Teaching strategies used by internal medicine residents on the wards.
Med Teach. …

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A blended approach to invasive bedside procedural instruction.
Med Teach. 2011;33(2):116-23
Authors: Lenchus J, Issenberg SB, Murphy D, Everett-Thomas R, Erben L, Arheart K, Birnbach DJ
This study assessed the impact o…

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Are journal clubs effective in supporting evidence-based decision making? A systematic review. BEME Guide No. 16.
Med Teach. 2011;33(1):9-23
Authors: Harris J, Kearley K, Heneghan C, Meats E, Roberts N, Perera R, Kearley-Shier…

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A multi-institutional survey of internal medicine residents’ learning habits.

Med Teach. 2010;32(9):773-5

Authors: Edson RS, Beckman TJ, West CP, Aronowitz PB, Badgett RG, Feldstein DA, Henderson MC, Kolars JC, McDonald FS

Resident physicians are expected to demonstrate medical knowledge. However, little is known about the residents’ reading habits and learning preferences.

PMID: 20795809 [PubMed - indexed for MEDLINE]

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Cross-year peer tutoring on internal medicine wards: effects on self-assessed clinical competencies–a group control design study.

Med Teach. 2009 Feb;31(2):e32-5

Authors: Nikendei C, Andreesen S, Hoffmann K, Junger J

BACKGROUND: Peer-assisted learning (PAL) has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programmes are rare. We introduced a PAL programme with a focus on clinical competencies on internal medicine wards. AIMS: To assess the effects of an on-ward PAL programme on self-assessed clinical competencies. METHOD: A total of 168 medical students were randomly assigned to one of the seven intervention wards or one of the seven control wards. During their 5-week ward-placement, the intervention group (IG; n = 88) received 10 patient-centred tutorials lead by final year tutors: (I) history taking, (II) physical examination, (III) blood withdrawal, (IV) infusion, (V) patient files, (VI and VII) ECG, (VIII-X) chart rounds. The control group (CG; n = 80) did not take part in the PAL programme. Clinical competencies were self-assessed pre- and post-intervention. Results: For five of the ten assessed clinical competencies, increases in self-confidence ratings were significantly higher in the IG as compared to CG. CONCLUSIONS: Results provide preliminary evidence to suggest that PAL programmes on internal medicine wards and with final year students as peer tutors may represent a valuable additional tool within medical clerkships. However, the findings must be confirmed and clarified in further research.

PMID: 19330661 [PubMed - indexed for MEDLINE]

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Review of comparative studies of clinical skills training.

Med Teach. 2008;30(8):764-7

Authors: Byrne AJ, Pugsley L, Hashem MA

AIM: Our aim was to undertake a systematic review of the comparison of the methods used to train staff in clinical skills. METHODS: The only studies considered were those that compared two different training methods and contained defined outcome measures. The skills of intubation, venous cannulation and central venous line insertion were chosen as representative of the type of physical skills taught to clinicians. RESULTS: Only nine papers met the eligibility criteria with most papers evaluating a single teaching method. A wide range of teaching methods were used, including lectures, computer-based teaching, manikins and video assisted feedback. The studies included nurses, doctors, paramedics and medical students. CONCLUSIONS: Although no clear conclusions can be drawn from the studies, it appears that the teaching methods used have little effect on outcomes. In contrast, better outcomes are associated with workplace-based training and a course which provides repeated episodes of training spaced out over a period of weeks/months with the facility for practice of the skill. These findings are important as many current clinical skills training courses do not use the techniques associated with better outcomes.

PMID: 18946819 [PubMed - indexed for MEDLINE]

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Internal medicine residents’ perceptions of the Mini-Clinical Evaluation Exercise.

Med Teach. 2008;30(4):414-9

Authors: Malhotra S, Hatala R, Courneya CA

BACKGROUND: The mini-clinical evaluation exercise (mini-CEX) is a 30 minute observed clinical encounter which allows assessment of a resident’s clinical competence with feedback on their performance. AIMS: To assess residents’ perceptions of the mini-CEX using qualitative methods. METHODS: After introducing the mini-CEX into the University of British Columbia’s Internal Medicine Residency Program, a one hour semi-structured focus group with voluntary first and second year residents was undertaken. The focus groups were conducted by an independent moderator, audio-taped, and transcribed verbatim. Using a phenomenological approach, the comments made by the focus group participants were read independently by the three authors and organized into major themes. RESULTS: The major themes included Education, Assessment and Exam Preparation. Residents described a conflict between the mini-CEX’s role as a method of assessment and its utility as an educational tool. During initial mini-CEX encounters, they perceived the assessment format as anxiety-provoking. Over time, they felt that the mini-CEX provided insight into their clinical competence. Participants believed that the mini-CEX experience would benefit them in preparation and successful completion of their national specialty exam. CONCLUSIONS: Residents’ perceptions of the mini-CEX reflected a tension between the tool’s dual roles of assessment and education.

PMID: 18569664 [PubMed - indexed for MEDLINE]

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Does responsibility drive learning? Lessons from intern rotations in general practice.

