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1.  Promoting physical therapists’ use of research evidence to inform clinical practice: part 2 - a mixed methods evaluation of the PEAK program 
BMC Medical Education  2014;14:126.
Background
Clinicians need innovative educational programs to enhance their capacity for using research evidence to inform clinical decision-making. This paper and its companion paper introduce the Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program, an educational program designed to promote physical therapists’ integration of research evidence into clinical decision-making. This, second of two, papers reports a mixed methods feasibility study of the PEAK program among physical therapists at three university-based clinical facilities.
Methods
A convenience sample of 18 physical therapists participated in the six-month educational program. Mixed methods were used to triangulate results from pre-post quantitative data analyzed concurrently with qualitative data from semi-structured interviews and focus groups. Feasibility of the program was assessed by evaluating change in participants’ attitudes, self-efficacy, knowledge, skills, and self-reported behaviors in addition to their perceptions and reaction to the program.
Results
All 18 therapists completed the program. The group experienced statistically significant improvements in evidence based practice self-efficacy and self-reported behavior (p < 0.001). Four themes were supported by integrated quantitative and qualitative results: 1. The collaborative nature of the PEAK program was engaging and motivating; 2. PEAK participants experienced improved self-efficacy, creating a positive cycle where success reinforces engagement with research evidence; 3. Participants’ need to understand how to interpret statistics was not fully met; 4. Participants believed that the utilization of research evidence in their clinical practice would lead to better patient outcomes.
Conclusions
The PEAK program is a feasible educational program for promoting physical therapists’ use of research evidence in practice. A key ingredient seems to be guided small group work leading to a final product that guides local practice. Further investigation is recommended to assess long-term behavior change and to compare outcomes to alternative educational models.
doi:10.1186/1472-6920-14-126
PMCID: PMC4080990  PMID: 24965574
Knowledge translation; Evidence based practice; Education; Post-graduate training; Physical therapy; Mixed methods
2.  Effectiveness of interprofessional education by on-field training for medical students, with a pre-post design 
BMC Medical Education  2015;15:121.
Background
Interprofessional Education (IPE) implies how to achieve successful teamwork, and is based on collaborative practice which enhance occasions for relationships between two or more healthcare professions. This study evaluates the effectiveness of IPE in changing attitudes after a training recently introduced to medical education for second-year students at the University of Padova, Italy.
Methods
All medical students following a new program for IPE were enrolled in this study. The Interdisciplinary Education Perception Scale (IEPS) was administered before and after training, according to observation-based and practice-based learning. Data were analysed with Student's paired t-test and Wilcoxon's signed rank test.
Results
277 medical students completed both questionnaires. Statistically significant improvements were found in students' overall attitudes as measured by the IEPS and four subscale scores. Gender-stratified analyses showed that improvements were observed only in female students in subscale 4 (“Understanding Others’ Values”). Students who had a physician and/or health worker in their family did not show any improvement in subscales 2 (“Perceived need for cooperation”) or 4 (“Understanding Others’ Values”).
Conclusions
Our results indicate that IPE training has a positive influence on students’ understanding of collaboration and better attitudes in interprofessional teamwork. More research is needed to explore other factors which may influence specific perceptions among medical students.
Electronic supplementary material
The online version of this article (doi:10.1186/s12909-015-0409-z) contains supplementary material, which is available to authorized users.
doi:10.1186/s12909-015-0409-z
PMCID: PMC4518727  PMID: 26220412
Interprofessional education; Interdisciplinary education perception scale; Interprofessional training; Medical students
3.  Foundation doctors’ induction experiences 
BMC Medical Education  2015;15:118.
Background
It is well established that trainee doctors struggle with the transition from medical school to starting work and feel unprepared for many aspects of their new role. There is evidence that suitable induction experiences improve competence and confidence, but available data indicate that trainee doctors on the UK Foundation Programme are commonly not experiencing useful inductions. The aim of the reported research was to explore trainee doctors’ experiences with induction during their first year of the Foundation Programme to identify the most useful characteristics.
Methods
A questionnaire was designed to explore trainee doctors’ experiences with induction at two points during their first Foundation year, during the first and third of three rotations, to enable all induction experiences on offer during the year to be surveyed. Data were collected using an anonymous questionnaire distributed during a teaching session, with an online version available for those trainees not present. Questions gathered information about characteristics of the inductions, usefulness of components of the inductions and what gaps exist.
Results
192 Foundation trainee doctors completed the questionnaire during Rotation 1 and 165 during Rotation 3. The findings indicated that induction experiences at the beginning of the year, including the local Preparation for Professional Practice week, were more useful than those received for later rotations. Longer inductions were more useful than shorter. Departmental inductions were generally only moderately helpful and they missed many important characteristics. Gaps in their inductions identified by many trainees matched those aspects judged to be most useful by those trainees who had experienced these characteristics.
