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The authors share 12 practical tips on creating effective titles and abstracts for a journal publication or conference presentation. When crafting a title authors should: (1) start thinking of the title from the start; (2) brainstorm many key words, create permutations, and ask others for input; (3) strive for an informative and indicative title; (4) start the title with the most important words; and (5) wait to finalize the title until the very end. When writing the abstract, authors should: (6) wait until the end to write the abstract; (7) copy and paste from main text as the starting point; (8) start with a detailed structured format; (9) describe what they did; (10) describe what they found; (11) highlight what readers can do with this information; and (12) ensure that the abstract aligns with the full text and conforms to submission guidelines. [ABSTRACT FROM AUTHOR]

Background: Responses and conceptual frameworks used by clinical preceptors when giving feedback to students (clerks, interns, residents) during clinical rotations are not well documented. Findings: Inventories of responses and frameworks from two systematic and methodical studies are summarized along with suggestions for instruction and faculty development. [ABSTRACT FROM AUTHOR]

Medical Education 2011: : 87-94 Although firmly grounded in Flexner's legacy of ideas, today's medical curriculum, as both an entity and a process, has become more and more complex. The curriculum as an entity is portrayed according to five key elements: the expected competencies and roles; the learners at the centre of the enterprise; assessment linking competencies and learners; the conditions and resources for learning; and a multifaceted socio-politico-cultural context in which the learning occurs. Significant developments have also occurred in the disciplines of curriculum studies, cognitive psychology and organisational change over the past century, as well as in institutional best practices, that help us to better understand and plan curricular innovations. Practical advice is offered to help curriculum developers in designing or reforming the medical curriculum. The key points of this are: (i) while focusing reform and innovation on specific elements of the curriculum, consider how those elements affect other elements and vice versa, in positive and negative ways; (ii) while grounding the reform or innovation in sound conceptual frameworks, seize any opportunities to formulate a research agenda that can build upon and advance our understanding of curricular innovations, and, (iii) moving beyond considering the curriculum as an entity, use deliberative and leadership processes that can lead to enduring curriculum reform. [ABSTRACT FROM AUTHOR]

Context In a recent study of the quality of reporting experimental studies in medical education, barely half the articles examined contained an explicit statement of the conceptual framework used. Conceptual frameworks represent ways of thinking about a problem or a study, or ways of representing how complex things work. They can come from theories, models or best practices. Conceptual frameworks illuminate and magnify one’s work. Different frameworks will emphasise different variables and outcomes, and their inter-relatedness. Educators and researchers constantly use conceptual frameworks to guide their work, even if they themselves are not consciously aware of the frameworks. Methods Three examples are provided on how conceptual frameworks can be used to cast development and research projects in medical education. The examples are accompanied by commentaries and a total of 13 key points about the nature and use of conceptual frameworks. Conclusions Ultimately, scholars are responsible for making explicit the assumptions and principles contained in the conceptual framework(s) they use in their development and research projects. [ABSTRACT FROM AUTHOR]

The article discusses the impact of continuing medical education (CME) on physician knowledge in the U.S. A systematic review of the effectiveness of CME was conducted by the John Hopkins Evidence-based Practice Center for Healthcare Research and Quality. The results indicated that multimedia, multiple instructional techniques and multiple exposures can be used whenever possible in CME.

The article discusses the major issues in the primary study design and in the systematic review process of continuing medical education (CME) studies in the U.S. It is noted that the methods section of the evidence-based practice center report were reviewed by the evidence-based guideline committee. Several proposals were made including a standard nomenclature of terms in common use in CME and a more rigorous process of searching, distilling and synthesizing the primary literature.

Context Authors have questioned the degree to which medical education research informs practice and advances the science of medical education. Objective This study aims to propose a framework for classifying the purposes of education research and to quantify the frequencies of purposes among medical education experiments. Methods We looked at articles published in 2003 and 2004 in Academic Medicine, Advances in Health Sciences Education, American Journal of Surgery, Journal of General Internal Medicine, Medical Education and Teaching and Learning in Medicine (1459 articles). From the 185 articles describing education experiments, a random sample of 110 was selected. The purpose of each study was classified as description (‘What was done?’), justification (‘Did it work?’) or clarification (‘Why or how did it work?’). Educational topics were identified inductively and each study was classified accordingly. Results Of the 105 articles suitable for review, 75 (72%) were justification studies, 17 (16%) were description studies, and 13 (12%) were clarification studies. Experimental studies of assessment methods (5/6, 83%) and interventions aimed at knowledge and attitudes (5/28, 18%) were more likely to be clarification studies than were studies addressing other educational topics (< 8%). Conclusions Clarification studies are uncommon in experimental studies in medical education. Studies with this purpose (i.e. studies asking: ‘How and why does it work?’) are needed to deepen our understanding and advance the art and science of medical education. We hope that this framework stimulates education scholars to reflect on the purpose of their inquiry and the research questions they ask, and to strive to ask more clarification questions. [ABSTRACT FROM AUTHOR]

