Ann Roex

Effectiveness of Nonresuscitative First Aid Training in Laypersons: A Systematic Review

STUDY OBJECTIVE This study reviewed evidence on the effects of nonresuscitative first aid training on competence and helping behavior in laypersons. METHODS We identified randomized and nonrandomized controlled trials and interrupted time series on nonresuscitative first aid training for laypersons by using 12 databases (including MEDLINE, EMBASE, and PsycINFO), hand searching, reference checking, and author communication. Two reviewers independently evaluated selected studies with the Cochrane Effective Practice and Organisation of Care Review Group quality criteria. One reviewer extracted data with a standard form and another checked them. In anticipation of substantial heterogeneity across studies, we elected a descriptive summary of the included studies. RESULTS We included 4 studies, 3 of which were randomized trials. We excluded 11 studies on quality issues. Two studies revealed that participants trained in first aid demonstrated higher written test scores than controls (poisoning first aid: relative risk 2.11, 95% confidence interval [CI] 1.64 to 2.72; various first aid cases: mean difference 4.75, 95% CI 3.02 to 6.48). Two studies evaluated helping responses during unannounced simulations. First aid training improved the quality of help for a bleeding emergency (relative risk 25.94; 95% CI 3.60 to 186.93), not the rate of helping (relative risk 1.13; 95% CI 0.88 to 1.45). Training in first aid and helping behavior increased the helping rates in a chest pain emergency compared with training in first aid only (relative risk 2.80; 95% CI 1.05 to 7.50) or controls (relative risk 3.81; 95% CI 0.98 to 14.89). Participants trained in first aid only did not help more than controls (relative risk 1.36; 95% CI 0.28 to 6.61). CONCLUSION First aid programs that also train participants to overcome inhibitors of emergency helping behavior could lead to better help and higher helping rates.

4C/ID in medical education: How to design an educational program based on whole-task learning: AMEE Guide No. 93

Abstract Medical education increasingly stresses that medical students should be prepared to take up multiple roles as a health professional. This requires the integrated acquisition of multiple competences such as clinical reasoning and decision making, communication skills and management skills. To promote such complex learning, instructional design has focused on the use of authentic, real-life learning tasks that students perform in a real or simulated task environment. The four-component instructional design model (4C/ID) model is an instructional design model that starts from the use of such tasks and provides students with a variety of learning tools facilitating the integrated acquisition of knowledge, skills and attitudes. In what follows, we guide the reader on how to implement educational programs based on the 4C/ID model and illustrate this with an example from general practice education. The developed learning environment is in line with the whole-task approach, where a learning domain is considered as a coherent, integrated whole and where teaching progresses from offering relatively simple, but meaningful, authentic whole tasks to more complex tasks. We describe the steps that were taken, from prototype over development to implementation, to build five learning modules (patient with diabetes; the young child with fever; axial skeleton; care for the elderly and physically undefined symptoms) that all focus on the integrated acquisition of the Canadian Medical Education Directives for Specialists roles in general practice. Furthermore, a change cycle for educational innovation is described that encompasses practice-based challenges and pitfalls about the collaboration between different stakeholders (students, developers and teachers) and the transition from traditional, fragmented and classroom-based learning to integrated and blended learning based on sound instructional design principles.

Let's talk about thinking.

Routledge 2003;33–52. 7 Rees CE, Ajjawi R, Monrouxe L. The construction of power in family medicine bedside teaching: a video-observation study. Med Educ 2013; In press. 8 Engeström Y. Expansive learning at work: toward an activity theoretical reconceptualisation. J Educ Work 2001;14 (1):133–56. 9 Bleakley A. Broadening conceptions of learning in medical education: the message from teamworking. Med Educ 2006;40 (2):150–7. 10 Wenger E. Communities of Practice: Learning, Meaning and Identity. Cambridge: Cambridge University Press 1998;3–15 .

A computerized adaptive knowledge test as an assessment tool in general practice : a pilot study.

Advantageous to assessment in many fields, CAT (computerized adaptive testing) use in general practice has been scarce. In adapting CAT to general practice, the basic assumptions of item response theory and the case specificity must be taken into account. In this context, this study first evaluated the feasibility of converting written extended matching tests into CAT. Second, it questioned the content validity of CAT. A stratified sample of students was invited to participate in the pilot study. The items used in this test, together with their parameters, originated from the written test. The detailed test paths of the students were retained and analysed thoroughly. Using the predefined pass–fail standard, one student failed the test. There was a positive correlation between the number of items and the candidates ability level. The majority of students were presented with questions in seven of the 10 existing domains. Although proved to be a feasible test format, CAT cannot substitute for the existing high-stakes large-scale written test. It may provide a reliable instrument for identifying candidates who are at risk of failing in the written test.