Conclusions
Many Foundation trainee doctors are experiencing inadequate inductions, notably at the department level. Trainees are starting rotations in new departments without rudimentary knowledge about their role and responsibilities in that department, where to find equipment and documentation, who to contact and how to contact them, local preferences, policies and procedures. Unsurprisingly, trainees who do receive such information in their inductions regard it as highly useful. Action is urgently needed to improve departmental inductions so that all trainees have the information they require to work confidently and competently in each new department they rotate into.
Electronic supplementary material
The online version of this article (doi:10.1186/s12909-015-0395-1) contains supplementary material, which is available to authorized users.
doi:10.1186/s12909-015-0395-1
PMCID: PMC4513374  PMID: 26206239
Induction; Trainee doctor; Foundation programme; Preparedness for practice; Transition; Medical education; Postgraduate training
4.  Family physicians enhance end-of-life care: evaluation of a new continuing medical education learning module in British Columbia 
BMC Medical Education  2015;15:119.
Background
The Practice Support Program (PSP) is an innovative peer-to-peer continuing medical education (CME) program that offers full-service family physicians/general practitioners (GPs) in British Columbia (BC), Canada, post-graduate training on a variety of topics. We present the evaluation findings from the PSP learning module on enhancing end-of-life (EOL) care within primary care.
Methods
Pen-and-paper surveys were administered to participants three times: at the beginning of the first training session (n = 608; 69.6 % response rate), at training completion (n = 381, 55.6 % response rate), and via a mail-out survey at 3-6 months following training completion (n = 109, 24.8 % response rate). Surveys asked GPs about current EOL-related practices and confidence in EOL-related skills. At end of training, respondents also provided ratings of satisfaction and perceptions of the module’s impact on their practice and their EOL patients.
Results
Satisfaction and impact were rated very highly by over 90 % of the GP respondents. Module participation increased the GPs’ confidence on EOL-related communication and collaboration skills: e.g., initiating conversations about EOL care, developing an action plan for EOL care, communicating the patient’s needs and wishes to other care providers, participating in collaborative care with home and community care nurses, and accessing and referring patients to EOL specialists in the community. Increased confidence was maintained at 3-6 months following completion of training.
Conclusions
The EOL learning module offered by the PSP to family physicians in BC is a successful and impactful CME accredited training module for enhancing end-of-life care in primary care settings.
doi:10.1186/s12909-015-0392-4
PMCID: PMC4513376  PMID: 26206113
End-of-life care; Primary care; Continuing education; Practice change; Evaluation
5.  A process evaluation of PRONTO simulation training for obstetric and neonatal emergency response teams in Guatemala 
BMC Medical Education  2015;15:117.
Background
Despite expanding access to institutional birth in Guatemala, maternal mortality remains largely unchanged over the last ten years. Enhancing the quality of emergency obstetric and neonatal care is one important strategy to decrease mortality. An innovative, low-tech, simulation-based team training program (PRONTO) aims to optimize care provided during obstetric and neonatal emergencies in low-resource settings.
Methods
We conducted PRONTO simulation training between July 2012 and December 2012 in 15 clinics in Alta Verapaz, Huehuetenango, San Marcos, and Quiche, Guatemala. These clinics received PRONTO as part of a larger pair-matched cluster randomized trial of a comprehensive intervention package. Training participants were obstetric and neonatal care providers that completed pre- and post- training assessments for the two PRONTO training modules, which evaluated knowledge of evidence-based practice and self-efficacy in obstetric and neonatal topics. Part of the training included a session for trained teams to establish strategic goals to improve clinical practice. We utilized a pre/post-test design to evaluate the impact of the course on both knowledge and self-efficacy with longitudinal fixed effects linear regression with robust standard errors. Pearson correlation coefficients were used to assess the correlation between knowledge and self-efficacy. Poisson regression was used to assess the association between the number of goals achieved and knowledge, self-efficacy, and identified facility-level factors.
Results
Knowledge and self-efficacy scores improved significantly in all areas of teaching. Scores were correlated for all topics overall at training completion. More than 60 % of goals set to improve clinic functioning and emergency care were achieved. No predictors of goal achievement were identified.
Conclusions
PRONTO training is effective at improving provider knowledge and self-efficacy in training areas. Further research is needed to evaluate the impact of the training on provider use of evidence-based practices and on maternal and neonatal health outcomes.
Trial registration
NCT01653626
doi:10.1186/s12909-015-0401-7
PMCID: PMC4513701  PMID: 26206373
In-situ simulation; Continuing medical education; Emergency obstetric care; Inter-professional training
6.  Implementation and evaluation of an interprofessional simulation-based education program for undergraduate nursing students in operating room nursing education: a randomized controlled trial 
BMC Medical Education  2015;15:115.
Background
The present study was designed to implement an interprofessional simulation-based education program for nursing students and evaluate the influence of this program on nursing students’ attitudes toward interprofessional education and knowledge about operating room nursing.
Methods
Nursing students were randomly assigned to either the interprofessional simulation-based education or traditional course group. A before-and-after study of nursing students’ attitudes toward the program was conducted using the Readiness for Interprofessional Learning Scale. Responses to an open-ended question were categorized using thematic content analysis. Nursing students’ knowledge about operating room nursing was measured.
