist.
Abstract: PurposeAs the U.S. health care system enters a new era, the importance of team-based care approaches grows. How is the health care community ensuring that providers and administrators are equipped with the knowledge, skills, and attitudes (KSAs) foundational for effective teamwork? Are these
TL;DR: The VMS Wellness Program is the first published model of a comprehensive medical student wellness initiative and the development and design of the program may serve as a framework for other institutions.
Abstract: Research suggests that student burnout and mental illness are increasing in U.S. medical schools. In response, students and administrators developed the Vanderbilt Medical Student (VMS) Wellness Program to promote student health and well-being through coordination of many new and existing resources. This program consists of three core components: The Advisory College Program, The Student Wellness Committee, and VMS LIVE. Each of the core components includes separate and unique individual programs, but each of these three components collaborates with the other two to accomplish the broad wellness goal of maximizing student health, happiness, and potential. The VMS Wellness Program has had early success with substantial growth and outstanding student buy-in since its inception in 2005. Preliminary data indicate that nearly every student has participated in at least two components of the VMS Wellness Program. In addition to participation, student response has been highly satisfactory, as evidenced by their positive feedback. The VMS Wellness Program is the first published model of a comprehensive medical student wellness initiative. The development and design of the program described in this article may serve as a framework for other institutions.
TL;DR: It is suggested that clinical training curricula incorporate exposure to multiple simulators to maximize educational benefit and potentially save educator time.
Abstract: Purpose To evaluate the effectiveness of a novel, simulation-based educational model rooted in scaffolding theory that capitalizes on a systematic progressive sequence of simulators that increase in realism (i.e., fidelity) and information content. Method Forty-five medical students were randomly assigned to practice intravenous catheterization using highfidelity training, low-fidelity training, or progressive training from low to mid to high fidelity. One week later, participants completed a transfer test on a standardized patient simulation. Blinded expert raters assessed participants’ global clinical performance, communication, procedure documentation, and technical skills on the transfer test. Participants’ management of the resources available during practice was also recorded. Data were analyzed using multivariate analysis of variance. The study was conducted in fall 2008 at the University of Toronto. Results The high-fidelity group scored higher (P .05) than the low-fidelity group on all measures except procedure documentation. The progressive group scored higher (P .05) than other groups for documentation and global clinical performance and was equivalent to the high-fidelity group for communication and technical skills. Total practice time was greatest for the progressive group; however, this group required little practice time on the resource-intensive high-fidelity simulator.
TL;DR: Specific barriers related to the position of residents, such as influences from staff members, lack of experience in EBM, and low possibilities to change conditions, were described.
Abstract: PurposeInsufficient time and lack of skills are important barriers to the practice of evidence-based medicine (EBM). Residents could have additional barriers because their practice can be strongly influenced by the educational system and clinical supervisors. The purpose of this study, there