The author reflects on the studies, which investigate the development and main results of clinical reasoning on prototypes and semantic networks. He highlights the importance of the theory in testing and theory building, and in the versatile nature of knowledge organisation in memory, as well as difference between experts and weaker problem solvers. Moreover, the author concludes that the disorders recalled first have more representative than those recalled later.

Objective In order to inform discussions about possible changes to Medical Education's blinding policy, members of the journal's editorial board were interested in discovering reviewers' and authors' preferences with regard to the current double-blind policy and various alternatives. Methods In September 2005, an 8-question, web-based survey was sent to all authors and reviewers who had submitted or reviewed a manuscript for Medical Education in 2003 and 2004 ( n = 2632). The questions asked about authorship and reviewing experiences and preferences regarding 5 types of blinding procedure, from double-blinding to fully unblinded, open reviews. Results Following 2 electronic mailings, 838 surveys were completed. There was a range of experience among respondents, with a high proportion of experienced authors (49% with over 20 publications) and reviewers (41% with over 20 reviews). Overall, 68% of respondents preferred a review process that concealed author names and 72% preferred a process that allowed for concealment of reviewer names. Less experienced authors and reviewers were significantly more likely to prefer concealing author names, but even the most experienced respondents had a 54% preference for author concealment. Reasons for concealing identities included facilitating fairness and honesty in reviews and acknowledging the need to avoid personal conflicts or rivalries. Reasons for revealing identities included facilitating greater transparency and accountability, and a better understanding of the author's and reviewer's contexts and credentials. Conclusions The Medical Education authors and reviewers who chose to respond to the survey voted strongly in favour of continuing the double-blinding procedure of concealing both author and reviewer identities during the review process. [ABSTRACT FROM AUTHOR]

Objectives Case specificity implies that success on any case is specific to that case. In examining the sources of error variance in performance on case-based examinations, how much error variance results from differences between cases compared with differences between items within cases? What is the optimal number of cases and questions within cases to maximise test reliability given some fixed period of examination time? Methods G and D generalisability studies were conducted to identify variance components and reliability for each examination analysed, and to optimise the reliability of the given test composition (1, 1.5, 2, 3, 4 and 5 questions per case), using data from 3 key features examinations of the Medical Council of Canada ( n = 6342 graduating medical students), each of which consisted of about 35 written cases followed by 1–4 questions regarding specific key elements of data gathering, diagnosis and/or management. Results The smallest variance component was due to subjects; the variance due to subject–item interaction was over 5 times the interaction with cases (on average, 0.1106 compared with 0.0195). Relatively little variance was due to differences between cases; about 80% of the error variance was due to variability in performance among items within cases. The D study showed that reliability varied between 0.541 and 0.579, was least with 1 item per case and highest at 2 and 3 items per case. Conclusions The main source of error variance was items within cases, not cases, and the optimal strategy in terms of enhancing reliability would use cases with 2–3 items per case. [ABSTRACT FROM AUTHOR]

While writing a grant proposal may take a few days, the planning of the study takes much longer and requires thoughtful consideration. The use of a systematic and itemised approach can help in planning crucial details of a study. An eight-step, 28-question, iterative approach is proposed to help with the careful planning of experiments in order to maximise the researchers' chances of acceptance when submitting the study for funding and its results for publication. The steps include defining a relevant research question; selecting instrumentation, study design and statistics; determining sample size and sampling procedure; ensuring data quality throughout data collection and analysis; setting personnel and budget requirements, and writing a convincing grant proposal. Reviewers pay particular attention to the importance of the research topic and question, the presence of a clear problem statement and up to date review of the literature, the use of an optimal design and instrumentation, a sufficient and unbiased sample, and appropriate and well applied statistics. They also appreciate a clear and easy to follow proposal. The research question is the keystone of the entire enterprise, followed by the selection of an optimal study design and the control of possible confounding variables. No study is perfect. The researchers must constantly weigh advantages and disadvantages and select the most scientifically sound and feasible alternatives. While the steps and questions presented are best applied to experimental studies, the principles are also applicable to a wide range of questions and observational, evaluative and qualitative designs. [ABSTRACT FROM AUTHOR]