Results
Nursing students from the interprofessional simulation-based education group showed statistically different responses to four of the nineteen questions in the Readiness for Interprofessional Learning Scale, reflecting a more positive attitude toward interprofessional learning. This was also supported by thematic content analysis of the open-ended responses. Furthermore, nursing students in the simulation-based education group had a significant improvement in knowledge about operating room nursing.
Conclusions
The integrated course with interprofessional education and simulation provided a positive impact on undergraduate nursing students’ perceptions toward interprofessional learning and knowledge about operating room nursing. Our study demonstrated that this course may be a valuable elective option for undergraduate nursing students in operating room nursing education.
doi:10.1186/s12909-015-0400-8
PMCID: PMC4496846  PMID: 26155839
Operating room nursing; Interprofessional; Simulation; Cooperative behavior
9.  Clinical realism: a new literary genre and a potential tool for encouraging empathy in medical students 
BMC Medical Education  2015;15:112.
Background
Empathy has been re-discovered as a desirable quality in doctors. A number of approaches using the medical humanities have been advocated to teach empathy to medical students. This paper describes a new approach using the medium of creative writing and a new narrative genre: clinical realism.
Methods
Third year students were offered a four week long Student Selected Component (SSC) in Narrative Medicine and Creative Writing. The creative writing element included researching and creating a character with a life-changing physical disorder without making the disorder the focus of the writing. The age, gender, social circumstances and physical disorder of a character were randomly allocated to each student. The students wrote repeated assignments in the first person, writing as their character and including details of living with the disorder in all of their narratives. This article is based on the work produced by the 2013 cohort of students taking the course, and on their reflections on the process of creating their characters. Their output was analysed thematically using a constructivist approach to meaning making.
Results
This preliminary analysis suggests that the students created convincing and detailed narratives which included rich information about living with a chronic disorder. Although the writing assignments were generic, they introduced a number of themes relating to illness, including stigma, personal identity and narrative wreckage. Some students reported that they found it difficult to relate to “their” character initially, but their empathy for the character increased as the SSC progressed.
Conclusion
Clinical realism combined with repeated writing exercises about the same character is a potential tool for helping to develop empathy in medical students and merits further investigation.
doi:10.1186/s12909-015-0372-8
PMCID: PMC4490761  PMID: 26138712
Medical education; Medical humanities; Creative writing; Empathy; Affinity; Clinical realism
10.  Exploring resilience in rural GP registrars – implications for training 
BMC Medical Education  2015;15:110.
Background
Resilience can be defined as the ability to rebound from adversity and overcome difficult circumstances. General Practice (GP) registrars face many challenges in transitioning into general practice, and additional stressors and pressures apply for those choosing a career in rural practice. At this time of international rural generalist medical workforce shortages, it is important to focus on the needs of rural GP registrars and how to support them to become resilient health care providers. This study sought to explore GP registrars’ perceptions of their resilience and strategies they used to maintain resilience in rural general practice.
Methods
In this qualitative interpretive research, semi-structured interviews were recorded, transcribed and analysed using an inductive approach. Initial coding resulted in a coding framework which was refined using constant comparison and negative case analysis. Authors developed consensus around the final conceptual model. Eighteen GP registrars from: Australian College of Rural and Remote Medicine Independent Pathway, and three GP regional training programs with rural training posts.
Results
Six main themes emerged from the data. Firstly, rural GP registrars described four dichotomous tensions they faced: clinical caution versus clinical courage; flexibility versus persistence; reflective practice versus task-focused practice; and personal connections versus professional commitment. Further themes included: personal skills for balance which facilitated resilience including optimistic attitude, self-reflection and metacognition; and finally GP registrars recognised the role of their supervisors in supporting and stretching them to enhance their clinical resilience.
Conclusion
Resilience is maintained as on a wobble board by balancing professional tensions within acceptable limits. These limits are unique to each individual, and may be expanded through personal growth and professional development as part of rural general practice training.
doi:10.1186/s12909-015-0399-x
PMCID: PMC4487989  PMID: 26134975
Resilience; Rural; GP Registrars; Medical education; Vocational training; Rural generalism
11.  International students’ experience of a western medical school: a mixed methods study exploring the early years in the context of cultural and social adjustment compared to students from the host country 
BMC Medical Education  2015;15:111.
Background
Few studies have addressed the challenges associated with international students as they adapt to studying medicine in a new host country. Higher level institutions have increasing numbers of international students commencing programmes. This paper explores the experiences of a cohort of students in the early years of medical school in Ireland, where a considerable cohort are from an international background.
Methods
A mixed exploratory sequential study design was carried out with medical students in the preclinical component of a five year undergraduate programme. Data for the qualitative phase was collected through 29 semi-structured interviews using the peer interview method. Thematic analysis from this phase was incorporated to develop an online questionnaire combined with components of the Student Adaptation to College Questionnaire and Student Integration Questionnaire. First year students were anonymously surveyed online. The Mokken Scaling procedure was used to investigate the students’ experiences, both positive and negative.