Med Teach. 2008 May;30(3):254-9

Authors: Cantillon P, Macdermott M

BACKGROUND: The intern (or pre-registration) year has been criticised in the past for its emphasis on service delivery at the expense of educational achievement. It is hoped that new approaches to early postgraduate training such as the foundation programmes in the UK, will make clinical education more structured and effective. Intern placements in non-traditional settings such as general practice have been shown in the past to improve the quality of learning. Little is known however about which features of the general practice learning environment contribute most to the perception of improved learning. AIMS: This aim of this study was to examine the learning environment in general practice from the perspective of interns, (the learners), to determine the factors that contribute most to motivating effective learning in a general practice setting. METHODS: This study used a qualitative case study approach to explore the effects of two different learning environments, (general practice and hospital) on learner motivation amongst a small group of interns. RESULTS: We found that the biggest difference between the hospital and general practice learning environments was the increased individual responsibility for patient care experienced by interns in general practice. Greater responsibility was associated with greater motivation for learning. CONCLUSIONS: Increased intern responsibility for patient care does appear to motivate learning. More work needs to be done on providing interns in hospital posts with greater patient responsibility within an effective supervisory structure.

PMID: 18484451 [PubMed - indexed for MEDLINE]

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Changes in clinical skills education resulting from the introduction of the USMLE step 2 clinical skills (CS) examination.

Med Teach. 2008 May;30(3):325-7

Authors: Gilliland WR, La Rochelle J, Hawkins R, Dillon GF, Mechaber AJ, Dyrbye L, Papp KK, Durning SJ

BACKGROUND: Step 2 Clinical Skills (CS) was recently introduced into the United States Medical Licensing Examination (USMLE) to ensure that successful candidates for licensure possess the clinical skills to provide safe and effective patient care. AIMS: To explore if medical schools had changed the objectives, content, or emphasis in their pre-clinical curriculum in response to its implementation. METHODS: In April 2005, the Clerkship Directors in Internal Medicine (CDIM) sent an electronic survey to a single member from each medical school with a CDIM member. The survey instrument included 26 pre-clinical curricular questions with nine questions specifically addressing changes in response to implementation of the Step 2 CS. RESULTS: Forty-five percent of respondents reported changes to the Introduction to Clinical Medicine (ICM) course objectives while 39% and 40% reported changes in content and emphasis. Seventy-four percent felt their students were adequately prepared for the Step 2 CS and 18% were unsure. CONCLUSIONS: Over a third of medical schools are implementing changes to the objectives, content, and/or emphasis of their curriculum, at least partially in response to the institution of Step 2 CS.

PMID: 18484462 [PubMed - indexed for MEDLINE]

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Validity, reliability, feasibility and satisfaction of the Mini-Clinical Evaluation Exercise (Mini-CEX) for cardiology residency training.

Med Teach. 2007 Oct;29(8):785-90

Authors: Alves de Lima A, Barrero C, Baratta S, Castillo Costa Y, Bortman G, Carabajales J, Conde D, Galli A, Degrange G, Van der Vleuten C

AIMS: The purpose of the study was to determine the validity, reliability, feasibility and satisfaction of the Mini-CEX. METHODS AND RESULTS: From May 2003 to December 2004, 108 residents from 17 cardiology residency programs in Buenos Aires were monitored by the educational board of the Argentine Society of Cardiology. Validity was evaluated by the instrument’s capability to discriminate between pre-existing levels of clinical seniority. For reliability, generalisability theory was used. Feasibility was defined by a minimum number of completed observations: 50% of the residents obtaining at least four Mini-CEX’s. Satisfaction was evaluated through a one to nine rating scale from the evaluators, and residents’ perspectives. The total number of encounters was 253. Regarding validity, Mini-CEX was able to discriminate significantly between residents of different seniority. Reliability analysis indicated that a minimum of ten evaluations are necessary to produce a minimally reliable inference, but more are preferable. Feasibility was poor: 15% of the residents were evaluated four or more times during the study period. High satisfaction ratings from evaluators’ and residents’ were achieved. CONCLUSION: Mini-CEX discriminates between pre-existing levels of seniority, requires considerable sampling to achieve sufficient reliability, and was not feasible within the current circumstances, but it was considered a valuable assessment tool as indicated by the evaluators’ and residents’ satisfaction ratings.

PMID: 17917984 [PubMed - indexed for MEDLINE]

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Do pressure and fatigue influence resident job performance?

Med Teach. 2007 Jun;29(5):495-7

Authors: Feddock CA, Hoellein AR, Wilson JF, Caudill TS, Griffith CH

BACKGROUND: Global surveys of residents have consistently identified stress variables as important factors in resident job performance. AIMS: Determine whether an association exists between resident stress and job performance. METHOD: Over a three month period, interns on our inpatient ward services were surveyed regarding their current call schedule, whether their prior night’s sleep was sufficient, whether they felt pressed by other commitments, whether they spent enough time teaching medical students and whether they had completed all patient care issues on a given day. Multiple logistic regression was used to assess the association between call status, pressure and sleep adequacy with reported omissions in patient care and adequacy of teaching. RESULTS: In the regression analysis, ratings of high pressure and insufficient sleep but not call status independently predicted outcomes. For example, if an intern felt both pressed and tired, they were over eight times more likely to omit a patient care issue and over four times more likely to report inadequate teaching. CONCLUSIONS: Subjective ratings of high pressure and insufficient sleep are associated with poor job performance in medical residents.

PMID: 17885979 [PubMed - indexed for MEDLINE]

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