Can training improve laypersons helping behaviour in first aid? A randomised controlled deception trial

Background There is limited evidence indicating that laypersons trained in first aid provide better help, but do not help more often than untrained laypersons. This study investigated the effect of conventional first aid training versus conventional training plus supplementary training aimed at decreasing barriers to helping. Methods The authors conducted a randomised controlled trial. After 24 h of conventional first aid training, the participants either attended an experimental lesson to reduce barriers to helping or followed a control lesson. The authors used a deception test to measure the time between the start of the unannounced simulated emergency and seeking help behaviour and the number of particular helping actions. Results The authors randomised 72 participants to both groups. 22 participants were included in the analysis for the experimental group and 36 in the control group. The authors found no statistically or clinically significant differences for any of the outcome measures. The time until seeking help (geometrical mean and 95% CI) was 55.5 s (42.9 to 72.0) in the experimental group and 56.5 s (43.0 to 74.3) in the control group. 57% of the participants asked a bystander to seek help, 40% left the victim to seek help themselves and 3% did not seek any help. Conclusion Supplementary training on dealing with barriers to helping did not alter the helping behaviour. The timing and appropriateness of the aid provided can be improved. Trial registration The authors registered this trial at ClinicalTrials.gov as NCT00954161.

Usable knowledge, hazardous ignorance - Beyond the percentage correct score

Background: Little attention has been paid to the metacognitive ability of medical students. Aim: We used confidence marking to explore certainty of knowledge and ignorance. Methods: One hundred and twenty-seven of 169 general practice trainees took part. Students sat a written multiple choice question (MCQ) test. Each answer was followed by a degree of certainty judgement. Answers attributed with a high degree of certainty were used to compute overall usable knowledge, hazardous ignorance, proportions of knowledge that is usable and of ignorance that is hazardous. The former variables were analysed according to MCQ score, year of training and gender. Results: At a group level, the mean amount of usable knowledge on the MCQ was 21.13%, mean amount of hazardous ignorance on the MCQ was 5.21%, mean proportion of knowledge that was usable was 36.57%, mean proportion of ignorance that was hazardous was 14.32%. There were neither significant differences between highest and lowest quartiles of MCQ score, nor according to year of training. Men had higher levels of ignorance that is hazardous. Conclusion: A third of trainees’ knowledge was partial. A sixth of their ignorance was hazardous. Confidence marking can aid formative assessment and could potentially be implemented into summative assessments.

Medical Trainees’ Epistemological Beliefs and Their Cognitive Flexibility

In this chapter, we test three propositions: (1) The beliefs medical trainees hold about knowledge and knowing consist of different dimensions, which are stable across different medical domains. (2) Sophisticated beliefs lead to higher levels of cognitive flexibility (CF). (3) In order to foster CF in medical trainees, medical curricula should be revised to encourage trainees to reflect upon the structure and certainty of knowledge. Different methods were used to elaborate upon the three propositions. A questionnaire was developed to identify and measure medical trainees’ EB both in the domain of urogenital and of the musculoskeletal tract (n = 363). In order to unravel the link between the epistemological beliefs (EB) and cognitive flexibility of the medical trainees (n = 117), we explored to what extent medical trainees with more sophisticated EB performed better in the modules (knowledge test, objective-structured clinical examination (OSCE), and semi-structured oral examination) of the certification examination for general practitioners (GPs) in Flanders (Dutch-speaking part of Belgium). An explanation for the findings was sought in the international definitions of general practice and in existing educational agendas.

How to connect classroom and workplace learning

Transition, the ‘dynamic process in which the individual moves from one set of circumstances to another’, features prominently in the training of students across the health professions. 1 Changes in students’ expectations, tasks or responsibilities frequently accompany each transition. 1 One of these transitions occurs when students move from the nonclinical setting or classroom to the clinical environment. 2 To avoid an abrupt transition into real clinical work, workplace experiences are increasingly integrated into the fi rst years of medical school; 3 however, no matter how integrated curricula may be, changes and transitions are unavoidable. 4 Within all transitions, students are required to continuously apply and refi ne the classroomacquired Transition features prominently in the training of students across the health professions Editors’ note: Health professional educators are increasingly interested in times of transition: from school to university; from student to recently graduated health professional in the fi rst days of practice; and from predominantly classroom-based learning to immersion in clinical settings. This toolbox article focuses on this last transition, an important time in the education of (in this case) medical students. The authors base the six practical recommendations on their own experiences as clinical educators as well as being guided by the literature on this topic. The transfer of learning to the workplace and to patient care may be diffi cult. Students require regular supervised practise of the competencies learned in the classroom and through simulation. Timely interactive feedback is important. One role of clinical teachers is to provide student support in order to facilitate students in their transition to workplace learning.

How competent do general practice residents feel and why

BACKGROUND General practice residency aims to produce competent general practitioners (GPs) who will practice independently, i.e. who demonstrate adequate levels of actual and self-perceived competence. PURPOSES To measure self-perceived competence in GP residents at our institution and explore potential determinants. METHODS We conducted a cross-sectional study of our GP residents. Self-perceived competence was measured in four domains. Independent variables included gender, postgraduate year, patient contacts, on-call duties, practice of specific tasks, self-assessed effort and knowledge. RESULTS Between 1.6 and 37.8% of GP residents assessed their competence as less than average. Self-perceived competence was not consistently linked to any of the hypothesised factors. CONCLUSIONS A significant proportion of residents reported less than satisfactory levels of self-perceived competence. Longitudinal studies should be conducted as well as qualitative studies focusing on the role of other factors in the development of high levels of self-perceived competence during general practice training.