Purpose Problem representation, as mediated by semantic qualifiers (SQs), has been associated with better diagnostic outcomes. The purpose of this study was to assess the effect of training medical students to use semantic abstractions as a means of building problem representations. Methods Sixty second-year medical students were assigned to either an intervention group (n = 20) or a control group ( n = 40) during 8 months of an Essentials in Clinical Medicine course which used standardized patient-based workshops. Students were trained to transform findings into SQs and to use abstractions to compare and contrast diagnostic hypotheses. Students were assessed using a standardized patient data collection checklist, a post-encounter patient finding questionnaire (PFQ), and case summaries and write-ups. Results Experimental subjects used over twice as many SQs in their summaries as control group members (1·40 versus 0·63, P = 0·006). The correlation between checklist and PFQ scores was higher for the experimental group than for the control group ( r = 0·70 versus r = 0·58, P ≤ 0·001). There was no difference between groups in either the number of SQs used in write-ups nor in diagnostic accuracy ( P > 0·56). Conclusion A short instructional intervention was successful in promoting the use of SQs and enabled students to recall elicited findings better. This intervention did not enhance data interpretation and diagnostic accuracy. Use of SQs may therefore be a necessary tool for efficient problem representation but one that is insufficient when used in isolation. The naturalistic setting used in this study imposed a number of limitations, implying that further research should test whether instructional efforts should also emphasize recognition of key patient findings and knowledge representation. [ABSTRACT FROM AUTHOR]

ContextA fundamental premise of medical education is that faculty should educate trainees, that is, students and residents, to provide high quality patient care. Yet, there is little research on the effect of medical education on patient outcomes. ObjectiveA content analysis of leading medical education journals was performed to determine the primary foci of medical education research, using a three- dimensional outcomes research framework based on the paradigm of health services outcomes research. Data sourcesAll articles in three medical education journals (Academic Medicine, Medical Education, and Teaching and Learning in Medicine) from 1996 to 1998 were reviewed. Papers presented at the Research in Medical Education conference at the Association of American Medical Colleges annual meeting during the same period, and published as Academic Medicine supplements, were also analysed. Study selectionOnly data-driven articles were selected for analysis; thus editorials and abstracts were excluded. Data extractionEach article was categorized according to primary participant (i.e. trainee, faculty, provider and patient), outcome (performance, satisfaction, professionalism and cost), and level of analysis (geographic, system, institution and individual(s)). Data synthesisA total of 599 articles were analysed. Trainees were the most frequent participants studied (68·9%), followed by faculty (19·4%), providers (8·1%) and patients (3·5%). Performance was the most common outcome measured (49·4%), followed by satisfaction (34·1%). Cost was the focus of only 2·3% of articles and patient outcomes accounted for only 0·7% of articles. ConclusionsMedical education research is dominated by assessment of trainee performance followed by trainee satisfaction. Leading journals in medical education contain little information concerning the cost and products of medical education, that is, provider performance and patient outcomes. The study of these medical education outcomes represents an important challenge to medical education researchers. [ABSTRACT FROM AUTHOR]

The article presents a letter to the editor in response to the article "Functional Neuroimaging Correlates of Thinking Flexibility and Knowledge Structure in Memory: Exploring the Relationships Between Clinical Reasoning and Diagnostic Thinking" by S. J. Durning et al.

The article assesses the ability of residents to anticipate, elicit and interpret the physical findings associated with the main diagnostic possibilities relevant to given cases. A procedure to assess residents' ability to conduct a hypothesis-driven physical examination is developed. The findings suggest that assessing the ability to anticipate and correctly elicit and interpret findings specific to diagnostic alternatives provides a useful profile of resident skills.

