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Introduction: Ventral hernia repair cost the U.S. healthcare system nearly 3 billion dollars annually. Surgical repair is a critical competency for residents yet hernia recurrence rates following mesh-based repair range from 0.8% to 24%. Improving surgical techniques using cadavers is often cost-prohibited for many education programs and limited research exists using simulation models with a corresponding hernia repair curriculum in the graduate medical education setting. This pilot project aimed to develop a low cost, easily reproducible novel abdominal wall reconstruction model and pilot-test the ventral hernia repair curriculum to inform further refinement prior to formal evaluation., Material and Methods: This descriptive study pilot-tested the newly refined Abdominal Wall Surgical Skills Operative Model (AWSSOM) simulator for ventral hernia repair with mesh and its corresponding 2-h training curriculum for use at all levels of general surgery graduate medical education. The AWSSOM is a 3D printed synthetic anatomically realistic abdominal wall model consisting of silicone cured layers of skin, fat, rectus abdominis and a posterior rectus sheath fascia, and silicone tubules to simulate lateral neurovascular bundles. The curriculum incorporated didactic content reflecting surgical practice guidelines, hands-on practice, and faculty guidance promoting interactive critical thinking development during task performance. A pre-/post-assessment included a 10-item knowledge test, a 19-item psychomotor assessment, and 4-items confidence survey to examine changes in performance, knowledge, and confidence in competently completing the ventral hernia repair technique. Descriptive statistics were used to report the limited results of six military surgical resident participants and inform further model and curriculum refinement prior to formal evaluation., Results: The five-layer AWSSOM model was manufactured in 65 h at a material cost of $87 per model frame, is reusable model, and secure base. Six surgical residents were recruited; only four completed both pre- and post-tests due to resident schedule conflicts. The average increase in knowledge was 25%, although variable changes in confidence were observed over the four program year participants. A larger sample size and a control group are needed to demonstrate curriculum effectiveness at improving knowledge, performance, and confidence in ventral hernia repair with mesh and better delineate if high scores translate to better operative skills. A key improvement requested by residents was a more secure model base for dissection and performance of the hernia repair., Conclusions: The novel abdominal wall surgical skills operative model fills an important proof of concept gap in simulation training. It is low cost with the potential to improve cognitive and psychomotor skills, as well as confidence to competently complete ventral hernia repair with mesh in the graduate medical education setting. Prior to formal effectiveness testing, our lessons learned should be addressed in both the model and curriculum. Future studies must include an adequately powered statistical evaluation with a larger sample across all levels of training., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

The Competencies and Recommendations for Educating undergraduate Nursing Students (CARES) was originally designed for nursing students' palliative and end-of-life care education. The competencies were later revised to align with the 2021 American Association of Colleges of Nursing Essentials core competencies for baccalaureate nursing education. This project aimed to (1) review the courses in an accelerated baccalaureate nursing program for alignment with CARES, (2) determine any gaps, and (3) make program recommendations. The CARES competencies and Essentials were mapped according to the nursing program's 12 core curriculum courses and evaluated. Three CARES competencies were not met, and 12 were partially met. Areas of improvement were identified across the curriculum. Results of the mapping included palliative concepts needing earlier program introduction, reflective journaling was recommended for clinical practice courses, and incorporation of palliative care simulations was proposed to bridge the gaps., Competing Interests: The author has no conflicts of interest to disclose., (Copyright © 2024 by The Hospice and Palliative Nurses Association. All rights reserved.)

Introduction: Developing the clinical reasoning skills necessary to becoming an astute diagnostician is essential for medical students. While some medical schools offer longitudinal opportunities for students to practice clinical reasoning during the preclinical curriculum, there remains a paucity of literature fully describing what that curriculum looks like. As a result, medical educators struggle to know what an effective clinical reasoning curriculum should look like, how it should be delivered, how it should be assessed, or what faculty development is necessary to be successful. We present our Introduction to Clinical Reasoning course that is offered throughout the preclinical curriculum of the Uniformed Services University of the Health Sciences. The course introduces clinical reasoning through interactive lectures and 28 case-based small group activities over 15 months.The curriculum is grounded in script theory with a focus on diagnostic reasoning. Specific emphasis is placed on building the student's semantic competence, constructing problem lists, comparing and contrasting similar diagnoses, constructing a summary statement, and formulating a prioritized differential diagnosis the student can defend. Several complementary methods of assessment are utilized across the curriculum. These include assessments of participation, knowledge, and application. The course leverages clinical faculty, graduate medical education trainees, and senior medical students as small group facilitators. Feedback from students and faculty consistently identifies the course as a highly effective and engaging way to teach clinical reasoning., Conclusion: Our Introduction to Clinical Reasoning course offers students repeated exposure to well-selected cases to promote their development of clinical reasoning. The course is an example of how clinical reasoning can be taught across the preclinical curriculum without extensive faculty training in medical education or clinical reasoning theory. The course can be adapted into different instructional formats to cover a variety of topics to provide the early learner with sequential exposure and practice in diagnostic reasoning., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Introduction: Surgical cricothyroidotomy (SC) is a vital skill that combat first responders must master as airway obstruction is the third most preventable cause of death on the battlefield. Degradation of skills over time is a known problem, and there is inadequate knowledge regarding the rate of SC skill retention. Our prior study showed that simulation-based mastery learning was effective in training 89 novices how to reliably perform an en route SC to mastery performance standards. This study aims to assess the durability of this skill by bringing participants back in 3 separate cohorts at 6, 12, or 24 months following the initial training to perform SC in the same test environment., Materials and Methods: This was a randomized prospective trial. Random cohorts of equal subjects who previously underwent SC simulation-based mastery learning training were selected to return at 6, 12, and 24 months to retest in the same en route medical evacuation (MEDEVAC) helicopter scenario. A total of 22, 14, and 10 subjects returned at 6, 12, and 24 months, respectively, due to Coronavirus-19 impacts and travel limitations. Participants in the 24-month cohort received a refresher training prior to retesting. All attempts were recorded and blindly graded using the same 10 item standardized SC checklist used in initial training. Our previous work found that mastery criteria for performing a SC were ≤40 seconds and completion of 9/10 items on the checklist. Outcome measures in this study were time to complete the procedure and percent of subjects who completed at least 9/10 items on the SC checklist., Results: There was an increase in time required to complete the procedure compared to initial training in all three retesting cohorts (initial: median 27.50, interquartile range 25.38-31.07 seconds; 6 months: median 36.33, interquartile range 31.59-55.22 seconds; 12 months: median 49.50, interquartile range 41.75-60.75 seconds; 24 months: median 38.79, interquartile range 30.20-53.08 seconds; P < .0001, P < .0001, P = .0039). There was a decline in median value checklist scores compared to initial training in the 6- and 12-month retesting cohorts (initial: median 10.00/10, interquartile range 9.50-10.00; 6 months: median 8.00/10, interquartile range 6.75-9.00; 12 months: median 8.00/10, interquartile range 6.75-9.25; P < .0001, P < .001). There was no difference in median checklist scores between the initial and 24-month retesting scenario (initial: median 10.00/10, interquartile range 9.50-10.00; 24 months: 10.00/10, interquartile range 9.00-10.00; P= .125). There was a decrease in retention of skills as only 31.82% of subjects at 6 months and 14.29% at 12 months met the defined passing criteria of time to completion of ≤40 seconds and checklist score of ≥9/10. A brief refresher course several months prior to the 24-month cohort retesting greatly increased the retention of SC procedural skills, with 60% of subjects meeting the time and checklist criteria., Conclusions: This study showed that the skill required to perform a SC after initial mastery training does decay significantly. A brief refresher course can help increase retention of skills. Based on our findings SC skills should be refreshed at a minimum of every 6 months to assure optimal proficiency., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Objectives: We evaluated internal medicine residents' confidence and knowledge of personal finance, perceptions of burnout, and relations between these issues before and after an educational intervention., Methods: We surveyed internal medicine residents at two university-based training programs in 2018. We developed and implemented a curriculum at both sites, covering topics of budgeting, saving for retirement, investment options, and the costs of investing. Each site used the same content but different strategies for dissemination. One used a condensed-form lecture series (two 1-hour sessions) and the other used a microlecture series (four 30-minute sessions) series. Residents were resurveyed following the intervention for comparison., Results: The preintervention survey response rate was 41.2% (122/296) and the postintervention response rate was 44.3% (120/271). Postintervention mean scores for personal finance knowledge improved for basic concepts (52.6% vs 39.4%, P < 0.001), mutual fund elements (30.8% vs 19.7%, P < 0.001), investment plans (68.5% vs. 49.2%, P < 0.001), and overall knowledge (50.1% vs 36.1%, P < 0.001). A significantly smaller proportion of residents reported feelings of burnout following the intervention (23.3% vs 36.9%, P = 0.022)., Conclusions: Our findings show that residents want to learn about finances. Our brief educational intervention is a practical way to improve overall knowledge. Our intervention suggests that improving knowledge of finance may be associated with decreased feelings of burnout.