Results
Three main themes are identified; social adjustment, social alienation and cultural alienation. The response rate for the survey was 49 % (467 Respondents). The Mokken Scaling method identified the following scales (i) Positive experience of student life; (ii) Social alienation, which comprised of negative items about feeling lonely, not fitting in, being homesick and (iii) Cultural alienation, which included the items of being uncomfortable around cultural norms of dress and contact between the sexes. With the threshold set to H = 0.4. Subscales of the positive experiences of student life scale are explored further.
Conclusions
Overall student adjustment to a western third level college was good. Students from regions where cultural distance is greatest reported more difficulties in adjusting. Students from these regions also demonstrate very good adaptation. Some students from the host country and more similar cultural backgrounds were also struggling. Acculturation is more complex than being associated with cultural distance and worthy of further exploration.
doi:10.1186/s12909-015-0394-2
PMCID: PMC4488065  PMID: 26134823
International; Students; Culture; Medical education; Acculturation; Internationalisation; Social adjustment
12.  Medical education departments: a study of four medical schools in Sub-Saharan Africa 
BMC Medical Education  2015;15:109.
Background
Many African countries are investing in medical education to address significant health care workforce shortages and ultimately improve health care. Increasingly, training institutions are establishing medical education departments as part of this investment. This article describes the status of four such departments at sub-Saharan African medical schools supported by the Medical Education Partnership Initiative (MEPI). This article will provide information about the role of these institutional structures in fostering the development of medical education within the African context and highlight factors that enable or constrain their establishment and sustainability.
Methods
In-depth interviews were conducted with the heads or directors of the four medical education departments using a structured interview protocol developed by the study group. An inductive approach to analysis of the interview transcripts was adopted as the texts were subjected to thematic content analysis.
Results
Medical education departments, also known as units or centers, were established for a range of reasons including: to support curriculum review, to provide faculty development in Health Professions Education, and to improve scholarship in learning and teaching. The reporting structures of these departments differ in terms of composition and staff numbers. Though the functions of departments do vary, all focus on improving the quality of health professions education. External and internal funding, where available, as well as educational innovations were key enablers for these departments. Challenges included establishing and maintaining the legitimacy of the department, staffing the departments with qualified individuals, and navigating dependence on external funding. All departments seek to expand the scope of their services by offering higher degrees in HPE, providing assistance to other universities in this domain, and developing and maintaining a medical education research agenda.
Conclusions
The establishment of medical education departments in Sub-Saharan Africa is a strategy medical schools can employ to improve the quality of health professions education. The creation of communities of practice such as has been done by the MEPI project is a good way to expand the network of medical education departments in the region enabling the sharing of lessons learned across the continent.
doi:10.1186/s12909-015-0398-y
PMCID: PMC4486688  PMID: 26126821
13.  Common concepts in separate domains? Family physicians’ ways of understanding teaching patients and trainees, a qualitative study 
BMC Medical Education  2015;15:108.
Background
Medical education is increasingly expanding into new community teaching settings and the need for clinical teachers is rising. Many physicians taking on this new role are already skilled patient educators. The purpose of this research was to explore how family physicians conceptualize teaching patients compared to the teaching of trainees. Our aim was to understand if there is any common ground between these two roles in order to support faculty development based on already existing skills.
Methods
Semi-structured interviews with twenty-five family physician preceptors were conducted in Vancouver, Canada and thematically analyzed.
Results
We identified four key areas of overlap between the two fields (being learner-centered; supporting the acquisition, application and integration of knowledge; role modeling and self-disclosure; and facilitating autonomy) and three areas of divergence (aim of teaching and setting the learning objectives; establishing rapport; and providing feedback).
Conclusions
Finding common ground between these two teaching roles would support knowledge translation and inquiry between the domains of teaching patients and trainees. It would furthermore open up new avenues for improving training and practice for clinical teachers by better linking faculty development and continuing medical education (CME).
doi:10.1186/s12909-015-0397-z
PMCID: PMC4484642  PMID: 26123000
Family medicine; Patient; Physician; Qualitative research; Trainee; Faculty development
14.  Puzzle-based versus traditional lecture: comparing the effects of pedagogy on academic performance in an undergraduate human anatomy and physiology II lab 
BMC Medical Education  2015;15:107.
Background
A traditional lecture-based pedagogy conveys information and content while lacking sufficient development of critical thinking skills and problem solving. A puzzle-based pedagogy creates a broader contextual framework, and fosters critical thinking as well as logical reasoning skills that can then be used to improve a student’s performance on content specific assessments. This paper describes a pedagogical comparison of traditional lecture-based teaching and puzzle-based teaching in a Human Anatomy and Physiology II Lab.