Theory: Feedback and debriefing, as portrayed in expertise development and self-assessment, play critical roles in providing residents with useful information to foster their progress.Hypotheses: Prior work has shown that clinical preceptors' use of conceptual frameworks (CFs; ways of thinking based on theories, best practices, or models) while giving feedback to residents was positively associated with a greater diversity of responses. Also, senior preceptors produced more responses, used more CFs, and asked more probing-challenging questions than junior preceptors. The purpose was to confirm the generalization of these initial findings with a broader and better defined sample of preceptors.Method: We conducted a mixed-method study with 20 junior and 20 senior preceptors in a controlled environment to analyze their responses and rationales to residents' educational needs as portrayed in 6 written vignettes. The preceptors were recruited from 3 primary care specialties preceptors (family medicine, internal medicine, pediatrics) of the 3 French-speaking faculties of medicine in Québec, Canada.Results: The preceptors increased the 2012 list of response topics (96 to 126) and doubled the number of distinct CFs (16 to 32). The junior and senior preceptors expressed the same number and diversity of CFs. On average, senior preceptors asked more clarification questions and reflected more than juniors on the learning process that occurs during case discussions. Preceptor specialty and prior training in medical education did not influence the number and diversity of responses and CFs, except that preceptors with prior training generated more responses per vignette and were more reflective. Senior preceptors had a stronger positive relationship between the number of total and distinct CFs and the number of responses than the juniors.Conclusions: Although senior preceptors did not give more responses or use more CFs compared to the prior study, they continue to probe residents more and reflected more. The positive relationship between responses and CFs has important implications for faculty development and calls for more research to better understand the specific contribution of CFs to feedback. [ABSTRACT FROM PUBLISHER]

The article presents information related to Competency-Based Education.

Context Recent reviews have claimed that the script concordance test ( SCT) methodology generally produces reliable and valid assessments of clinical reasoning and that the SCT may soon be suitable for high-stakes testing. Objectives This study is intended to describe three major threats to the validity of the SCT not yet considered in prior research and to illustrate the severity of these threats. Methods We conducted a review of SCT reports available through the Web of Science database. Additionally, we reanalysed scores from a previously published SCT administration to explore issues related to standard SCT scoring practice. Results Firstly, the predominant method for aggregate and partial credit scoring of SCTs introduces logical inconsistencies in the scoring key. Secondly, our literature review shows that SCT reliability studies have generally ignored inter-panel, inter-panellist and test-retest measurement error. Instead, studies have focused on observed levels of coefficient alpha, which is neither an informative index of internal structure nor a comprehensive index of reliability for SCT scores. As such, claims that SCT scores show acceptable reliability are premature. Finally, SCT criteria for item inclusion, in concert with a statistical artefact of the SCT format, cause anchors at the extremes of the scale to have less expected credit than anchors near or at the midpoint. Consequently, SCT scores are likely to reflect construct-irrelevant differences in examinees' response styles. This makes the test susceptible to bias against candidates who endorse extreme scale anchors more readily; it also makes two construct-irrelevant test taking strategies extremely effective. In our reanalysis, we found that examinees could drastically increase their scores by never endorsing extreme scale points. Furthermore, examinees who simply endorsed the scale midpoint for every item would still have outperformed most examinees who used the scale as it is intended. Conclusions Given the severity of these threats, we conclude that aggregate scoring of SCTs cannot be recommended. Recommendations for revisions of SCT methodology are discussed. [ABSTRACT FROM AUTHOR]

Context Informative titles and abstracts facilitate reading and searching the literature. Objective To evaluate the quality of titles and abstracts of full-length reports of experimental studies in medical education. Methods We used a random sample of 110 articles (of 185 eligible articles) describing education experiments. Articles were published in 2003 and 2004 in Academic Medicine, Advances in Health Sciences Education, American Journal of Surgery, Journal of General Internal Medicine, Medical Education and Teaching and Learning in Medicine. Titles were categorised as informative, indicative, neither, or both. Abstracts were evaluated for the presence of a rationale, objective, descriptions of study design, setting, participants, study intervention and comparison group, main outcomes, results and conclusions. Results Of the 105 articles suitable for review, 86 (82%) had an indicative title and 10 (10%) had a title that was both indicative and informative. A rationale was present in 66 abstracts (63%), objectives were present in 84 (80%), descriptions of study design in 20 (19%), setting in 29 (28%), and number and stage of training of participants in 42 (40%). The study intervention was defined in 55 (52%) abstracts. Among the 48 studies with a control or comparison group, this group was defined in 21 abstracts (44%). Study outcomes were defined in 64 abstracts (61%). Data were presented in 48 (46%) abstracts. Conclusions were presented in 97 abstracts (92%). Conclusions Reports of experimental studies in medical education frequently lack the essential elements of informative titles and abstracts. More informative reporting is needed. [ABSTRACT FROM AUTHOR]