Purpose: As global health education and training shift toward competency-based approaches, academic institutions and organizations must define appropriate assessment strategies for use across health professions. The authors aim to develop entrustable professional activities (EPAs) for global health to apply across academic and workplace settings., Method: In 2019, the authors invited 55 global health experts from medicine, nursing, pharmacy, and public health to participate in a multiround, online Delphi process; 30 (55%) agreed. Experts averaged 17 years of global health experience, and 12 (40%) were from low- to middle-income countries. In round one, participants listed essential global health activities. The authors used in vivo coding for round one responses to develop initial EPA statements. In subsequent rounds, participants used 5-point Likert-type scales to evaluate EPA statements for importance and relevance to global health across health professions. The authors elevated statements that were rated 4 (important/relevant to most) or 5 (very important/relevant to all) by a minimum of 70% of participants (decided a priori) to the final round, during which participants evaluated whether each statement represented an observable unit of work that could be assigned to a trainee. Descriptive statistics were used for quantitative data analysis. The authors used participant comments to categorize EPA statements into role domains., Results: Twenty-two EPA statements reached at least 70% consensus. The authors categorized these into 5 role domains: partnership developer, capacity builder, data analyzer, equity advocate, and health promoter. Statements in the equity advocate and partnership developer domains had the highest agreement for importance and relevance. Several statements achieved 100% agreement as a unit of work but achieved lower levels of agreement regarding their observability., Conclusions: EPAs for global health may be useful to academic institutions and other organizations to guide the assessment of trainees within education and training programs across health professions., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of American Medical Colleges.)

Purpose: The ability of medical schools to accurately and reliably assess medical student clinical performance is paramount. The RIME (reporter-interpreter-manager-educator) schema was originally developed as a synthetic and intuitive assessment framework for internal medicine clerkships. Validity evidence of this framework has not been rigorously evaluated outside of internal medicine. This study examined factors contributing to variability in RIME assessment scores using generalizability theory and decision studies across multiple clerkships, thereby contributing to its internal structure validity evidence., Method: Data were collected from RIME-based summative clerkship assessments during 2018-2019 at Virginia Commonwealth University. Generalizability theory was used to explore variance attributed to different facets through a series of unbalanced random-effects models by clerkship. For all analyses, decision (D-) studies were conducted to estimate the effects of increasing the number of assessments., Results: From 231 students, 6,915 observations were analyzed. Interpreter was the most common RIME designation (44.5%-46.8%) across all clerkships. Variability attributable to students ranged from 16.7% in neurology to 25.4% in surgery. D-studies showed the number of assessments needed to achieve an acceptable reliability (0.7) ranged from 7 in pediatrics and surgery to 11 in internal medicine and 12 in neurology. However, depending on the clerkship each student received between 3 and 8 assessments., Conclusions: This study conducted generalizability- and D-studies to examine the internal structure validity evidence of RIME clinical performance assessments across clinical clerkships. Substantial proportion of variance in RIME assessment scores was attributable to the rater, with less attributed to the student. However, the proportion of variance attributed to the student was greater than what has been demonstrated in other generalizability studies of summative clinical assessments. Overall, these findings support the use of RIME as a framework for assessment across clerkships and demonstrate the number of assessments required to obtain sufficient reliability., (Copyright © 2020 by the Association of American Medical Colleges.)

Phenomenon: There is currently a move to provide residency programs with accurate competency-based assessments of their candidates, yet there is a gap in knowledge regarding the role and effectiveness of interventions in easing the transition to residency. The impact of key stakeholder engagement, learner-centeredness, intrinsic competencies, and assessment on the efficacy of this process has not been examined. The objective of this scoping review was to explore the nature of the existing scholarship on programs that aim to facilitate the transition from medical school to residency. Approach: We searched MEDLINE and EMBASE from inception to April 2020. Programs were included if they were aimed at medical students completing undergraduate medical training or first year residents and an evaluative component. Two authors independently screened all abstracts and full text articles in duplicate. Data were extracted and categorized by type of program, study design, learner-centeredness, key stakeholder engagement, the extent of information sharing about the learner to facilitate the transition to residency, and specific program elements including participants, and program outcomes. We also extracted data on intrinsic (non- Medical Expert ) competencies, as defined by the CanMEDS competency framework. Findings: Of the 1,006 studies identified, 55 met the criteria for inclusion in this review. The majority of the articles that were eligible for inclusion were from the United States (n = 31, 57%). Most of the studies (n = 47, 85%) employed quantitative, or mixed method research designs. Positive outcomes that were commonly reported included increased self-confidence, competence in being prepared for residency, and satisfaction with the transition program. While a variety of learner-centered programs that focus on specific intrinsic competencies have been implemented, many (n = 29, 52%) did not report engaging learners as key stakeholders in program development. Insights: While programs that aim to ease the transition from medical school to residency can enhance both Medical Expert and other intrinsic competencies, there is much room for novel transition programs to define their goals more broadly and to incorporate multiple areas of professional development. The existing literature highlights various gaps in approaches to easing the transition from medical school to residency, particularly with respect to key stakeholder engagement, addressing intrinsic CanMEDS competencies, and focusing on individual learners' needs.