Methods
Using a single subject/cross-over design half of the students from seven sections of the course were taught using one type of pedagogy for the first half of the semester, and then taught with a different pedagogy for the second half of the semester. The other half of the students were taught the same material but with the order of the pedagogies reversed. Students’ performance on quizzes and exams specific to the course, and in-class assignments specific to this study were assessed for: learning outcomes (the ability to form the correct conclusion or recall specific information), and authentic academic performance as described by (Am J Educ 104:280–312, 1996).
Results
Our findings suggest a significant improvement in students’ performance on standard course specific assessments using a puzzle-based pedagogy versus a traditional lecture-based teaching style. Quiz and test scores for students improved by 2.1 and 0.4 % respectively in the puzzle-based pedagogy, versus the traditional lecture-based teaching. Additionally, the assessments of authentic academic performance may only effectively measure a broader conceptual understanding in a limited set of contexts, and not in the context of a Human Anatomy and Physiology II Lab.
Conclusion
In conclusion, a puzzle-based pedagogy, when compared to traditional lecture-based teaching, can effectively enhance the performance of students on standard course specific assessments, even when the assessments only test a limited conceptual understanding of the material.
doi:10.1186/s12909-015-0390-6
PMCID: PMC4485342  PMID: 26100835
Puzzle; Lecture; Teaching; Pedagogy; Anatomy; Physiology; Performance; Concept
15.  Voluntary peer-led exam preparation course for international first year students: Tutees’ perceptions 
BMC Medical Education  2015;15:106.
Background
While the number of international students has increased over the last decade, such students face diverse challenges due to language and cultural barriers. International medical students suffer from personal distress and a lack of support. Their performance is significantly lower than non-international peers in clinical examinations. We investigated whether international students benefit from a peer-led exam preparation course.
Methods
An exam preparation course was designed, and relevant learning objectives were defined. Two evaluations were undertaken: Using a qualitative approach, tutees (N = 10) were asked for their thoughts and comments in a semi-structured interview at the end of the semester. From a quantitative perspective, all participants (N = 22) were asked to complete questionnaires at the end of each course session.
Results
International students reported a range of significant benefits from the course as they prepared for upcoming exams. They benefited from technical and didactic, as well as social learning experiences. They also considered aspects of the tutorial’s framework helpful.
Conclusion
Social and cognitive congruence seem to be the key factors to success within international medical students’ education. If tutors have a migration background, they can operate as authentic role models. Furthermore, because they are still students themselves, they can offer support using relevant and understandable language.
doi:10.1186/s12909-015-0391-5
PMCID: PMC4477474  PMID: 26084490
Evaluation; Exam preparation course; International medical students; Semi-structured interviews
16.  Learning results of GP trainers in a blended learning course on EBM: a cohort study 
BMC Medical Education  2015;15:104.
Background
General practitioners (GPs) experience barriers to the use of evidence-based medicine (EBM) related to a negative attitude and to insufficient knowledge and skills. We therefore designed a blended learning intervention to develop the competence of GP trainers in EBM. This study investigated the effectiveness of this intervention in increasing the trainers’ EBM competencies (i.e. knowledge, skills, attitude and behaviour).
Methods
In total 129 GP trainers participated in the blended learning course on EBM consisting of four 3-h face-to-face meetings and an intensive preparatory e-course before each meeting over a 12-month period. The primary outcomes were changes in knowledge and skills (Fresno test), changes in attitude (McColl test) and intentions to change behaviour. Secondary outcomes were changes in self-rated knowledge, skills and attitude, and the relation between personal characteristics and changes in knowledge, skills and attitude. Data were collected before the start of the intervention (T0), at the end of the last day of the intervention (T1) and four months after the end of the intervention (T2).
Results
The mean changes in scores on the Fresno test were ∆T1-T0 = 40.8 (SD ±36.7, p < .001) and ∆T2-T0 = 20.8 (±39.9, p < .001). The mean changes in scores on the McColl test were ∆T1-T0 = 2.2 (SD ±12.8, p = .16) and ∆T2-T0 = -.87 (±10.0, p = .49). Of the GP trainers, 16.7 % fulfilled their intentions to change in behaviour, 47.6 % partly fulfilled them and 35.7 % did not fulfil them at all. Female trainers scored significantly higher on the Fresno test after the intervention compared to male trainers. There was a weak positive correlation between self-rated knowledge and the scores on the Fresno test. A moderate correlation was found between the overall score on the McColl test and self-rated attitude.
Conclusion
An intensive blended learning course on EBM for GP trainers induces an increase in knowledge and skills that, although decreased, remains after four months. Attitude and behaviour towards EBM show no differences before and after the intervention, although GPs’ intention to use EBM more often in their practice is present.
doi:10.1186/s12909-015-0386-2
PMCID: PMC4472415  PMID: 26067056
17.  Using clinical supervision to improve the quality and safety of patient care: a response to Berwick and Francis 
BMC Medical Education  2015;15:103.