Objective Determine the prevalence of essential elements of reporting in experimental studies in medical education. Design Systematic review. Data Sources Articles published in 2003 and 2004 in Academic Medicine, Advances in Health Sciences Education, American Journal of Surgery, Journal of General Internal Medicine, Medical Education, and Teaching and Learning in Medicine. Review Methods Articles describing education experiments, including evaluation studies with experimental designs, were identified ( n = 185) by reviewing titles and abstracts. A random sample ( n = 110) was selected for full review. The full text of each article was evaluated for the presence of guideline-based features of quality reporting: a critical literature review, conceptual framework, statement of study intent (e.g. aim, research question, or hypothesis), statement of study design, definition of main intervention and comparison intervention or control group, and consideration of human subject rights. Results Of the 105 articles suitable for review, 47 (45%) contained a critical literature review and 58 (55%) presented a conceptual framework. A statement of study intent was present in 80 articles (76%), among which the independent and dependent variables were operationally defined in 38 (47%) and 26 articles (32%), respectively. A total of 17 articles (16%) contained an explicit study design statement. Among the 48 studies with a comparison group, 35 (73%) clearly defined the comparison intervention or control group. Institutional review board approval or participant consent was reported in 44 articles (42%). Conclusions The quality of reporting of experimental studies in medical education was generally poor. Criteria are proposed as a starting point for establishing reporting standards for medical education research. [ABSTRACT FROM AUTHOR]

Context: The script concordance test (SCT), designed to measure clinical reasoning in complex cases, has recently been the subject of several critical research studies. Amongst other issues, response process validity evidence remains lacking. We explored the response processes of experts on an SCT scoring panel to better understand their seemingly divergent beliefs about how new clinical data alter the suitability of proposed actions within simulated patient cases. Methods: A total of 10 Argentine gastroenterologists who served as the expert panel on an existing SCT re‐answered 15 cases 9 months after their original panel participation. They then answered questions probing their reasoning and reactions to other experts' perspectives. Results: The experts sometimes noted they would not ordinarily consider the actions proposed for the cases at all (30/150 instances [20%]) or would collect additional data first (54/150 instances [36%]). Even when groups of experts agreed about how new clinical data in a case affected the suitability of a proposed action, there was often disagreement (118/133 instances [89%]) about the suitability of the proposed action before the new clinical data had been introduced. Experts reported confidence in their responses, but showed limited consistency with the responses they had given 9 months earlier (linear weighted kappa = 0.33). Qualitative analyses showed nuanced and complex reasons behind experts' responses, revealing, for example, that experts often considered the unique affordances and constraints of their varying local practice environments when responding. Experts generally found other experts' alternative responses moderately compelling (mean ± standard deviation 2.93 ± 0.80 on a 5‐point scale, where 3 = moderately compelling). Experts switched their own preferred responses after seeing others' reasoning in 30 of 150 (20%) instances. Conclusions: Expert response processes were not consistent with the classical interpretation and use of SCT scores. However, several fruitful and justifiable alternatives for the use of SCT‐like methods are proposed, such as to guide assessments for learning. Why do experts respond to complex simulated clinical cases differently? Exploring the mechanism underlying this phenomenon suggests challenges for assessors and possibilities for educational improvements. [ABSTRACT FROM AUTHOR]

Context: In postgraduate medical programmes, the progressive development of autonomy places residents in situations in which they must cope with uncertainty. We explored the phenomenon of hesitation, triggered by uncertainty, in the context of the operating room in order to understand the social behaviours surrounding supervision and progressive autonomy. Methods: Nine surgical residents and their supervising surgeons at a Canadian medical school were selected. Each resident–supervisor pair was observed during a surgical procedure and subsequently participated in separate post‐observation, semi‐structured interviews. Constructivist grounded theory was used to guide the collection and analysis of data. Results: Three hesitation‐related themes were identified: the principle of progress; the meaning of hesitation, and the judgement of competence. Supervisors and residents understood hesitation in the context of a core surgical principle we termed the ‘principle of progress’. This principle reflects the supervisors’ and residents’ shared norm that maintaining progress throughout a surgical procedure is of utmost importance. Resident hesitation was perceived as the first indication of a disruption to this principle and was therefore interpreted by supervisors and residents alike as a sign of incompetence. This interpretation influenced the teaching–learning process during these moments when residents were working at the edge of their abilities. Conclusions: The principle of progress influences the meaning of hesitation which, in turn, shapes judgements of competence. This has important implications for teaching and learning in direct supervision settings such as surgery. Without efforts to change the perception that hesitation represents incompetence, these potential teaching–learning moments will not fully support progressive autonomy. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented by the authors of the article "Threats to validity in the use and interpretation of script concordance test scores"in response to the article "Scoring the scrip concordance test: not a black and white issue" by S. Lunbarsky, R. Gagnon, and B. Charlin from a 2013 issue.

