Patricia S. O’Sullivan

Becoming an academic doctor: perceptions of scholarly careers

Objectives  Despite a recognised need to prepare future faculty members, little research has been conducted on how best to accomplish this task, especially among learners and faculty members within research‐intensive medical schools.

A comparison of two methods of teaching reflective ability in Year 3 medical students

Medical Education 2012: 46: 807–814

Understanding trust as an essential element of trainee supervision and learning in the workplace

Clinical supervision requires that supervisors make decisions about how much independence to allow their trainees for patient care tasks. The simultaneous goals of ensuring quality patient care and affording trainees appropriate and progressively greater responsibility require that the supervising physician trusts the trainee. Trust allows the trainee to experience increasing levels of participation and responsibility in the workplace in a way that builds competence for future practice. The factors influencing a supervisor’s trust in a trainee are related to the supervisor, trainee, the supervisor–trainee relationship, task, and context. This literature-based overview of these five factors informs design principles for clinical education that support the granting of entrustment. Entrustable professional activities offer promise as an example of a novel supervision and assessment strategy based on trust. Informed by the design principles offered here, entrustment can support supervisors’ accountability for the outcomes of training by maintaining focus on future patient care outcomes.

Student performance problems in medical school clinical skills assessments.

Background Though most medical schools administer comprehensive clinical skills assessments to identify students who have not achieved competence, the types of problems uncovered by these exams have not been characterized. Method The authors interviewed 33 individuals responsible for remediation after their schools’ comprehensive assessments, to explore their experience with the problems students demonstrate and strategies for and success with remediation. Results Respondents perceived that technique problems in history taking and physical examination were readily correctable, but that poor performance resulting from inadequate knowledge or poor clinical reasoning ability was more difficult to ameliorate. Interpersonal skill deficiencies, which often manifested as detachment from the patient, and professionalism problems attributed to lack of insight, were most refractory to remediation. Conclusions Poor performance in comprehensive assessments often indicates underlying deficiencies in cognitive ability, communication skills, or professionalism. The challenge of remediating these deficiencies late in medical school calls for earlier identification and intervention.

Remediation Techniques for Student Performance Problems After a Comprehensive Clinical Skills Assessment

Purpose Poor performance on a medical school comprehensive clinical skills assessment after core clerkships requires remediation. Little is known about techniques used to remedy students’ skills deficits and their effectiveness. The authors identified remediation strategies used at U.S. medical schools and determined instructors’ confidence in remediation. Method In the fall of 2007, the authors surveyed persons responsible for remediation at U.S. medical schools that conduct comprehensive clinical assessments and remediation. Respondents reported their use of four types of remediation strategies: (1) clinical activities, (2) independent study, (3) precepted video review of exam recording, and (4) organized group activities for deficits in history-taking, physical examination, knowledge, clinical reasoning, professionalism, and communication. The authors assessed confidence in remediation for the six skill areas and analyzed these measures using repeated-measures analysis of variance. Results Fifty-three of 71 (74.6%) participants responded. Educators most commonly employ the precepted video review remediation activity across the six skill areas, and they use the clinical activities least commonly. Confidence in remediating the six skill areas was below the “agree” level. Confidence was highest for remediating history-taking and physical examination problems and lowest for professionalism. Conclusion Educators express modest confidence in remediating fourth-year students’ clinical skills deficiencies. The finding that schools employ primarily video review for remediation suggests a potential need to augment opportunities for mentored skills practice to address deficits more effectively. The remediation literature similarly stresses the importance of multiple approaches tailored to particular deficits.

Reliability and validity of reflection exercises for obstetrics and gynecology residents

OBJECTIVE Self-evaluation is an essential skill throughout a physicians career, and reflection is thought to be a necessary mechanism for effective self-evaluation. The aim of our study was to establish the reliability and validity of structured assessments of critical self-reflection. STUDY DESIGN Thirty-two residents completed 6 exercises that were scored from 0 (no description of event) to 6 (deep reflection). We calculated interrater and internal consistency reliability for the exercises and compared scores by postgraduate year and with other competency assessments. RESULTS Residents completed 183 reflections. Interrater reliability was 0.89. Surgical skill reflections scored highest (score, 3.2 +/- 0.91 [SD]). Five exercises had adequate internal consistency reliability (0.62). Senior residents received higher reflection scores than junior residents; the magnitude of difference was similar for other competency measures and not statistically significant. Reflection scores were correlated with professionalism and communication skill assessments (score, 0.36-0.37; P < .01) but not with medical knowledge. CONCLUSION Self-reflection can be assessed reliably with scored exercises that demonstrate concurrent validity with other assessments. We encourage further research that should include multiple training programs to further evaluate our approach for the assessment of reflection in postgraduate education.

