Beatrice A. Boateng

The Development of a Competency-Based Assessment Rubric to Measure Resident Milestones

BACKGROUND The outcomes-based assessment rubric is a novel systematic instrument for documenting improvement in clinical learning. APPROACH This article describes the development of a rubric aimed at introducing specific performance indicators to measure the Accreditation Council for Graduate Medical Education competencies. RESULTS The potential benefits and implications for medical education include specifying performance indicators and outcomes, ensuring that assessment is coherent and consistent for all residents, measuring resident outcomes based on real-life criteria, providing opportunities for residents to demonstrate proficiency in a specific competency and outcome level, and improving the quality of assessment.

Adolescent health care and the trainee: roles of self-efficacy, standardized patients, and an adolescent medicine rotation.

Purpose Pediatric residents often cite a lack of confidence with adolescents owing to minimal exposure during training. Self-efficacy has been evaluated in a general context but not in relation to perception of knowledge and communication skill. Study objectives were to evaluate resident self-efficacy during a month-long adolescent rotation and to assess knowledge and communication skills in their relationship to self-efficacy. Methods Data were collected as part of the adolescent medicine rotation for pediatric residents at a local children’s hospital. Residents completed 2 standardized patient cases at the beginning of the rotation and a self-efficacy instrument before/after the cases and at the end of the rotation. The study assessed trends in self-efficacy using repeated-measures analysis of variance and &khgr;2 tests to examine relationships between self-efficacy and knowledge as well as communication in preventative and sexually transmitted infection adolescent health. Results Resident (n = 44) self-efficacy levels significantly changed over all time points and were significantly related to knowledge and communication levels. Although self-efficacy levels decreased immediately after the standardized patient cases, all self-efficacy items were significantly higher at the end of the rotation. Residents confident or very confident in general health topics were deficient in asking basic history items and residents confident or very confident in high-risk topics often did not actually assess these areas with patients. Conclusions Residents’ personal assessments on paper may differ from actual clinical interactions. Standardized patient cases expose resident strengths and weaknesses with adolescents, and a month-long adolescent rotation allows for repetitive experiences with special adolescent health care topics with associated increase in self-efficacy, knowledge application, and communication skill.

How Can We Ease the Social Isolation of Underrepresented Minority Students

To the Editor: In an environment in which there may be a lack of cultural sensitivity, a lack of shared experiences, and a lack of inclusion or like-mindedness, underrepresented minority (URM) students may feel isolated1,2 and not part of a social network. In our experience, such students may be mistakenly perceived as having a lack of knowledge, being unprofessional, or just not being interested academically and socially. Furthermore, evaluations of clinical rotations have a significant subjective component and are influenced by social interactions of students and faculty and the implicit expectations of both. We have seen the lack of social interaction of some URMs lead to misperceptions of their competencies and to their receiving less-thandeserved evaluations. This translates into lower class rankings, which, in turn, may reduce some URMs’ competitive status during the residency selection process.

Underrepresented minorities and the health professions pipeline.

We see no need or justification to establish for-profit medical schools. The for-profit status of Rocky Vista is dismissed by its proponents as merely a “tax status” that does not affect the quality or operation of the school. However, we cannot help but wonder whether, in order to make a profit and generate a return for its investor, Rocky Vista will have to divert funds that could otherwise be used to enhance research and education, while at the same time maximizing price (tuition) to competitive market levels.

High-Fidelity Hybrid Simulation of Allergic Emergencies Demonstrates Improved Preparedness for Office Emergencies in Pediatric Allergy Clinics

BACKGROUND Simulation models that used high-fidelity mannequins have shown promise in medical education, particularly for cases in which the event is uncommon. Allergy physicians encounter emergencies in their offices, and these can be the source of much trepidation. OBJECTIVE To determine if case-based simulations with high-fidelity mannequins are effective in teaching and retention of emergency management team skills. METHODS Allergy clinics were invited to Arkansas Childrens Hospital Pediatric Understanding and Learning through Simulation Education center for a 1-day workshop to evaluate skills concerning the management of allergic emergencies. A Clinical Emergency Preparedness Team Performance Evaluation was developed to evaluate the competence of teams in several areas: leadership and/or role clarity, closed-loop communication, team support, situational awareness, and scenario-specific skills. Four cases, which focus on common allergic emergencies, were simulated by using high-fidelity mannequins and standardized patients. Teams were evaluated by multiple reviewers by using video recording and standardized scoring. Ten to 12 months after initial training, an unannounced in situ case was performed to determine retention of the skills training. RESULTS Clinics showed significant improvements for role clarity, teamwork, situational awareness, and scenario-specific skills during the 1-day workshop (all P < .003). Follow-up in situ scenarios 10-12 months later demonstrated retention of skills training at both clinics (all P ≤ .004). CONCLUSION Clinical Emergency Preparedness Team Performance Evaluation scores demonstrated improved team management skills with simulation training in office emergencies. Significant recall of team emergency management skills was demonstrated months after the initial training.