Background: Although evidence-based practice (EBP) has been spreading since the 1990s, it has not yet been sufficiently implemented., Aim: Following the reform of initial training for healthcare professions in France 2012, we sought to determine whether the new curriculum was associated with more frequent use of EBP., Methods: We performed an online, cross-sectional survey of nurses, occupational therapists, and podiatrists (divided into pre- and post-reform groups) in June 2018. The questionnaire covered demographic data, use of EBP, and the perception of EBP. As holding a master's degree may enhance knowledge and use of EBP, we adjusted for this variable. Categories to analyze qualitative data were created regarding the five steps in EBP and its definition., Results: The total sample was N = 595 (pre-reform group n = 301; post-reform group n = 294). The proportion of respondents who frequently read the professional literature was lower in the post-reform group than in the pre-reform group (33% vs. 54%, respectively; OR [95% CI] = .52 [.37-.73]; p < .001). The main stated reasons for reading the professional literature were "keeping up to date with practice" and "making clinical decisions." Respondents in both groups mentioned a lack of time as the most frequent barrier to reading the literature (82%), a lack of access to bibliographical resources, and that EBP was not encouraged. Most professionals limited their definition of EBP to reading the literature and implementing research results., Linking Evidence to Action: There is a need to teach the five steps of EBP more explicitly and to embed its position into daily practice, for example, through reflective analysis practice. Professional trainings about EBP should be offered on a regular basis. Guidance coming from the healthcare directorate should include expected daily practice time for reading and journal club and giving more access to international healthcare literature., (© 2020 Sigma Theta Tau International.)

Purpose: Students perceive bias in learning environments. Curricula targeting implicit bias recognition and management increase student awareness and achieve strategy identification, but fall short of actual skill development to address bias. In light of this gap, the authors developed and evaluated a skills-based elective to recognize and manage implicit bias in the learning environment., Method: Nine 1.5-hour sessions were delivered to 15 first-year medical students from 2017 to 2019. An evidence-based conceptual framework and transformative learning theory informed the instructional design; it incorporated active learning exercises. Skills assessment occurred through direct observation of student performances in role-play exercises. Using thematic analysis, the authors conducted a program evaluation based on focus groups with students and data from notes taken by the investigative team., Results: Students engaged with all aspects of instruction, including role-plays. Authors identified 3 themes from the program evaluation: (1) Student engagement can be enhanced, (2) Instruction is empowering, and (3) It (addressing bias in one's own and witnessed encounters) can be done! Analysis additionally highlighted opportunities for improvement and lessons learned., Conclusions: This innovative course achieved skill development and practice for medical students in implicit bias recognition and management as it pertains to 3 facets of clinical care present at every stage of a health professional's career. These include interpersonal encounters, advocating for patients when bias is perceived in witnessed encounters with peers and supervisors, and addressing comments made by others within the learning environment. Outcomes could inform novel, skills-based curricula across the spectrum of health professions training and practice.

Clinical judgment, one's ability to think like a nurse, is an essential skill for safe nursing practice. With the rise of simulation to replace clinical experiences, there is limited evidence regarding the effectiveness of simulation on the development of clinical judgment. This study explored differences in clinical judgment in maternal-newborn courses between undergraduate nursing students participating exclusively in simulation and those participating in hospital-based clinical experiences. Following completion of the clinical rotation, students participated in an evaluative maternal-newborn high-fidelity simulation experience that was recorded and evaluated using the Lasater's Clinical Judgment Rubric (2007). Lasater's Clinical Judgment Rubric scores between the simulation and clinical practice groups were compared using an independent sample t -test. There was no statistical difference in clinical judgment scores between the simulation and hospital-based clinical groups ( t = -1.056, P = .295). Our findings suggest that simulation may be a comparable alternative to clinical experience in nursing education.

Doctors need to acquire telehealth consultation skills to thrive in the increasingly pressurized health system of delivering high-quality, high-volume health care with a shrinking health care workforce. Telehealth consultations require the same degree of thoroughness and careful clinical judgment as face-to-face consultations. The distinct differences between telehealth and face-to-face consultations warrant training in telehealth, which should be incorporated into core curricula of medical schools and continuing medical education. We describe competency-based training for telehealth piloted with medical residents. The use of competency-based training for telehealth operationalized as an entrustable professional activity will facilitate high-quality, safe, and effective telehealth consultations., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Despite cancer being the leading cause of mortality, cancer education and patient exposure are lacking in many medical schools. The aim of this study was to evaluate the nature of cancer patient exposure, relative to the clinical setting for medical students on placement and to explore their experiences. Participants were asked to maintain a logbook of cancer patient encounters and were invited to attend a structured focus group upon completion of the academic year. Eleven students submitted logbooks (rr = 6.15%) and eight participated in the focus groups (4.47%). A total of 247 cancer patient encounters were recorded. Third-year students primarily saw cancer patients in surgery (18.62%) and general practice (8.50%), whilst final year students saw cancer patients most frequently in palliative care (35.22%) and ENT surgery (13.77%). Students highlighted that the quality of their interactions with cancer patients varied significantly between clinical settings. Outpatient clinics and surgical in-patients had the lowest level of interaction, with students having a predominantly observatory role. Repeated themes of uncertainty and awkwardness regarding history, examination and discussing death and dying were outcomes of the thematic analysis. Exposure to cancer patients remains highly variable and opportunistic. Students voiced concerns for preparedness to practice and many found it worrisome that they will likely examine a primary cancer when they have graduated, without having done so during their training. Our study suggests that a more structured approach to teaching and clinical exposure to cancer patients is required.

The appropriateness of the paradigm underlying competency frameworks and their specific application in the list of definitions developed by a Task Group of Society for Community Research and Action (SCRA) for US community psychologists need further consideration. This paper considers the technicist and behavioural roots of some of these concepts, illustrating tensions when applying them to community psychology. It then proposes a competency perspective from the global South. Drawing from focus group discussions with, and written reflections from, postgraduate Master's students in training as clinical and counselling psychologists, this paper builds inductively from the recorded data. Following a template analysis of the material, four integrating themes were evident. The distinctive nature of community psychology is highlighted through the themes: relational foundations, activity evolution, self-management and the awareness and influences of processes. Proposals for an alternative framework ("RASP") are based on its emergence from the applications of learning to practice, emphasising community-based principles. The importance of reflection as the basis for the learning is highlighted. The imperatives to foreground social justice and to enable reflexive thinking on action are discussed, along with concepts based on Humanist and Social Constructivist paradigms, to lead to more interactive and inclusive processes in work on competencies., (© 2020 Wiley Periodicals LLC.)