Background: SNAPPS is a learner-centered approach to case presentations that was shown, in American studies, to facilitate the expression of clinical reasoning and uncertainties in the outpatient setting. Aim: To evaluate the SNAPPS technique in an Asian setting. Methods: We conducted a quasi-experimental trial comparing the SNAPPS technique to the usual-and-customary method of case presentations for fifth-year medical students in an ambulatory internal medicine clerkship rotation at Khon Kaen University, Thailand. We created four experimental groups to test main and maturation effects. We measured 12 outcomes at the end of the rotations: total, summary, and discussion presentation times, number of basic clinical findings, summary thoroughness, number of diagnoses in the differential, number of justified diagnoses, number of basic attributes supporting the differential, number of student-initiated questions or discussions about uncertainties, diagnosis, management, and reading selections. Results: SNAPPS users (90 case presentations), compared with the usual group (93 presentations), had more diagnoses in their differentials (1.81 vs. 1.42), more basic attributes to support the differential (2.39 vs. 1.22), more expression of uncertainties (6.67% vs. 1.08%), and more student-initiated reading selections (6.67% vs. 0%). Presentation times did not differ between groups (12 vs. 11.2 min). There were no maturation effects detected. Conclusions: The use of the SNAPPS technique among Thai medical students during their internal medicine ambulatory care clerkship rotation did facilitate the expression of their clinical reasoning and uncertainties. More intense student-preceptor training is needed to better foster the expression of uncertainties. [ABSTRACT FROM AUTHOR]

Objectives Despite significant evidence supporting the use of three-option multiple-choice questions ( MCQs), these are rarely used in written examinations for health professions students. The purpose of this study was to examine the effects of reducing four- and five-option MCQs to three-option MCQs on response times, psychometric characteristics, and absolute standard setting judgements in a pharmacology examination administered to health professions students. Methods We administered two versions of a computerised examination containing 98 MCQs to 38 Year 2 medical students and 39 Year 3 pharmacy students. Four- and five-option MCQs were converted into three-option MCQs to create two versions of the examination. Differences in response time, item difficulty and discrimination, and reliability were evaluated. Medical and pharmacy faculty judges provided three-level Angoff ( TLA) ratings for all MCQs for both versions of the examination to allow the assessment of differences in cut scores. Results Students answered three-option MCQs an average of 5 seconds faster than they answered four- and five-option MCQs (36 seconds versus 41 seconds; p = 0.008). There were no significant differences in item difficulty and discrimination, or test reliability. Overall, the cut scores generated for three-option MCQs using the TLA ratings were 8 percentage points higher (p = 0.04). Conclusions The use of three-option MCQs in a health professions examination resulted in a time saving equivalent to the completion of 16% more MCQs per 1-hour testing period, which may increase content validity and test score reliability, and minimise construct under-representation. The higher cut scores may result in higher failure rates if an absolute standard setting method, such as the TLA method, is used. The results from this study provide a cautious indication to health professions educators that using three-option MCQs does not threaten validity and may strengthen it by allowing additional MCQs to be tested in a fixed amount of testing time with no deleterious effect on the reliability of the test scores. [ABSTRACT FROM AUTHOR]

Context First-year residents begin clinical practice in settings in which attending staff and senior residents are available to supervise their work. There is an expectation that, while being supervised and as they become more experienced, residents will gradually take on more responsibilities and function independently. Objectives This study was conducted to define 'entrustable professional activities' ( EPAs) and determine the extent of agreement between the level of supervision expected by clinical supervisors ( CSs) and the level of supervision reported by first-year residents. Methods Using a nominal group technique, subject matter experts ( SMEs) from multiple specialties defined EPAs for incoming residents; these represented a set of activities to be performed independently by residents by the end of the first year of residency, regardless of specialty. We then surveyed CSs and first-year residents from one institution in order to compare the levels of supervision expected and received during the day and night for each EPA. Results The SMEs defined 10 EPAs (e.g. completing admission orders, obtaining informed consent) that were ratified by a national panel. A total of 113 CSs and 48 residents completed the survey. Clinical supervisors had the same expectations regardless of time of day. For three EPAs (managing i.v. fluids, obtaining informed consent, obtaining advanced directives) the level of supervision reported by first-year residents was lower than that expected by CSs (p < 0.001) regardless of time of day (i.e. day or night). For four more EPAs (initiating the management of a critically ill patient, handing over the care of a patient to colleagues, writing a discharge prescription, coordinating a patient discharge) differences applied only to night-time work (p ≤ 0.001). Conclusions First-year residents reported performing EPAs with less supervision than expected by CSs, especially during the night. Using EPAs to guide the content of the undergraduate curriculum and during examinations could help better align CSs' and residents' expectations about early residency supervision. [ABSTRACT FROM AUTHOR]