Background
After widely publicised investigations into excess patient deaths at Mid Staffordshire hospital the UK government commissioned reports from Robert Francis QC and Professor Don Berwick. Among their recommendations to improve the quality and safety of patient care were lifelong learning, professional support and ‘just culture’. Clinical supervision is in an excellent position to support these activities but opportunities are in danger of being squeezed out by regulatory and managerial demands. Doctors who have completed their training are responsible for complex professional judgements for which narrative supervision is particularly helpful. With reference to the literature and my own practice I propose that all practicing clinicians should have regular clinical supervision.
Discussion
Clinical supervision has patient-safety and the quality of patient care as its primary purposes. After training is completed, doctors may practice for the rest of their career without any clinical supervision, the implication being that the difficulties dealt with in clinical supervision are no longer difficulties, or are better dealt with some other way. Clinical supervision is sufficiently flexible to be adapted to the needs of experienced clinicians as its forms can be varied, though its functions remain focused on patient safety, good quality clinical care and professional wellbeing.
Summary
The evidence linking clinical supervision to the quality and safety of patient care reveals that supervision is most effective when its educational and supportive functions are separated from its managerial and evaluative functions. Among supervision’s different forms, narrative-based-supervision is particularly useful as it has been developed for clinicians who have completed their training. It provides ways to explore the complexity of clinical judgements and encourages doctors to question one another’s authority in a supportive culture. To be successful, supervision should also be professionally led and learner centred rather than externally imposed and centred on institutions. I propose that regular clinical supervision should be a professional requirement if the quality and safety aspirations of Francis and Berwick are to be met.
doi:10.1186/s12909-015-0324-3
PMCID: PMC4464130  PMID: 26062608
Supervision; Narrative; Quality; Safety; Reflection; Education; Coaching; Mentoring
18.  Preparation by mandatory E-modules improves learning of practical skills: a quasi-experimental comparison of skill examination results 
BMC Medical Education  2015;15:102.
Background
Until recently, students at UMC Utrecht Faculty of Medicine prepared for practical skills training sessions by studying recommended literature and making written assignments, which was considered unsatisfactory. Therefore, mandatory e-modules were gradually introduced as substitute for the text based preparation. This study aimed to investigate whether this innovation improved students’ performance on the practical skills (OSCE) examination.
Method
In both the 2012 and 2013 OSCEs, e-modules were available for some skill stations whereas others still had text based preparation. We compared students’ performance, both within and between cohorts, for skill stations which had e-module preparation versus skill stations with text based preparation.
Results
We found that performance on skill stations for which students had prepared by e-modules was significantly higher than on stations with text based preparation, both within and between cohorts. This improvement cannot be explained by overall differences between the two cohorts.
Conclusion
Our results show that results of skills training can be improved, by the introduction of e-modules without increasing teacher time. Further research is needed to answer the question whether the improved performance is due to the content of the e-modules of to their obligatory character.
doi:10.1186/s12909-015-0376-4
PMCID: PMC4468809  PMID: 26058347
E-learning; Blended learning; Skills education; Undergraduate education
19.  Why medical students do not choose a career in geriatrics: a systematic review 
BMC Medical Education  2015;15:101.
Background
While the demand for doctors specialised in the medical care of elderly patients is increasing, the interest among medical students for a career in geriatrics is lagging behind.
Methods
To get an overview of the different factors reported in the literature that affect the (low) interest among medical students for a career in geriatrics, a systematic literature search was conducted using PubMed, Embase, PsycINFO, and ERIC. Quality assessment criteria were applied.
Results
Twenty studies met the criteria and were included in the review.
In relation to the nature of the work, the preference of medical students is young patients, and acute somatic diseases that can be cured. The complexity of the geriatric patient deters students from choosing this specialty. Exposure by means of pre-clinical and particularly clinical education increases interest. The lack of status and the financial aspects have a negative influence on interest.
Conclusion
Exposure to geriatrics by means of education is necessary. The challenge in geriatric education is to show the rewarding aspects of the specialty.
Electronic supplementary material
The online version of this article (doi:10.1186/s12909-015-0384-4) contains supplementary material, which is available to authorized users.
doi:10.1186/s12909-015-0384-4
PMCID: PMC4470031  PMID: 26043772
Medical students; Career choice; Geriatrics
20.  Designing faculty development to support the evaluation of resident competency in the intrinsic CanMEDS roles: practical outcomes of an assessment of program director needs 
BMC Medical Education  2015;15:100.
Background
The Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada mandate that faculty members demonstrate they are evaluating residents on all CanMEDS (Canadian Medical Education Directions for Specialists) roles as part of the accreditation process. Postgraduate Medical Education at the University of Ottawa initiated a 5-year project to develop and implement a comprehensive system to assess the full spectrum of CanMEDS roles. This paper presents the findings from a needs assessment with Program Directors, in order to determine how postgraduate medical faculty can be motivated and supported to evaluate residents on the intrinsic CanMEDS roles.
Methods
Semi-structured individual interviews were conducted with 60 Postgraduate Program Directors in the Faculty of Medicine. Transcribed interviews were analyzed using qualitative analysis. Once the researchers were satisfied the identified themes reflected the views of the participants, the data was assigned to categories to provide rich, detailed, and comprehensive information that would indicate what faculty need in order to effectively evaluate their residents on the intrinsic roles.