Medical student self-efficacy, knowledge and communication in adolescent medicine

Objectives To evaluate student self-efficacy, knowledge and communication with teen issues and learning activities. Methods Data were collected during the 8-week pediatric rotation for third–year medical students at a local children’s hospital. Students completed a self-efficacy instrument at the beginning and end of the rotation; knowledge and communication skills were evaluated during standardized patient cases as part of the objective structured clinical examination. Self-efficacy, knowledge and communication frequencies were described with descriptive statistics; differences between groups were also evaluated utilizing two-sample t-tests. Results Self-efficacy levels of both groups increased by the end of the pediatric rotation, but students in the two-lecture group displayed significantly higher self-efficacy in confidentiality with adolescents (t(35)=-2.543, p=0.02); interviewing adolescents, assessing risk, sexually transmitted infection risk and prevention counseling, contraception counseling were higher with marginal significance. No significant differences were found between groups for communication; assessing sexually transmitted infection risk was marginally significant for knowledge application during the clinical exam. Conclusions Medical student self-efficacy appears to change over time with effects from different learning methods; this higher self-efficacy may increase future comfort and willingness to work with this high-risk, high-needs group throughout a medical career.

An examination of eating disorder education and experience in a 1-month adolescent medicine rotation: what is sufficient to foster adequate self-efficacy?

Abstract Objective Medical students and professionals report receiving limited education/training related to treating eating disorders. Because medical professionals are the point of initial contact for these patients and are involved necessarily in their treatment, sufficient knowledge on identification and intervention are imperative. This research set out to examine the impact of the eating disorder education and experience offered through a 1-month Adolescent Medicine rotation at a medical university on medical student/resident self-efficacy. Methods The 1-month rotation includes a standardized patient (SP) simulation, 1.5 h of didactic education, and 1 day observing the MD, nutritionist and psychologist within the outpatient Multidisciplinary Child/Adolescent Eating Disorders Clinic. All residents’ (n = 132) eating disorder self-efficacy was assessed before (PRE) completing simulation and didactic session and again at the end of the 1-month rotation (END). Self-efficacy was also assessed after simulation and before the didactic session for group 1 (n = 92) and after simulation and didactic session for group 2 (n = 40). Results For group 1, self-efficacy was not significantly impacted PRE to POST. For group 2, self-efficacy significantly improved PRE to POST. POST to END changes were significant for both groups; however, group 2 scored significantly better across all self-efficacy areas at END. Conclusion Resident training in eating disorders requires more than is offered in many residency programs. SP simulation is strengthened as an effective training tool in assessing and promoting resident self-efficacy if it is followed by didactic education. Clinical observation and extended practice that includes ongoing guidance/feedback on performance is recommended in fostering self-efficacy.

Evaluating Evidence-Based Practice Knowledge and Beliefs Through the e-Learning EBP Academy

BACKGROUND This research examined evidence-based practice (EBP) knowledge and beliefs before and after a 3-month e-learning program was implemented to build EBP capacity at a large childrens hospital. METHOD Ten clinicians completed the development, implementation, and evaluation of the e-learning education, comprising phase one. Revision and participation by 41 clinicians followed in phase two. Participants in both phases completed the EBP Beliefs and Implementation Scales preintervention, postintervention, and 6 months after postintervention. RESULTS EBP beliefs and implementation increased immediately and 6 months after postintervention, with statistically significant increases in both phases. Participants in both phases applied knowledge by completing mentor-supported EBP projects. CONCLUSION Although EBP beliefs and implementation scores increased and e-learning provided flexibility for clinician participation, challenges arose, resulting in lower-than-expected completion. Subsequent revisions resulted in hybrid education, integrating classroom and e-learning with project mentoring. This funded e-learning research contributes knowledge to the growing specialty of professional development. J Contin Educ Nurs. 2017;48(7):304-311.