Advances in health sciences education : theory and practice
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Adv Health Sci Educ Theory Pract · May 2016
Randomized Controlled TrialCan student self-ratings be compared with peer ratings? A study of measurement invariance of multisource feedback.
Measurement invariance is a prerequisite for comparing measurement scores from different groups. In medical education, multi-source feedback (MSF) is utilized to assess core competencies, including the professionalism. However, little attention has been paid to the measurement invariance of assessment instruments; that is, whether an instrument holds the same meaning across different rater groups. ⋯ In addition, same factor structure and similar factor loadings and intercepts of NTU P-MSF scores between both groups indicate that NTU P-MSF scores had configural, metric, and scalar invariance. Thus, students' self-assessments and peer assessments can be compared in terms of the constructs of NTU P-MSF scores, change in NTU P-MSF scores, and its factor scores. This study demonstrates how to investigate the measurement invariance of a professionalism MSF and contributes to the discussion on self- and peer assessment in medical education.
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Adv Health Sci Educ Theory Pract · Dec 2015
Consequences of contextual factors on clinical reasoning in resident physicians.
Context specificity and the impact that contextual factors have on the complex process of clinical reasoning is poorly understood. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of resident physicians in order to describe what impact the presence of contextual factors have on their clinical reasoning. Participants viewed three video recorded clinical encounters portraying straightforward diagnoses in internal medicine with select patient contextual factors modified. ⋯ When confronted with the presence of contextual factors in a clinical scenario, residents experienced difficulty with closure of the encounter, exhibited as diagnostic uncertainty. This finding raises important questions about the relationship between contextual factors and clinical reasoning activities and how this relationship might influence the cost effectiveness of care. This study also provides insight into how the phenomena of context specificity may be explained using situated cognition theory.
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Adv Health Sci Educ Theory Pract · Oct 2015
Randomized Controlled TrialPart versus whole: a randomized trial of central venous catheterization education.
Central venous catheterization (CVC) is a complex but commonly performed procedure. How best to teach this complex skill has not been clearly delineated. We conducted a randomized trial of the effects of two types of teaching of CVC on skill acquisition and retention. ⋯ Participants in the part-task group outperformed the whole-task group in skill acquisition (2.2 ± 0.8 vs 1.3 ± 1.0; g = 1.01; p = 0.04) and in skill retention (1.5 ± 0.7 vs 0.5 ± 0.8; g = 1.39; p = 0.006) using the global rating scale. Scores rated by the checklist were not significantly different (52.0 ± 25.3 vs 43.5 ± 23.4; g = 0.33; p = 0.47 for skill acquisition; and 48.5 ± 34.9 vs 41.1 ± 20.4; g = 0.35; p = 0.44 for skill retention). For teaching ultrasound-guided CVC to novice learners, teaching in part is preferable than teaching in whole.
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Adv Health Sci Educ Theory Pract · Oct 2015
Why verifying diagnostic decisions with a checklist can help: insights from eye tracking.
Making a diagnosis involves ratifying or verifying a proposed answer. Formalizing this verification process with checklists, which highlight key variables involved in the diagnostic decision, is often advocated. However, the mechanisms by which a checklist might allow clinicians to improve their verification process have not been well studied. ⋯ Checklist use was associated with enhanced analytic scrutiny in all eye tracking measures assessed (F 6,10 = 6.0, p = .02). In this experiment, using a key variable checklist to verify diagnostic decisions improved error detection. This benefit was associated with enhanced analytic scrutiny of those key variables as measured by eye tracking.
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Adv Health Sci Educ Theory Pract · Oct 2015
Historical ArticleCost in medical education: one hundred and twenty years ago.
The first full paper that is dedicated to cost in medical education appears in the BMJ in 1893. This paper "The cost of a medical education" outlines the likely costs associated with undergraduate education at the end of the nineteenth century, and offers guidance to the student on how to make financial planning. Many lessons can be gleaned from the paper about the cost and other aspects of nineteenth century medical education. ⋯ The paper encourages the reader to reflect on what has and has not changed in this field since 1893. Modern medical education is still expensive; its expense deters students; and we have only started to think about how to control costs or how to ensure value. Too much of the cost of medical education continues to burden students and their families.