Nele R. Michels

A Delphi study to construct a CanMEDS competence based inventory applicable for workplace assessment

BackgroundDuring workplace based learning students develop professional competences and an appropriate performance. To gain insight in the learning process and to evaluate competences and performance, assessment tools are essential and need to be of good quality. We aimed to construct a competence inventory applicable as an instrument to measure the content validity of workplace based assessment tools, such as portfolio.MethodsA Delphi study was carried out based on the CanMEDS Roles Framework. In three rounds, experts (N = 25–30) were invited to score the key competences per CanMEDS role on relevance (6-point Likert-scale), and to comment on the content and formulation bearing in mind its use in workplace based assessment. A descriptive analysis of relevances and comments was performed.ResultsAlthough all competences were scored as relevant, many comments pointed at a lack of concrete, transparent and applicable descriptions of the key competences for the purpose of assessment. Therefore, the CanMEDS roles were reformulated in this Delphi procedure as concrete learning outcomes, observable and suitable for workplace based assessment.ConclusionsA competence based inventory, ready for validating workplace based assessment tools, was constructed using a Delphi procedure and based on a clarification and concretisation of the CanMEDS roles.

Impact of family medicine clerkships in undergraduate medical education: a systematic review.

Objective Synthesise evidence about the impact of family medicine/general practice (FM) clerkships on undergraduate medical students, teaching general/family practitioners (FPs) and/or their patients. Data sources Medline, ERIC, PsycINFO, EMBASE and Web of Knowledge searched from 21 November to 17 December 2013. Primary, empirical, quantitative or qualitative studies, since 1990, with abstracts included. No country restrictions. Full text languages: English, French, Spanish, German, Dutch or Italian. Review methods Independent selection and data extraction by two authors using predefined data extraction fields, including Kirkpatrick’s levels for educational intervention outcomes, study quality indicators and Best Evidence Medical Education (BEME) strength of findings’ grades. Descriptive narrative synthesis applied. Results Sixty-four included articles: impact on students (48), teaching FPs (12) and patients (8). Sample sizes: 16-1095 students, 3-146 FPs and 94-2550 patients. Twenty-six studies evaluated at Kirkpatrick level 1, 26 at level 2 and 6 at level 3. Only one study achieved BEME’s grade 5. The majority was assessed as grade 4 (27) and 3 (33). Students reported satisfaction with content and process of teaching as well as learning in FM clerkships. They enhanced previous learning, and provided unique learning on dealing with common acute and chronic conditions, health maintenance, disease prevention, communication and problem-solving skills. Students’ attitudes towards FM were improved, but new or enhanced interest in FM careers did not persist without change after graduation. Teaching FPs reported increased job satisfaction and stimulation for professional development, but also increased workload and less productivity, depending on the setting. Overall, student’s presence and participation did not have a negative impact on patients. Conclusions Research quality on the impact of FM clerkships is still limited, yet across different settings and countries, positive impact is reported on students, FPs and patients. Future studies should involve different stakeholders, medical schools and countries, and use standardised and validated evaluation tools.

Increased herpes zoster risk associated with poor HLA-A immediate early 62 protein (IE62) affinity

Around 30% of individuals will develop herpes zoster (HZ), caused by the varicella zoster virus (VZV), during their life. While several risk factors for HZ, such as immunosuppressive therapy, are well known, the genetic and molecular components that determine the risk of otherwise healthy individuals to develop HZ are still poorly understood. We created a computational model for the Human Leukocyte Antigen (HLA-A, -B, and -C) presentation capacity of peptides derived from the VZV Immediate Early 62 (IE62) protein. This model could then be applied to a HZ cohort with known HLA molecules. We found that HLA-A molecules with poor VZV IE62 presentation capabilities were more common in a cohort of 50 individuals with a history of HZ compared to a nationwide control group, which equated to a HZ risk increase of 60%. This tendency was most pronounced for cases of HZ at a young age, where other risk factors are less prevalent. These findings provide new molecular insights into the development of HZ and reveal a genetic predisposition in those individuals most at risk to develop HZ.