Results
Findings indicated faculty members need faculty development and shared point of care resources to support them with how to not only evaluate, but also teach, the intrinsic roles. Program Directors expressed the need to collaborate and share resources across departments and national specialty programs. Based on our findings, we designed and delivered workshops with companion eBooks to teach and evaluate residents at the point of care (Developing the Professional, Health Advocate and Scholar).
Conclusions
Identifying stakeholder needs is essential for designing effective faculty development. By sharing resources, faculties can prevent ‘reinventing the wheel’ and collaborate to meet the Colleges’ accreditation requirements more efficiently.
doi:10.1186/s12909-015-0375-5
PMCID: PMC4472249  PMID: 26043731
Medical education; CanMEDS; Intrinsic roles; Resident evaluation; Faculty development
21.  Making medical student course evaluations meaningful: implementation of an intensive course review protocol 
BMC Medical Education  2015;15:99.
Background
Ongoing course evaluation is a key component of quality improvement in higher education. The complexities associated with delivering high quality medical education programs involving multiple lecturers can make course and instructor evaluation challenging. We describe the implementation and evaluation of an “intensive course review protocol” in an undergraduate medical program
Methods
We examined pre-clerkship courses from 2006 to 2011 - prior to and following protocol implementation. Our non-parametric analysis included Mann-Whitney U tests to compare the 2006/07 and 2010/11 academic years.
Results
We included 30 courses in our analysis. In the 2006/07 academic year, 13/30 courses (43.3 %) did not meet the minimum benchmark and were put under intensive review. By 2010/11, only 3/30 courses (10.0 %) were still below the minimum benchmark. Compared to 2006/07, courses ratings in the 2010/11 year were significantly higher (p = 0.004). However, during the study period mean response rates fell from 76.5 % in 2006/07 to 49.7 % in 2010/11.
Conclusion
These results suggest an intensive course review protocol can have a significant impact on pre-clerkship course ratings in an undergraduate medical program. Reductions in survey response rates represent an ongoing challenge in the interpretation of student feedback.
Electronic supplementary material
The online version of this article (doi:10.1186/s12909-015-0387-1) contains supplementary material, which is available to authorized users.
doi:10.1186/s12909-015-0387-1
PMCID: PMC4460774  PMID: 26041364
22.  The positive impact of interprofessional education: a controlled trial to evaluate a programme for health professional students 
BMC Medical Education  2015;15:98.
Background
Collaborative interprofessional practice is an important means of providing effective care to people with complex health problems. Interprofessional education (IPE) is assumed to enhance interprofessional practice despite challenges to demonstrate its efficacy. This study evaluated whether an IPE programme changed students’ attitudes to interprofessional teams and interprofessional learning, students’ self-reported effectiveness as a team member, and students’ perceived ability to manage long-term conditions.
Methods
A prospective controlled trial evaluated an eleven-hour IPE programme focused on long-term conditions’ management. Pre-registration students from the disciplines of dietetics (n = 9), medicine (n = 36), physiotherapy (n = 12), and radiation therapy (n = 26) were allocated to either an intervention group (n = 41) who received the IPE program or a control group (n = 42) who continued with their usual discipline specific curriculum. Outcome measures were the Attitudes Toward Health Care Teams Scale (ATHCTS), Readiness for Interprofessional Learning Scale (RIPLS), the Team Skills Scale (TSS), and the Long-Term Condition Management Scale (LTCMS). Analysis of covariance compared mean post-intervention scale scores adjusted for baseline scores.
Results
Mean post-intervention attitude scores (all on a five-point scale) were significantly higher in the intervention group than the control group for all scales. The mean difference for the ATHCTS was 0.17 (95 %CI 0.05 to 0.30; p = 0.006), for the RIPLS was 0.30 (95 %CI 0.16 to 0.43; p < 0.001), for the TSS was 0.71 (95 %CI 0.49 to 0.92; p < 0.001), and for the LTCMS was 0.75 (95 %CI 0.56 to 0.94; p < 0.001). The mean effect of the intervention was similar for students from the two larger disciplinary sub-groups of medicine and radiation therapy.
Conclusions
An eleven-hour IPE programme resulted in improved attitudes towards interprofessional teams and interprofessional learning, as well as self-reported ability to function within an interprofessional team, and self-reported confidence, knowledge, and ability to manage people with long-term conditions. These findings indicate that a brief intervention such as this can have immediate positive effects and contribute to the development of health professionals who are ready to collaborate with others to improve patient outcomes.
Electronic supplementary material
The online version of this article (doi:10.1186/s12909-015-0385-3) contains supplementary material, which is available to authorized users.
doi:10.1186/s12909-015-0385-3
PMCID: PMC4462076  PMID: 26041132
Controlled trial; Interprofessional education; Long-term conditions management; Pre-registration; Pre-licensure; Dietetics; Medicine; Physiotherapy; Radiation therapy; Primary health care
23.  Longitudinal mentorship to support the development of medical students’ future professional role: a qualitative study 
BMC Medical Education  2015;15:97.