Introduction: The physical examination is an essential clinical competence for all physicians. Most medical schools have students who learn the physical examination maneuvers using a head-to-toe approach. However, this promotes a rote approach to the physical exam, and it is not uncommon for students later on to fail to appreciate the meaning of abnormal findings and their contribution to the diagnostic reasoning process. The purpose of the project was to develop a model teaching session for the hypothesis-driven physical examination (HDPE) approach in which students could practice the physical examination in the context of diagnostic reasoning. Methods: We used an action research methodology to create this HDPE model by developing a teaching session, implementing it over 100 times with approximately 700 students, conducting internal reflection and external evaluations, and making adjustments as needed. Results: A model nine-step HDPE teaching session was developed, including: (1) orientation, (2) anticipation, (3) preparation, (4) role play, (5) discussion-1, (6) answers, (7) discussion-2, (8) demonstration and (9) reflection. Discussions and conclusions: A structured model HDPE teaching session and tutor guide were developed into a workable instructional intervention. Faculty members are invited to teach the physical examination using this model. [ABSTRACT FROM AUTHOR]

Medical Education 2010: 44: 775–785 Objectives This study aimed to test the extent to which the use of medicalese (i.e. formal medical terminology and semantic qualifiers) alters the test performance of medical graduates; to tease apart the extent to which any observed differences are driven by language difficulties versus differences in medical knowledge; and to assess the impact of varying the language used to present clinical features on the ability of the test to consistently discriminate between candidates. Methods Six clinical cases were manipulated in the context of pilot items on the Canadian national qualifying examination. Features indicative of two diagnoses were presented uniformly in lay terms, medical terminology and semantic qualifiers, respectively, and in mixed combinations (e.g. features of one diagnosis were presented using lay terminology and features of the other using medicalese). The rate at which the indicated diagnoses were named was considered as a function of language used, site of training, birthplace and medical knowledge (as measured by overall performance on the examination). Results In the mixed conditions, Canadian medical graduates were not influenced by the language used to present the cases, whereas international medical graduates (IMGs) were more likely to favour the diagnosis associated with medical terminology relative to that associated with lay terms. This was true regardless of whether the entire sample or only North American-born candidates were considered. Within the IMG cohort, high performers were not influenced by the language manipulation, whereas low performers were. Uniform use of lay terminology resulted in the highest test reliability compared with the other experimental conditions. Conclusions The results indicate that the influence of medical terminology is driven more by substandard medical knowledge than by the language issues that challenge some candidates. Implications for both the assessment and education of medical professionals are discussed. [ABSTRACT FROM AUTHOR]

Context Diagnostic accuracy is maximised by having clinical signs and diagnostic hypotheses in mind during the physical examination (PE). This diagnostic reasoning approach contrasts with the rote, hypothesis-free screening PE learned by many medical students. A hypothesis-driven PE (HDPE) learning and assessment procedure was developed to provide targeted practice and assessment in anticipating, eliciting and interpreting critical aspects of the PE in the context of diagnostic challenges. Objectives This study was designed to obtain initial content validity evidence, performance and reliability estimates, and impact data for the HDPE procedure. Methods Nineteen clinical scenarios were developed, covering 160 PE manoeuvres. A total of 66 Year 3 medical students prepared for and encountered three clinical scenarios during required formative assessments. For each case, students listed anticipated positive PE findings for two plausible diagnoses before examining the patient; examined a standardised patient (SP) simulating one of the diagnoses; received immediate feedback from the SP, and documented their findings and working diagnosis. The same students later encountered some of the scenarios during their Year 4 clinical skills examination. Results On average, Year 3 students anticipated 65% of the positive findings, correctly performed 88% of the PE manoeuvres and documented 61% of the findings. Year 4 students anticipated and elicited fewer findings overall, but achieved proportionally more discriminating findings, thereby more efficiently achieving a diagnostic accuracy equivalent to that of students in Year 3. Year 4 students performed better on cases on which they had received feedback as Year 3 students. Twelve cases would provide a reliability of 0.80, based on discriminating checklist items only. Conclusions The HDPE provided medical students with a thoughtful, deliberate approach to learning and assessing PE skills in a valid and reliable manner. [ABSTRACT FROM AUTHOR]