Background and Purpose: To describe the design, implementation, and evaluation of systematic progressive community pharmacy-based prescription verification activities across a skills-based laboratory course series., Educational Activity and Setting: Community pharmacy-based prescription verification activities were implemented into three laboratory courses, Abilities Lab (ABL) 1, 2, and 4. During each activity, students practiced prescription verification using a handout with two components. First, a checklist outlining an eight-step verification process serves as a student resource. In the second handout component, students are required to identify which step contains a prescription error(s), the appropriate pharmacist action, and the recommendation needed in order to correct the error(s). After verifying and completing the handout, the students participate in a facilitator-led discussion on the recommendations necessary to dispense the prescription. As students progressed through ABL 1, 2, and 4, both the error type and scope of the verification process expanded. Class verification exercises culminated in a final practical assessment at the end of each semester., Findings: In ABL 1 students scored an average of 99.5% (n = 161, standard deviation (SD) = 1.92) on the final practical assessment. In ABL 2, students scored an average of 97.6% (n = 166, SD = 3.07). In ABL 4, students scored an average of 90.3% (n = 159, SD = 11.2)., Summary: This manuscript adds value to the current literature by describing the implementation of progressive community pharmacy-based prescription verification activities across a skills-based laboratory course series., Competing Interests: Declaration of competing interest None., (Published by Elsevier Inc.)

Background: Lesotho has been experiencing health challenges as indicated by its high maternal mortality ratio of 620 per 100 000 live births for the year 2010, which has been linked to its limited human resources., Objectives: The knowledge and skills of final-year student nurse-midwives related to the active management of the third stage of labour were determined., Method: A quantitative, descriptive survey design was used to conduct this study with 99 final-year midwifery students at four nursing schools in Lesotho using stratified sampling. The structured questionnaire collected data on the knowledge and self-reported competency. Subsequently, the controlled cord traction marks, extracted from the objective structured clinical examination (OSCE), were compared to the self-reported competency of these midwifery students using R software version 3.4.0., Results: The mean score for knowledge and the OSCE was 73.8% (n = 99) and 77.2% (n = 99), respectively. The majority of respondents (95.2%, n = 99) rated themselves highly in terms of the active management of the third stage of labour competency. There was no correlation between the self-reported competency and knowledge (r = 0.08, p = 0.4402), and self-reported competency and OSCE scores (r = -0.004, p = 0.01)., Conclusion: The high mean scores for the knowledge and the OSCE indicate that the theoretical component of the curriculum on the active management of the third stage of labour was effective in equipping final-year midwifery students with knowledge and skills to carry out this competency.

The teaching of professional roles in medical education is an interdisciplinary concern. However, surgeons require specific standards of professionalism for certain context-based situations. In addition to communication, studies require collaboration, leadership, error-/conflict-management, patient-safety and decision-making as essential competencies for surgeons. Standards for corresponding competencies are defined in special chapters of the German National Competency-based Learning Objectives for Undergraduate Medical Education (NKLM; chapter 8, 10). The current study asks whether these chapters are adequately taught in surgical curricula. Eight German faculties contributed to analysing mapping data considering surgical courses of undergraduate programs. All faculties used the MERlin mapping platform and agreed on procedures for data collection and processing. Sub-competency and objective coverage, as well as the achievement of the competency level were mapped. Overall counts of explicit citations were used for analysis. Collaboration within the medical team is a strongly represented topic. In contrast, interprofessional cooperation, particularly in healthcare sector issues is less represented. Patient safety and dealing with errors and complications is most emphasized for the Manager/Leader, while time management, career planning and leadership are not addressed. Overall, the involvement of surgery in teaching the competencies of the Collaborator and Manager/Leader is currently low. However, there are indications of a curricular development towards explicit teaching of these roles in surgery. Moreover, implicitly taught roles are numerous, which indicates a beginning awareness of professional roles., Competing Interests: The authors have declared that no competing interests exist.

Background: Reflective practice affects all levels of nursing, including students, as well as practicing nurses. Self-reflective practice is a widespread concept in nursing; however, few empirical studies have demonstrated the possible effects of such a practice. The purpose of this integrative literature review was to identify evidence of the effects of self-reflective practice on baccalaureate-level nursing students, especially stress., Methods: The literature search was conducted utilizing CINAHL and PubMed databases. The inclusion criteria were studies published between 2013 and 2018, articles that were peer-reviewed, written in English, and focused on nursing education of baccalaureate programs only. A total of 15 articles were reviewed., Results: There is limited but growing evidence to suggest self-reflective practices have positive effects on baccalaureate-level nursing students. The self-reflective practices decreased stress and anxiety and increased learning, competency, and self-awareness of nursing practice. While written reflections were most commonly used in the studies, other forms of reflection, such as verbal and photography, were effective as well., Linking Evidence to Action: Nursing students can benefit from incorporating reflection into the didactic and clinical settings. Nursing faculty are encouraged to integrate reflection into the nursing curriculum. Nurses within the first year of practice could benefit from using reflective practice as well. Experienced nurses and nurse managers can encourage and mentor novice nurses on the use and benefits of reflective practice., (© 2020 Sigma Theta Tau International.)

Background: The Council on Chiropractic Education Australasia (CCE-A) is tasked with assessment and accreditation of chiropractic programs (CPs) in the Australasian community. To achieve this process the CCE-A has developed educational standards and graduate competencies which include minimum expectations of graduates prior to entry into the workforce. We sought to explore if these are changing overtime, and if so are these changes for the better., Method: The CCE-A 2009 and 2017 Competency Standards were located and downloaded. The competencies were placed into tables for a comparative analyses in a systematic manner to enable the identification of similarities and differences. In addition, word counts were conducted for the most commonly occurring words and this took place in December 2019., Results: The 2017 competency standards were over three times smaller than the previous standards 2009 standards. More similarities than differences between the old and the new standards were found. There were 18 additions to the 2017 graduate competencies with many that were in unison with contemporary aspects of healthcare such as patient centred-care, respect for practitioner-patient boundaries and patient sexual orientation, transitioning patients to self-management, and consideration of improving lifestyle options. Some competencies were not bought forward to the new standards and included, among others, students being competent in screening for mental health conditions, an expectation to discuss cost of care, re-evaluating and monitoring patients at each visit, and knowing when to discharge patients. The competencies continued to be silent on known issues within the chiropractic profession of a lack of a definition for chiropractic that would inform scope of practice and the presence of vitalism within CPs., Conclusion: There have been positive changes which reflect contemporary mainstream health care standards between CCE-A graduate competency revisions. The absence of a clear definition of chiropractic and its attendant scope of practice as well as continued silence on vitalism reflect known issues within the chiropractic profession. Recommendations are made for future accreditation standards to inform the required competencies and aid the integration of chiropractic into the broader health care community.