Background
Mentoring has been employed in medical education in recent years, but there is extensive variation in the published literature concerning the goals of mentoring and the role of the mentor. Therefore, there is still a need for a deeper understanding of the meaning of mentoring for medical students’ learning and development. The aim of this qualitative study is to explore how formal and longitudinal mentoring can contribute to medical students’ professional development.
Methods
Sixteen medical students at a Swedish university were interviewed individually about their experiences of combined group and one-to-one mentoring that is given throughout their studies. The mentoring programme was focused on the non-medical skills of the profession and used CanMEDS roles of a physician for students’ self-assessment. Data were analysed using a latent, interpretive approach to content analysis.
Results
The results comprise three themes: Integrating oneself with one’s future role as a physician, Experiencing clinical reality with the mentor creates incentives to learn and Towards understanding the professional competence of a physician. The mentorship enabled the students to create a view of their future professional role and to integrate it with their own personalities. The students’ understanding of professional competence and behaviour evolved during the mentorship and they made advances towards understanding the wholeness of the profession. This approach to mentorship supported different components of the students’ professional development; the themes Integrating oneself with one’s future role and Towards understanding the professional competence of a physician can be regarded as two parallel processes, while the third theme, Experiencing clinical reality with the mentor creates incentives to learn, promotes these processes.
Conclusions
Formalized and longitudinal mentoring focusing on the non-medical skills can be recommended to help medical students to integrate their professional role with themselves as individuals and promote understanding of professional competence in the process of becoming a physician.
doi:10.1186/s12909-015-0383-5
PMCID: PMC4458053  PMID: 26037407
Mentorship; Undergraduate medical students; Professional competence; Professional development
24.  Ureteroscopy and cystoscopy training: comparison between transparent and non-transparent simulators 
BMC Medical Education  2015;15:93.
Background
Simulators have been widely used to train operational skills in urology, how to improve its effectiveness deserves further investigation. In this paper, we evaluated training using a novel transparent anatomic simulator, an opaque model or no simulator training, with regard to post-training ureteroscopy and cystoscopy proficiency.
Methods
Anatomically correct transparent and non-transparent endourological simulators were fabricated. Ten experienced urologists provided a preliminary evaluation of the models as teaching tools. 36 first-year medical students underwent identical theoretical training and a 50-point examination of theoretical knowledge. The students were randomly assigned to receive training with the transparent simulator (Group 1), the non-transparent simulator (Group 2) or detailed verbal instruction only (Group 3). 12 days after the training session, the trainees’ skills at ureteral stent insertion and removal were evaluated using the Uro-Scopic Trainer and rated on an Objective Structured Assessment of Technical Skills (OSATS) scale.
Results
The new simulators were successfully fabricated in accordance with the design parameters. Of the ten urologists invited to evaluate the devices, 100 % rated the devices as anatomically accurate, 90 % thought both models were easy to use and 80 % thought they were good ureteroscopy and cystoscopy training tools. The scores on the theoretical knowledge test were comparable among the training groups, and all students were able to perform ureteral stent insertion and removal. The mean OSATS scores of groups 1, 2 and 3 were21.83 ± 3.64, 18.50 ± 4.03 and 15.58 ± 2.23 points, respectively, (p = 0.001).
Conclusions
Simulator training allowed students to achieve higher ureteroscopic and cystoscopic proficiency, and transparent simulators were more effective than non-transparent simulators.
doi:10.1186/s12909-015-0380-8
PMCID: PMC4457046  PMID: 26032174
Simulation; Ureteroscopy; Cystoscopy; Urinary tract; Medical education; Training
25.  A survey study on student preferences regarding pathology teaching in Germany: a call for curricular modernization 
BMC Medical Education  2015;15:94.
Background
Pathology is a discipline that provides the basis of the understanding of disease in medicine. The past decades have seen a decline in the emphasis laid on pathology teaching in medical schools and outdated pathology curricula have worsened the situation. Student opinions and thoughts are central to the questions of whether and how such curricula should be modernized.
Methods
A survey was conducted among 1018 German medical students regarding their preferences in pathology teaching modalities and their satisfaction with lecture-based courses. A qualitative analysis was performed comparing a recently modernized pathology curriculum with a traditional lecture-based curriculum. The differences in modalities of teaching used were investigated.
Results
Student satisfaction with the lecture-based curriculum positively correlated with student grades (spearman’s correlation coefficient 0.24). Additionally, students with lower grades supported changing the curriculum (spearman’s correlation coefficient 0.47). The majority supported virtual microscopy, autopsies, seminars and podcasts as preferred didactic methods.
Conclusions
The data supports the implementation of a pathology curriculum where tutorials, autopsies and supplementary computer-based learning tools play important roles.
doi:10.1186/s12909-015-0381-7
PMCID: PMC4460630  PMID: 26032301
Pathology education; Curriculum development; Student survey; Teaching

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