Educational training requirements for general practice/family medicine specialty training: recommendations for trainees, trainers and training institutions

ABSTRACT High-quality training is a prerequisite to teaching future general practitioners. To inspire and guide all countries to implement General Practice (GP) specialist education and training and bring it to the highest standards, we aimed, within the European context, to produce a collaborative document entitled ‘Educational Requirements for GP Specialty Training’. Through an iterative process existing documents from the European Academy of Teachers in GP and Family Medicine (EURACT) and the World Organization of Family Medicine Doctors (WONCA) were collated. Other reports, grey literature about specialty GP training and requirements for trainees, trainers and training institutions were included. State-of-the-art GP specialty training ‘core’ competences, characteristics and essential features of GP are described. General principles and specified tools for training and assessment are summarised. Recommendations on the duration and place(s) of training and selection of trainees are provided. Trainers should be accredited teachers and quality training institutions are essential. New insights, existing gaps and issues for debate have highlighted areas for further research. This document was produced in the specific context of Europe but its general principles are relevant to GP training in all countries.

Impact van de stage huisartsgeneeskunde: Een systematische review over de student, begeleider en patiënt

SamenvattingDoor het toenemend aantal patiënten met complexe aandoeningen wordt de complementaire rol tussen ziekenhuiszorg en eerstelijnszorg steeds belangrijker. De huidige aanbevelingen roepen dan ook op om studenten geneeskunde meer in contact te brengen met de eerstelijnszorg en in het bijzonder met de huisartsgeneeskunde als belangrijkste medische eerstelijnsdiscipline.

The efficacy of different training strategies for infiltration techniques

EURACT 2016 The efficacy of different training strategies for infiltration techniques Els Vanhomwegen and Nele R. Michels center for General Practice, university of antwerp, antwerp, Belgium Background Research shows that few GPs perform intraand periarticular infiltrations. Lack of good training strategies to teach these skills would be an important reason for this observation. Former studies demonstrated the efficacy of different training strategies, however few quality studies compared those strategies. Aim We investigated three training strategies for infiltrations of the glenohumeral joint, subacromial space, lateral epicondyle, carpal tunnel and knee joint. Method Residents in family practice were randomized into three teaching groups: a theoretical lecture (n = 18) or a lecture with training on anatomical models (n = 19) or on cadavers (n = 11). Before and after the course the participants’ self-efficacy (questionnaire) and skills (OSCE) were evaluated. The self-efficacy was assessed again three months later. Concurrently, participants were asked if they had performed more infiltrations since training. A Kruskal-Wallis test was used to compare the results before vs. after training and between groups (p < 0.05). Results All three training strategies had a significant benefit on the participants’ self-efficacy concerning knowledge and skills and on the skills test. This benefit on self-efficacy remained 3 months after the course. However, some participants still felt uncomfortable to perform infiltrations. Best scores for self-efficacy concerning skills and best scores on the skills test were observed after training on cadavers, followed by training on anatomical models. Almost half of participants stated they performed more infiltrations since attending the course. Conclusion Based on this study a course with training on cadavers can be recommended to teach infiltrations. To achieve an optimal effect, repeated courses may be necessary.

Content validity of workplace-based portfolios: A multi-centre study

Abstract Background: Portfolios are used as tools to coach and assess students in the workplace. This study sought to evaluate the content validity of portfolios as reflected in their capacity to adequately assess achieved competences of medical students during clerkships. Methods: We reviewed 120 workplace portfolios at three medical universities (Belgium and the Netherlands). To validate their content, we developed a Validity Inventory for Portfolio Assessment (VIPA) based on the CanMEDS roles. Two raters evaluated each portfolio and indicated for each VIPA item whether the portfolio provided sufficient information to enable satisfactory assessment of the item. We ran a descriptive analysis on the validation data and computed Cohen’s Kappa to investigate interrater agreement. Results: The portfolios adequately covered the items pertaining to the communicator (90%) and professional (87%) roles. Coverage of the medical expert, collaborator, scholar and manager roles ranged between 75% and 85%. The health advocate role, covering 59%, was clearly less well represented. This role also exhibited little interrater agreement (Kappa < 0.4). Conclusions: This study lends further credence to the evidence that portfolios can indeed adequately assess the different CanMEDS roles during clerkships, the health advocate role, which was less well represented in the portfolio content, excepted.