Background: Third-year medical students (MS3) were given clinical encounter cards (CECs) to stimulate feedback during their surgery clerkship. This study analyzes the feedback given on their clinical performance using CECs. Methods: Two hundred one students enrolled in the 12-week surgery clerkship were given CECs. Each card contained the chief focus of the encounter, which was rated on a six-point Likert scale. The CECs were analyzed to determine if they provided reliable formative information, identified marginal performances, and identified differences between raters, settings, rotations, and aspects of clinical performance evaluated. Results: Seven thousand three hundred eight CECs were submitted from 201 students. The CECs were completed most often (65%) in the inpatient setting. Technical skills were evaluated on 49% of CECs, history/physical examinations on 40%, and case presentations on 30%. There were comments written on half of the CECs and 89% of these were strictly positive. Women (52.8%) and faculty (63.3%) were more likely to provide written comments. The students were most likely to seek feedback from the interns and faculty who gave significantly higher ratings. The Cronbach-alpha reliability coefficient was 0.69, based on 12 raters per student. There was a significant positive correlation (P < 0.05) between the CEC composite rating and the clinical performance rating (r = 0.356), NBME score (r = 0.258), and the final grade (r = 0.250). Conclusions: The implementation of CECs in a surgery clerkship provided a large quantity of positive feedback. The quality was limited because there were minimal recommendations for improvement and they were a poor predictor of overall clinical performance. [Copyright &y& Elsevier]

Background: Despite the nearly universal practice of using standardized patients in introduction to clinical medicine (ICM) courses, no studies have compared the performance of students trained with standardized patients to that of those trained with hospitalized patients with regard to short- and long-term educational outcomes. Purpose: To examine the differential effect of the use of standardized patients in a simulation center versus the use of hospitalized patients in affiliated teaching hospitals for teaching history-taking and physical examination skills. Methods: This was a nonrandomized cohort study based on self-selection involving students from 2 academic years enrolled in an ICM course who received the final block of their ICM instruction with either standardized patients in the simulation center or hospitalized patients in affiliated hospitals. The primary, end-of-ICM (preclerkship)-outcome variables (k = 10) were data from a final observed history and physical examination, an observed structured clinical examination, a National Board of Medical Examiners subject examination for clinical medicine, and ICM preceptor evaluations. Secondary, postclerkship outcome variables (k = 5) included internal medicine clerkship scores, teacher ratings from the clerkship, and examination scores from end-of-clerkship tests. The statistical significance was set at p < .05. Results: No statistical differences were found between the means of the 2 groups in any of the primary or secondary outcome variables; there was significant power. Conclusions: The use of standardized patients in a simulated setting compared to the use of hospitalized patients in affiliated teaching hospitals is not a disadvantage in the education of students in ICM courses. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the study habits (SHs) of surgery residents preparing for the annual American Board of Surgery In-Training Examination (ABSITE).Methods: A validated instrument developed to assess SHs in college students, the Survey of Study Habits and Attitudes (SSHA), was modified slightly for use with residents. The modified SSHA contains 2 subscale scores, work methods and delay avoidance, and a combined overall study habit score. A total of 59 residents from 2 academic general surgical residency programs were administered the modified SSHA. The SSHA scores were correlated to performance on the in-training examination.Results: There was a small but significant correlation between scores on the modified SSHA instrument and performance on the ABSITE overall (r = 0.29; P <.05; r2 = 0.0841). Linear-regression analysis showed that the clinical component and overall performance on the ABSITE were significantly predicted by the total SH scores. Overall total ABSITE percent correct scores were significantly predicted by residency levels of training and the overall SSHA scales (delay avoidance and work methods). Together they predicted 63% of the total variance in the overall performance scores. Residency level was the strongest predictor. SH performance accounted for 5.9% of the total variance beyond that contributed by residency level of training.Conclusions: The correlations of surgical resident ABSITE performance with SSHA scores were on the same order of magnitude as those of college students and academic performance with the original SSHA. Although SH in this study accounted for a measurable yet small contribution to ABSITE performance, this contribution was not enough to consider using the SSHA instrument in its current modified form as a diagnostic and counseling tool. Published instruments not specifically designed for residents may not be tailored enough to measure residents'' unique SH. [Copyright &y& Elsevier]