Introduction: This study sought to determine pharmacy students' self-assessment of their level of competency in specified global health statements across various schools. It also evaluated attributes associated with competency and perception of importance, as well as explored students' perspectives on how best to incorporate global health content into pharmacy education., Methods: Cross-sectional survey administered online to pharmacy students from three pharmacy schools in the United States., Results: The self-assessed competency of pharmacy students in global health topic areas was low. Current or prior exposures outside of the PharmD curriculum to the global health content presented in the survey were significant indicators of self-assessed competency scores. Within individual participating schools, demographic characteristics such as gender, age category, speaking a non-English language, and progression through the PharmD curriculum were also significantly associated with competency scores reported. Most respondents (96%) agreed that relevant global health education should be incorporated into the pharmacy curriculum., Conclusions: Pharmacy students generally perceive global health competencies to be of great importance in practice, but acknowledge their deficiencies in this area. The current burden of global health education at the schools surveyed relies on individual student experience rather than curricular support. Ensuring that future pharmacists understand their role in global health teams and are able to achieve the necessary level of competency to function in interdisciplinary initiatives will require more strategic incorporation of relevant content into the curriculum., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Clinical reasoning is often not explicitly taught to novice medical students. Pre-clerkship clinical skills courses are an ideal venue to teach the clinical reasoning process. The aim of the study was to evaluate the impact of a preclinical clinical reasoning curriculum through an end-of-semester objective structured clinical examination., Methods: This study was conducted through our longitudinal clinical skills course. Second year medical (M2) students who received the clinical reasoning curriculum in 2018 formed the study cohort. M2 students from the previous year, who did not have the clinical reasoning curriculum, formed the comparison cohort. Several modalities were used to teach clinical reasoning including whole case approach, serial cue approach, self-explanation of pathophysiological mechanisms and comparison of closely related diagnoses. The students interviewed a standardized patient and documented the history along with three likely diagnoses., Results: Students in the study cohort achieved higher scores on differential diagnosis (1.98 vs. 1.64 in the comparison cohort, p < 0.001). There was no statistically significant difference in the frequency of relevant symptoms queried between the study and comparison cohorts (3.74 vs. 3.34, p > 0.05)., Discussion: Our study confirms that the introduction of clinical reasoning in a pre-clerkship clinical skills curriculum increases students' ability to select relevant symptoms and provides them with a roadmap for expanding their differential diagnoses.

Background: Competency-based education (CBE) has been recommended for nurse practitioner (NP) education. To implement CBE, existing NP core competencies need to be reduced in number and refined., Purpose: This study refined and reduced redundancy in the National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN) NP core competencies through the consensus of experts in NP practice. This study used the current NP Core Competencies (NONPF, 2017), the Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006), and the Common Advanced Practice Registered Nurse Doctoral-Level Competencies (AACN, 2017a) because these documents are the competencies-accredited NP programs commonly used in curriculum development. The primary aim of this study was to refine and reduce redundancy of these competencies; a secondary aim was to ensure that the final competencies were clear and measurable., Methods: A Delphi approach was used to reach consensus among an expert panel who reviewed the core competencies via an online questionnaire. Descriptive statistics were used to calculate median and interquartile ranges; content analysis was conducted with qualitative data., Results: Consensus was reached after 3 rounds and resulted in 49 final core competencies., Implications for Practice: This study provides the NP community with a manageable list of relevant, clear, and measurable competencies that faculty members can use to implement CBE in their programs.

Purpose: To examine the validity evidence for a scrub training knowledge assessment tool to demonstrate the utility and robustness of a multimodal, entrustable professional activity (EPA)-aligned, mastery learning scrub training curriculum., Method: Validity evidence was collected for the knowledge assessment used in the scrub training curriculum at Stanford University School of Medicine from April 2017 to June 2018. The knowledge assessment had 25 selected response items that mapped to curricular objectives, EPAs, and operating room policies. A mastery passing standard was established using the Mastery Angoff and Patient-Safety approaches. Learners were assessed pre curriculum, post curriculum, and 6 months after the curriculum., Results: From April 2017 to June 2018, 220 medical and physician assistant students participated in the scrub training curriculum. The mean pre- and postcurriculum knowledge scores were 74.4% (standard deviation [SD] = 15.6) and 90.1% (SD = 8.3), respectively, yielding a Cohen's d = 1.10, P < .001. The internal reliability of the assessment was 0.71. Students with previous scrub training performed significantly better on the precurriculum knowledge assessment than those without previous training (81.9% [SD = 12.6] vs 67.0% [SD = 14.9]; P < .001). The mean item difficulty was 0.74, and the mean item discrimination index was 0.35. The Mastery Angoff overall cut score was 92.0%., Conclusions: This study describes the administration of and provides validity evidence for a knowledge assessment tool for a multimodal, EPA-aligned, mastery-based curriculum for scrub training. The authors support the use of scores derived from this test for assessing scrub training knowledge among medical and physician assistant students.

Purpose: To investigate the effect of a change in the United States Medical Licensing Examination Step 1 timing on Step 2 Clinical Knowledge (CK) scores, the effect of lag time on Step 2 CK performance, and the relationship of incoming Medical College Admission Test (MCAT) score to Step 2 CK performance pre and post change., Method: Four schools that moved Step 1 after core clerkships between academic years 2008-2009 and 2017-2018 were analyzed. Standard t tests were used to examine the change in Step 2 CK scores pre and post change. Tests of differences in proportions were used to evaluate whether Step 2 CK failure rates differed between curricular change groups. Linear regressions were used to examine the relationships between Step 2 CK performance, lag time and incoming MCAT score, and curricular change group., Results: Step 2 CK performance did not change significantly (P = .20). Failure rates remained highly consistent (pre change: 1.83%; post change: 1.79%). The regression indicated that lag time had a significant effect on Step 2 CK performance, with scores declining with increasing lag time, with small but significant interaction effects between MCAT and Step 2 CK scores. Students with lower incoming MCAT scores tended to perform better on Step 2 CK when Step 1 was after clerkships., Conclusions: Moving Step 1 after core clerkships appears to have had no significant impact on Step 2 CK scores or failure rates, supporting the argument that such a change is noninferior to the traditional model. Students with lower MCAT scores benefit most from the change.

Over the last decade in the United States, a national emphasis on controlling health care costs has prompted the medical community to embrace the ideal of high-value care (HVC), with value defined as health outcomes achieved per dollar spent. Despite increasing recognition of its importance as a skill for the modern physician, the practice of HVC remains a relatively new concept. Integrating HVC into medical education has been heterogeneous at best, with the majority of current HVC education thus far implemented at the postgraduate level. The authors present the unique benefits of the earlier introduction of HVC training at the medical school level, including ease of standardization across programs, a synergy in learning the value of an intervention alongside its other innate qualities, and the establishment of a foundational HVC education to allow for specialty-specific value training during residency. In this Invited Commentary, the authors offer practical recommendations for the incorporation of HVC training into medical schools' curricula, with special attention to correlating specific education strategies with the preclerkship, clerkship, and elective years of medical school.

