Asela Olupeliyawa

The Teamwork Mini-Clinical Evaluation Exercise (T-MEX): a workplace-based assessment focusing on collaborative competencies in health care.

Purpose Teamwork is an important and challenging area of learning during the transition from medical graduate to intern. This preliminary investigation examined the psychometric and logistic properties of the Teamwork Mini-Clinical Evaluation Exercise (T-MEX) for the workplace-based assessment of key competencies in working with health care teams. Method The authors designed the T-MEX for direct observation and assessment of six collaborative behaviors in seven clinical situations important for teamwork, feedback, and reflection. In 2010, they tested it on University of New South Wales senior medical students during their last six-week clinical term to investigate its overall utility, including validity and reliability. Assessors rated students in different situations on the extent to which they met expectations for interns for each collaborative behavior. Both assessors and students rated the tool’s usefulness and feasibility. Results Assessment forms for 88 observed encounters were submitted by 25 students. The T-MEX was suited to a broad range of collaborative clinical practice situations, as evidenced by the encounter types and the behaviors assessed by health care team members. The internal structure of the behavior ratings indicated construct validity. A generalizability study found that eight encounters were adequate for high-stakes measurement purposes. The mean times for observation and feedback and the participants’ perceptions suggested usefulness for feedback and feasibility in busy clinical settings. Conclusions Findings suggest that the T-MEX has good utility for assessing trainee competence in working with health care teams. It fills a gap within the suite of existing tools for workplace-based assessment of professional attributes.

Nursing intensive care skills training: A nurse led, short, structured, and practical training program, developed and tested in a resource-limited setting☆

PURPOSE To assess the impact of a nurse-led, short, structured training program for intensive care unit (ICU) nurses in a resource-limited setting. METHODS A training program using a structured approach to patient assessment and management for ICU nurses was designed and delivered by local nurse tutors in partnership with overseas nurse trainers. The impact of the course was assessed using the following: pre-course and post-course self-assessment, a pre-course and post-course Multiple Choice Questionnaire (MCQ), a post-course Objective Structured Clinical Assessment station, 2 post-course Short Oral Exam (SOE) stations, and post-course feedback questionnaires. RESULTS In total, 117 ICU nurses were trained. Post-MCQ scores were significantly higher when compared with pre-MCQ (P < .0001). More than 95% passed the post-course Objective Structured Clinical Assessment (patient assessment) and SOE 1 (arterial blood gas analysis), whereas 76.9% passed SOE 2 (3-lead electrocardiogram analysis). The course was highly rated by participants, with 98% believing that this was a useful experience. CONCLUSIONS Nursing Intensive Care Skills Training was highly rated by participants and was effective in improving the knowledge of the participants. This sustainable short course model may be adaptable to other resource-limited settings.

A student-led process to enhance the learning and teaching of teamwork skills in medicine

CONTEXT The development of teamwork skills is a critical aspect of modern medical education. This paper reports on a project that aimed to identify student perceptions of teamwork-focused learning activities and generate student recommendations for the development of effective educational strategies. METHODS The project utilized a unique method, which drew on the skills of student research assistants (RAs) to explore the views of their peers. Using structured interview guides, the RAs interviewed their colleagues to clarify their perceptions of the effectiveness of current methods of teamwork teaching and to explore ideas for more effective methods. The RAs shared their deidentified findings with each other, identified preliminary themes, and developed a number of recommendations which were finalized through consultation with faculty. RESULTS The key themes that emerged focused on the need to clarify the relevance of teamwork skills to clinical practice, reward individual contributions to group process, facilitate feedback and reflection on teamwork skills, and systematically utilize clinical experiences to support experiential learning of teamwork. Based on these findings, a number of recommendations for stage appropriate teamwork learning and assessment activities were developed. Key among these were recommendations to set up a peer-mentoring system for students, suggestions for more authentic teamwork assessment methods, and strategies to utilize the clinical learning environment in developing teamwork skills. DISCUSSION The student-led research process enabled identification of issues that may not have been otherwise revealed by students, facilitated a better understanding of teamwork teaching and developed ownership of the curriculum among students. The project enabled the development of recommendations for designing learning, teaching, and assessment methods that were likely to be more effective from a student perspective.

Barriers to healthy dietary choice amongst students in Sri Lanka as perceived by school principals and staff

Summary Sri Lanka has experienced a massive demographic, environmental, economic and social transition in recent decades. Over this period of time the country has undergone rapid urbanization leading to accompanying shifts in lifestyle and it suffers a double burden of under- and over-nutrition. Current programmes in the country focus on improving the dietary behaviour of secondary school students. The purpose of this study was to investigate principals perceptions on barriers to healthy dietary choice among pupils within a socio-ecological framework. Focus groups (n = 11) were carried out with school principals and staff (n = 55) in two rural districts of Sri Lanka. Principals identified a number of barriers to healthy dietary choice by students, which could be found at a number of levels of influence of a socio-ecological framework: (i) structural level barriers included educational and agricultural policies, (ii) living and working level barriers included employment opportunities and local food production, (iii) social and community level barriers included traditions and social/cultural beliefs and (iv) individual level barriers included knowledge and preference. Findings from this study suggest that the barriers to healthy dietary choice amongst secondary school students in Sri Lanka occur at many levels supporting the use of multifactorial programmes to promote healthy eating. Only from understanding these barriers and finding ways to counter them can we hope to reduce the double burden of under- and over-nutrition the country is currently suffering.

The impact of programmatic assessment on student learning: what can the students tell us?

It has been my experience that the most challenging aspects of residency training have pertained to the ability to adapt to change, multitask and prioritise, and to the need for resiliency in the face of adversity. Despite this, I had very little guidance on how to appreciate and hone these skills during my formative training years in college and medical school. I urge that we respond to the increasing imperative of purposeful teaching in these non-clinical skills. Ultimately, I cannot foresee a training programme that removes the pager from the hip, but I can envision success for those that prepare trainees to manage the task of responding to the buzz.

Innovative Assessment That Combines Collaborative and Self-Directed Learning With Integration and Application of Knowledge: Teamwork Group Projects

Introduction There is a worldwide focus on the early development of collaborative skills in medical students as reflected in the design of the medicine program at the University of New South Wales, Australia. Integral to the success of student-centered curricula, is early development of students’ self-directed and collaborative learning skills. The purpose of this innovative assessment is to develop and assess students’ skills in self-directed and collaborative learning while they concurrently engage with stage-appropriate content knowledge. Methods The educational design of the group projects allows junior medical students to work collaboratively to develop a deep understanding of the concepts and principles of a clinical scenario. Students are required to integrate and apply knowledge from different disciplines and share their learning with a wider peer group through appropriate peer teaching strategies. Two variants of these group projects are described in this resource, and generic versions of student and assessor instructions are included as Appendices A and B. Results Feedback on the projects collected over the last 7 years has been positive. Students begin to see the relevance and benefits of learning together and appreciate the impact this has on the quality of their learning. They also begin to appreciate the relevance of collaborative skills to their future practice as doctors. Discussion The group projects are based on well-established educational principles, and the templates provided in the appendices can be adapted by other medical educators.