Collaborative research in medical education: a discussion of theory and practice.

Medical Education 2010: 44: 1175–1184

Transitional clerkship: an experiential course based on workplace learning theory.

Starting clerkships is anxiety provoking for medical students. To ease the transition from preclerkship to clerkship curricula, schools offer classroom-based courses which may not be the best model for preparing learners. Drawing from workplace learning theory, the authors developed a seven-day transitional clerkship (TC) in 2007 at the University of California, San Francisco School of Medicine in which students spent half of the course in the hospital, learning routines and logistics of the wards along with their roles and responsibilities as members of ward teams. Twice, they admitted and followed a patient into the next day as part of a shadow team that had no patient-care responsibilities. Dedicated preceptors gave feedback on oral presentations and patient write-ups. Satisfaction with the TC was higher than with the previous years classroom-based course. TC students felt clearer about their roles and more confident in their abilities as third-year students compared with previous students. TC students continued to rate the transitional course highly after their first clinical rotation. Preceptors were enthusiastic about the course and expressed willingness to commit to future TC preceptorships. The transitional course models an approach to translating workplace learning theory into practice and demonstrates improved satisfaction, better understanding of roles, and increased confidence among new third-year students.

Manual Laparoscopic Skills Development Using a Low-Cost Trainer Box in Tanzania

OBJECTIVES To explore the feasibility and effectiveness of guided practice using a low-cost laparoscopic trainer on the development of laparoscopic skills by surgeons in a resource-poor setting. DESIGN This was a prospective trial involving a pretest/posttest single-sample design. Study participants completed a background survey and pretest on the 5 McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) tasks using a simulator developed and validated by researchers from the University of California, San Francisco. On completion of a 3-month guided practice course, participants were again tested on the MISTELS tasks and completed an exit survey. SETTING The Muhimbili University of Health and Allied Sciences in Dar es Salaam, Tanzania. PARTICIPANTS Fourteen Tanzanian surgery residents and specialists completed the study. RESULTS Most of the subjects were surgical residents (64.3%). Only 2 participants (14.2%) had previous laparoscopic training, and baseline laparoscopic surgical experience was limited to intraoperative observation only. Study subjects practiced the MISTELS tasks for an average of 8.67 hours (range: 4.75-15.25) over the 3-month course. On the posttest, participants improved significantly in performance of each of the MISTELS tasks (p < 0.001). Total scores on the tasks increased from 24 ± 44 on the pretest to 384 ± 49 on the posttest (p < 0.001). All study participants were satisfied with the course, found the training personally valuable, and felt that their laparoscopic skills had improved on completion of the training. CONCLUSIONS We have demonstrated the feasibility and effectiveness of training with a low-cost laparoscopic trainer box in Tanzania. Study participants achieved impressive posttest scores on the 5 MISTELS tasks with minimal baseline laparoscopic exposure. We feel that guided training by an expert was key in ensuring correct technique during practice sessions.

Systems-Based Practice Learning Opportunities in Student-Run Clinics: A Qualitative Analysis of Student Experiences

Purpose Student-run clinics (SRCs) provide preclerkship medical students with systems-based practice (SBP) experiences as they engage in patient care and manage clinic operations. This study explored the types and context of SBP activities students participate in at SRCs. Method Between November 2011 and February 2012, the authors conducted in-depth, semistructured interviews with a purposive sample of medical students who served as volunteers and coordinators (student leadership role) at four independently run SRCs within the University of California, San Francisco, School of Medicine. They also interviewed SRC faculty advisors. Interviews focused on student roles in SRCs, SBP learning opportunities in SRCs, and comparisons of SBP experiences in SRCs with those in the formal preclerkship curriculum. The authors used thematic analysis techniques to code and synthesize data. Results Data from interviews with 8 volunteers, 14 coordinators, and 4 faculty suggested six major domains related to SBP learning opportunities in SRCs: interprofessional roles and collaboration; clinic organization; patient factors affecting access to care; awareness of the larger health care system and continuity of care; resource acquisition and allocation; and systems improvement. Coordinators, who managed SRCs, demonstrated greater depth of SBP understanding than volunteers, who provided patient care. Students and faculty agreed that SRCs provided students with SBP learning opportunities beyond those available in the formal curriculum. Conclusions Preclerkship students’ participation in SRCs provides opportunities for in-depth learning of SBP, particularly among students who take on leadership roles. SRCs may model ways to effectively introduce key components of SBP to early medical learners.