Introduction: Our objective was to assess postgraduate year one (PGY1) pharmacy resident perceived competence during medical emergencies before and after implementation of a longitudinal simulation training curriculum., Methods: At the University of California San Francisco (UCSF) Medical Center, PGY1 pharmacy residents serve as primary code team responders for code blue, code sepsis, and code stroke, among other medical emergencies. In 2015, the UCSF Residency Training Program implemented a longitudinal simulation curriculum for PGY1 pharmacy residents. Throughout the residency year, residents participated in four simulation lab sessions that addressed various medical emergencies. To assess the impact that the simulation curriculum had on resident perceived competence during medical emergencies, a 19-question survey (13 clinical questions and six control questions) was distributed to the residents at the end of the residency year. Resident responses from the 2015 to 2016 and 2016 to 2017 surveys were compared to a control residency class from 2014 to 2015 who did not undergo the simulation curriculum., Results: Simulation-trained PGY1 pharmacy residents reported significantly greater perceived competence in five of the twelve medical emergency scenarios (acute coronary syndromes, symptomatic bradycardia, supraventricular tachycardia, ventricular tachycardia, and cardiac arrest) as compared to non-simulation-trained controls. In addition, the PGY1 pharmacy residents felt that their performance as a clinical pharmacist would significantly improve as a result of the simulation curriculum., Conclusions: Incorporation of a longitudinal simulation curriculum into PGY1 pharmacy resident training can positively impact resident self-reported competence when performing essential pharmacist functions during medical emergencies., (Published by Elsevier Inc.)

In Australia, one in two men and one in three women will be diagnosed with cancer by the age of 85. Several studies have demonstrated a decline in the number of medical graduates having examined cancer patients during their training. The aim of this study was to evaluate the exposure of medical students to cancer patients during clinical placements. Eighty-eight logbooks (response rate = 24.75%) containing 9430 patients were analysed. A total of 829 patients (8.79%) had a diagnosis of cancer. Most cancer patients were seen on surgical placements, whilst general practice placements returned the lowest numbers. None were seen in paediatrics or ophthalmology. Given the role surgery plays in the staging and treatment of cancer, it is unsurprising that most cancer patients were seen during surgery.  Most concerning was the number of patients with common cancers seen by our students. Only 46% of students saw a patient with breast cancer. Even fewer saw patients with colorectal (41%), lung (32%) and prostate cancer (30%). Only 14% saw a melanoma patient. Variability in the quality of the logbooks is the main limitation of this study, and therefore, it is not a complete picture of cancer patient exposure. However, it builds upon previous studies by providing insight to the number and types of cancer patients to which students were exposed. Overall, the exposure to common cancers remains concerning and further research is needed to explore the type and quality of these interactions over the course of an entire year.

Introduction: Laboratory-based courses often require more manpower than faculty can provide to facilitate active learning activities in the classroom as well as skills-based assessments., Perspective: Pharmacy and graduate student and resident teaching assistants (TAs) can be incorporated into laboratory-based courses to help meet this need. Before using student and resident TAs in laboratory-based courses, a number of items need to be considered. This paper will discuss how to recruit, train, and evaluate student and resident TAs. It will also detail the benefits to the faculty, the students in the classroom, and the TAs themselves. Finally, lessons learned from five schools of pharmacy who use student and/or resident TAs will be shared., Implications: Schools of pharmacy should implement a formalized process for utilizing student and resident TAs in laboratory-based courses especially where faculty manpower limitations exist., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background and Purpose: Implementation of games is common in pharmacy education, but limited information exists about the relationship between students' game performances and course grades. Our study was designed to determine if scores on a comprehensive web-based review game correlate to overall pharmacotherapeutics course and course series grades., Educational Activity and Setting: Two cohorts of students in Pharmacotherapeutics IV, the last course in a four course series, were administered a web-based quiz review game (Kahoot!) at the end of the course. Student performance on the game was compared to grades throughout the Pharmacotherapeutics course sequence to determine if the games were reflective of the students' performances. All students enrolled in Pharmacotherapeutics IV in 2016 and 2017 were included in the analysis. Pearson correlation was performed on the scores from the review game compared to the grades in the pharmacotherapeutics course series., Findings: A total of 197 students, 111 in the 2016 cohort and 86 in the 2017 cohort, were included in the analysis. The correlation coefficient (r) for the review scores and Pharmacotherapeutics IV course grade was 0.399 and 0.461 for the 2 cohorts (p < 0.001). Almost all component comparisons between the review scores and the other pharmacotherapeutics course grades were also significantly correlated (p < 0.01)., Summary: Student performance on the review game significantly correlated with pharmacotherapeutics course grades. Review games are fun tools to review course content and can serve as an effective method to determine student understanding, progression, and knowledge., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The current Spanish curricula for degrees in dentistry include conscious sedation (CS) as a basic training competency. However, is the CS training delivered by Spanish dental schools a consensus-based educational framework enabling students to use this anesthetic technique after graduation? To answer this research question, a study was designed aiming to identify the strategies used to teach this competency in Spanish dental schools and the characteristics of teaching. The authors reviewed legislation concerning officially established requirements for a degree in dentistry as well as curricula currently taught in Spain. Our analysis identified clear discrepancies among the schools of dentistry studied. The only overlap was observed in reference to the level of proficiency imparted, which prevents Spanish dentistry students from using this anesthetic technique after graduation. Specific features of the normative framework and of the Spanish legislative system underlying the design of the present curricula of degrees in dentistry would explain the discrepancies in CS competencies taught at our schools of dentistry. Almost 10 years since its implementation and in light of the new demands of the complex society in which we live, Spanish universities must unify their educational criteria regarding CS training to ensure the appropriate qualification of our new dentists in this technique.

Objectives: Training in child and adolescent psychotherapy continues to be emphasized by accrediting organizations (ACGME and ABPN) but it is not known how these skills are taught and what types of therapy are highlighted in fellowships across the United States., Methods: A 16-question anonymous online survey was developed by the authors and covered six main areas: demographics, the priority of psychotherapy in training, the competency goals for different psychotherapy modalities, training strategies, types of supervision, and program directors' satisfaction of their training implementation and assessment of trainees. The survey was sent to every identified CAP program director during a three-month period in early 2017., Results: Data was gathered from 53 of the 131 program directors surveyed, giving a 40% response rate. Ninety percent of CAP program directors strongly agree or agree that it is important to preserve and promote training and practice of psychotherapy. Most (83%) program directors indicated competence or expertise as a training goal for CBT with more variability among programs for other psychotherapies. Seventy percent of program directors agree that their program provides adequate time for learning and practicing psychotherapy but the allotted time for psychotherapy is low across majority of programs over both years of training., Conclusions: These results indicate that there is a gap between the goals of providing optimal training in psychotherapy with the low amount of protected time for the practice of psychotherapy. These results should provide a foundation for program directors to learn from each other about developing, improving, and implementing effective psychotherapy training.

Introduction: Knowledge and skill development related to communication must incorporate both affective and behavioral components, which are often difficult to deliver in a learning activity. Using theater techniques and principles can provide medical educators with tools to teach communication concepts., Methods: This 75-minute faculty development workshop presents a variety of techniques from theater and adapts them for use in medical education. Using examples related to diversity and inclusion, this session addresses general educational and theater principles, role-play, sociodrama, applied improvisation, and practical aspects of involving theater partners. The session materials include a PowerPoint presentation with facilitator notes, interactive activities to demonstrate each modality, and an evaluation. The sessions can be extended to longer formats as needed., Results: Forty-five participants at Learn Serve Lead 2016: The AAMC Annual Meeting attended the 75-minute session. We emailed 32 participants 5 months after the conference, and eight responded. Participants reported that their confidence level in using theater techniques as a tool for medical education increased from low-to-medium confidence presession to high confidence postsession. All survey respondents who were actively teaching said they had made changes to their teaching based on the workshop. All commented that they appreciated the active learning in the session. Many indicated they would appreciate video or other follow-up resources., Discussion: Principles and techniques from theater are effective tools to convey difficult-to-teach concepts related to communication. This workshop presents tools to implement activities in teaching these difficult concepts., Competing Interests: None to report.

Competing Interests: FG and AL have received two grants from UCL to the department of clinical and professional practice for Practically Creating an Inclusive Curriculum and Decolonising the Medical Curriculum. AL is on the board of directors of the International MotherBaby Childbirth organisation and a trustee for the Birthlight Charitable Trust. She is a company director of a small publishing company called Docamali Ltd

Introduction: Children with neuromuscular disabilities (NMD) receive care in a wide variety of clinical settings. Residents lack training to develop physical examination skills for evaluating patients with NMD. We devised a curriculum to teach residents how to examine patients with NMD using a systematic and simplified approach., Methods: Creation of this resource was a response to a survey of final-year residents that revealed the need for education focused on developing physical examination skills. The curriculum has four components-multimedia PowerPoint with embedded video, knowledge assessment, clinical exam (CEX) assessment, and module feedback-and was completed by 37 residents over an 8-month period from January to September 2016. We utilized knowledge assessment, direct clinical skills observation using the CEX, and module-feedback responses as part of the evaluation., Results: All 37 residents completed the curriculum, with an overall knowledge score of greater than 80%. Residents demonstrated most of the desired patient care behaviors on the CEX assessment and provided positive feedback on the quality, usefulness, and applicability of the module, in addition to requesting more curricula to develop their physical examination skills., Discussion: The CEX assessment provided a unique opportunity for faculty feedback on residents' physical exam performance. After completing the module, residents achieved high scores in most areas of the standardized CEX and were able to conduct the NMD physical exam in a sensitive manner. The assessment highlighted the need to improve residents' skills of detecting abnormal clinical findings and communicating with the patient during the physical exam., Competing Interests: None to report.

Background and Purpose: This study determined the impact of an interprofessional education (IPE) simulation on family nurse practitioner (FNP) students' and family medicine residents' (FMRs) self-reported confidence in counseling women reluctant to engage in cancer screening or evaluation and assessed knowledge of breast and cervical cancer risk factors., Method: A multi-item knowledge survey on breast and cervical cancer risk factors was administered to 76 FNP students and FMRs followed by an IPE simulation with a pre-/postsurvey of self-reported confidence in counseling a woman reluctant to have breast and cervical cancer screening and evaluation., Discussion: Data demonstrated knowledge deficits in breast and cervical cancer risk factors in both disciplines with the average risk factor knowledge score of 8.5/12 for breast cancer and 7.8/12 for cervical cancer. Following IPE simulation, confidence in counseling women reluctant to have breast or cervical cancer screening improved across both disciplines (p < .05) and debrief feedback findings suggest improved attitudes toward collegiality, communication, and understanding of other interprofessional roles among both disciplines., Conclusion: Knowledge gaps exist among both FNP students and FMRs in breast and cervical cancer risk factors. This study suggests IPE simulation is effective in building individual provider confidence and team collegiality.

Introduction: The goal of this assessment was to determine knowledge acquisition by pharmacy students during an infectious diseases (ID) advanced pharmacy practice experience (APPE)., Methods: A 50-question knowledge-based examination was given to every student on a five-week ID APPE between July 1, 2013 and May 5, 2017. The examination was also given to control students (those who did not have an ID APPE) immediately prior to graduation. The primary outcome was difference in examination performance after completion of the ID APPE. Secondary outcomes included correlations between examination performance and number of previous inpatient clinical rotations (ICR), average score in therapeutic coursework (TC), and rotation block (RB)., Results: Forty students were included (control = 5, experimental = 35). Average pre-test scores were similar between experimental and control students [61.7 (10.9)% versus 62.0 (5.1)%, respectively], but experimental post-test scores [80.2 (7.9)%] were significantly better than pre-test scores for both experimental (p < .05) and control student (p < .05) examination scores. ICR [1.3 (1.0) rotations], TC [81.5 (3.9)%], and RB (median = 4) had a positive correlation with pre-examination performance (R = .5, .5, and .4, respectively)., Discussion: Improved ID pharmacotherapy knowledge is needed. Baseline scores of students taking an ID elective were similar to control students who completed the entire year of APPEs, and knowledge scores were higher in ID students after APPE completion. There was a positive, but not strong, correlation between pre-examination performance and number of previous rotations, therapeutic coursework, and rotation block., Conclusion: A five-week ID elective APPE improved student performance on a knowledge-based examination. Consideration should be given to more consistent integration of ID principles across all rotation types., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Deliberate clinical inertia is the art of doing nothing as a positive response. To be able to apply this concept, individual clinicians need to specifically focus on their clinical decision-making. The skill of solving problems and making optimal clinical decisions requires more attention in medical training and should play a more prominent part of the medical curriculum. This paper provides suggestions on how this may be achieved. Strategies to mitigate common biases are outlined, with an emphasis on reversing a 'more is better' culture towards more temperate, critical thinking. To incorporate such an approach in medical curricula and in clinical practice, institutional endorsement and support is required., (© 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Background and Purpose: Teaching students therapeutic knowledge is not the same as teaching them how to reason through clinical problems. It was determined a new approach was necessary to close the gap between classroom learning and clinical application., Educational Activity and Setting: A stand-alone clinical reasoning course was developed to enhance students' ability to think about and solve clinical problems. This course involved a variety of active-learning strategies based upon literature regarding clinical reasoning., Findings: The objective of this study was to determine if a clinical reasoning course influenced student perceptions on evolution of their thinking and learning strategies and ways to improve. Thematic analysis of midpoint student reflections (n = 133) revealed eight different themes of how students perceived evolution of their thinking. Top themes were approaching a problem (n = 76), evaluating information (n = 62), and efficiency (n = 44). Thematic analysis of final student reflections (n = 138) included two categories: thinking and improvement. Reflections related to evolvement of thinking revealed five themes, the top three of which were approaching a problem (n = 89), holistic (n = 55), and efficiency (n = 46). Reflections of improvement revealed four themes, the top two of which were continue applying (n = 74) and communication (n = 23)., Discussion: The themes indicate that students began to understand clinical reasoning as a set of skills necessary to become an effective practitioner., Conclusions: A novel course designed to develop clinical reasoning skills can help students evolve their perception of thinking and learning strategies and engage them in a process for the application of knowledge to patient care., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background and Objectives: Dermatology is often an overlooked and underemphasized area of training in postgraduate primary care medical education, with an abundance of dermatological educational resources available, but no clear guidelines on how to best take advantage of them. The objective of this study was to develop a dermatology digital tool kit designed to describe, evaluate, recognize, and manage (DERM) common dermatological conditions in primary care residency education and to evaluate potential improvement in clinical confidence., Methods: A total of 14 family medicine (FM) and 33 internal medicine (IM) residents were given the DERM tool kit to complete over 7 weeks. Effects on residents' self-reported comfort with dermatology and resources used were measured by voluntary anonymous surveys distributed before and after DERM completion., Results: A response rate of 100% (14/14) for FM residents and 52% (17/33) for IM residents was achieved. The majority of residents (61%) recalled minimal dermatology education-less than 2 weeks-in medical school and 71% agreed that there is not enough dermatology in their residency curriculum. A statistically significant increase in resident comfort with describing (P=0.002), recognizing and diagnosing (P&lt;0.001), and managing (P=0.001) dermatologic conditions was observed postcompletion. Residents reported they would recommend this tool to other primary care residents., Conclusions: Implementing the DERM digital tool kit is feasible with primary care residents and appears to improve comfort with describing, recognizing and diagnosing, and managing dermatologic conditions.

Background and Objectives: Because patients often present to their family physicians with undifferentiated medical problems, uncertainty is common. Family medicine residents must manage both the ambiguity inherent in the field as well as the very real uncertainty of learning to become a skilled physician with little experience to serve as a guide. The purpose of this analysis was to assess the impact of a new curriculum on family medicine residents' tolerance of ambiguity., Methods: We conducted an exploratory quasi-experimental study to assess the impact of a novel curriculum designed to improve family medicine residents' tolerance of ambiguity. Four different surveys were administered to 25 family medicine residents at different stages in their training prior to and immediately and 6 months after the new curriculum., Results: Although many constructs remained unchanged with the intervention, one important construct, namely perceived threats of ambiguity, showed significant and sustained improvement relative to before undertaking this curriculum (score of 26.2 prior to the intervention, 22.1 immediately after, and 22.0 6 months after the intervention)., Conclusions: A new curriculum designed to improve tolerance to ambiguity appears to reduce the perceived threats of ambiguity in this small exploratory study.

Competing Interests: Competing interests: None declared.

Background: Further efforts are warranted to identify innovative approaches to best implement competencies in nursing education. To bridge the gap between competency-based education, practice, and implementation of knowledge, skills, and attitudes, one emerging approach is entrustable professional activities (EPAs)., Purpose: The objective of this study was to introduce the concept of EPAs as a framework for curriculum and assessment in graduate nursing education and training., Methods: Seven steps are provided to develop EPAs for nurses through the example of a quality and safety EPA. The example incorporates the Quality and Safety Education for Nurses (QSEN) patient safety competencies and evidence-based literature., Findings: EPAs provide a practical approach to integrating competencies in nursing as quality and safety are the cornerstones of nursing practice, education, and research., Discussion: Introducing the EPA concept in nursing is timely as we look to identify opportunities to enhance nurse practitioner (NP) training models and implement nurse residency programs., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Undergraduate medical education in Germany takes place in the medical faculties of universities, whereas postgraduate medical education takes place in nearly all hospitals under the aegis of medical associations. Both phases of the medical qualification process live on their own; the communication between the two responsible bodies is negligible. Previous reforms have always tackled undergraduate education only, whereas postgraduate education takes place without public attention., Objective: This position paper discusses the origins and consequences of the complete separation between undergraduate and postgraduate medical education in Germany with regard to responsible bodies, learning objectives, and didactical concepts. On the basis of this critical analysis, proposals are presented to narrow the gap between the two phases., Materials and Methods: This paper is based on several sources: data from historical documents, information retrieved from the internet on educational concepts in other OECD countries as well as intensive discussions among the authors., Results and Discussion: The dissociation between under- and postgraduate education has historical reasons. Over a longer period of time the German Federal States reduced their responsibility for postgraduate education in favor of medical associations. The authors propose steps towards a better integration of both sequences, towards seeing the educational process as a continuum. In such a concept, medical associations would have a greater influence on undergraduate education and - vice versa - medical faculties on the postgraduate phase.

In Germany, future physicians have to pass a national licensing examination at the end of their medical studies. Passing this examination is the requirement for the license to practice medicine. The Masterplan Medizinstudium 2020 with its 41 measures aims to shift the paradigm in medical education and medical licensing examinations.The main goals of the Masterplan include the development towards competency-based and practical medical education and examination as well as the strengthening of general medicine. The healthcare policy takes into account social developments, which are very important for the medical education and licensing examination.Seven measures of the Masterplan relate to the realignment of the licensing examinations. Their function to drive learning should better support students in achieving the study goal defined in the German Medical Licensure Act: to educate a medical doctor scientifically and practically who is qualified for autonomous and independent professional practice, postgraduate education and continuous training.

Objective: To describe the experience of the use of simulation as active teaching methodology in the Developmental Psychology discipline and share its impacts on the students' learning process., Method: Based on Active Methodologies, the students in Nursing of Universidade do Oeste Paulista - Presidente Prudente-SP developed simulated visits to older users of the Family Health Strategies., Results: In accordance with the 2014 National Curriculum Guidelines and the Brazilian Unified Health System, particularities of the needs of older adults at their homes were problematized. Final considerations: Addressing the biopsychosocial needs and integrality associated with the health of older adults in simulated home visits provides a differentiated instrument in the development of skills and competence of future nurses.

Background: Prospective nurses need specific and sufficient knowledge to be able to provide quality care. The Swedish Society of Nursing has emphasized the importance of the six quality and safety competencies (QSEN), originated in the US, in Swedish nursing education., Purpose: To investigate the visibility of the QSEN competencies in the assessment tools used in clinical practice METHOD: A quantitative descriptive method was used to analyze assessment tools from 23 universities., Results and Conclusion: Teamwork and collaboration was the most visible competency. Patient-centered care was visible to a large degree but was not referred to by name. Informatics was the least visible, a notable concern since all nurses should be competent in informatics to provide quality and safety in care. These results provide guidance as academic and clinical programs around the world implement assessment of how well nurses have developed these essential quality and safety competencies., (Copyright © 2017 Elsevier Ltd. All rights reserved.)