Reliability of scores obtained from standardized patient and instructor assessments.

INTRODUCTION: To obtain more reliable results from observation-based assessments, high-quality raters are key. Although this quality can be obtained by using instructors, extra workload can be a burden on them. To overcome this problem, one alternative to instructor raters can be standardized patients (SPs). METHOD: In this study, the students carried out an SP interview related to communication with an applicant/patient in the context of clinical skills training course. SPs rated student interviews just after interview and after watching a recording. Instructors rated students just by watching the recordings. To determine the appropriateness of use of SPs as raters, ratings of SPs and instructors were compared by using mean scores given to the interview performances of students' communication skills. Moreover, G theory was used to determine the reliability of scores. RESULTS: Standardized patients' ratings immediately after the interviews showed the highest scores, and these ratings were statistically different from the SPs' and instructors' ratings done while watching recordings. Besides, the G coefficient for the 4 instructors was 0.71, while that for the 12 SPs was estimated as 0.73. However, even when using 12 SPs, the obtained reliability coefficient of 0.73 brings into question the reliability of their ratings. Moreover, it was found that the one who contributed the most to reliability among instructors was the most experienced person in subject area. CONCLUSIONS: If SPs are to be used as raters, they will need more comprehensive training. More importantly, regardless of who the rater is, rater training is one of the most important factors in achieving more reliable and valid results. Moreover, having experience and knowledge about assessed topic is another crucial point of performance assessment by means of obtaining reliable results.

Development and Evaluation of a Training Program for Organ Procurement Coordinators Using Standardized Patient Methodology.

OBJECTIVES: The low rate of consent by next of kin of donor-eligible patients is a major limiting factor in organ transplant. Educating health care professionals about their role may lead to measurable improvements in the process. Our aim was to describe the developmental steps of a communication skills training program for health care professionals using standardized patients and to evaluate the results. MATERIALS AND METHODS: We developed a rubric and 5 cases for standardized family interviews. The 20 participants interviewed standardized families at the beginning and at the end of the training course, with interviews followed by debriefing sessions. Participants also provided feedback before and after the course. The performance of each participant was assessed by his or her peers using the rubric. We calculated the generalizability coefficient to measure the reliability of the rubric and used the Wilcoxon signed rank test to compare achievement among participants. Statistical analyses were performed with SPSS software (SPSS: An IBM Company, version 17.0, IBM Corporation, Armonk, NY, USA). RESULTS: All participants received higher scores in their second interview, including novice participants who expressed great discomfort during their first interview. The participants rated the scenarios and the standardized patients as very representative of real-life situations, with feedback forms showing that the interviews, the video recording sessions, and the debriefing sessions contributed to their learning. CONCLUSIONS: Our program was designed to meet the current expectations and implications in the field of donor consent from next of kin. Results showed that our training program developed using standardized patient methodology was effective in obtaining the communication skills needed for family interviews during the consent process. The rubric developed during the study was a valid and reliable assessment tool that could be used in further educational activities. The participants showed significant improvements in communication skills.

Who Is the Preferred Tutor in Clinical Skills Training: Physicians, Nurses, or Peers?

Phenomenon: Clinical skills centers allow structured training of undergraduate medical students for the acquisition of clinical skills in a simulated environment. Physician, nurse, or peer tutors are employed for training in those centers. All tutors should have appropriate training about the methodology used in the clinical skills training. Many of the studies revealed the effectiveness of various types of tutors. The aim of our study was to evaluate medical students' satisfaction with clinical skills training, and their opinions about the differences in coaching skills among the physician, nurse, and peer tutors. APPROACH: This study was conducted with third-year students (467 students) in 2013-2014 academic year at Hacettepe University Faculty of Medicine. Participation rate was 85 % (397 students). The students attended the suturing skill training in groups of 40 students. First, a faculty member from the Department of Medical Education delivered a video demonstration and conducted discussion. After the demonstration, the students were divided into groups of 5-6 students. A physician, nurse, or a peer tutor facilitated each group. The students were asked to complete the Coaching Skills Evaluation Form after the practicum session. It contained 13 criteria for assessing the coaching skills. Additionally, the form included a question for rating the student's satisfaction with the tutor. The performance of the tutors at each step was rated on a three-point scale. FINDINGS: Kruskal Wallis analysis was used to compare students' scores for their tutors. The students' satisfaction with tutors was high for all of the tutors. However, there was no difference between students' scores in suturing skill, and between physician, nurse, and peer tutors' coaching skills. Insights: In this study, we revealed that physician, nurse, and peer tutors were equally effective on the students' performances. They were also regarded as effective in their teaching role by students. But the most important point was that sufficient tutor training and preparation was crucial for the success of models.

Developing a Simulation-Based Training Program for the Prehospital Professionals and Students on the Management of Middle East Respiratory Syndrome.

INTRODUCTION: Middle East Respiratory Syndrome (MERS) is a major global health threat. Prehospital professionals face the risk of infection as they work to save lives. They should be made aware of the disease and be prepared to handle such cases. The aims of our study are to develop a training program about the prehospital management of a MERS case using standardized patient (SP) scenarios, to evaluate the awareness and preparedness of the participants about MERS, and to evaluate the effectiveness of this training. METHODS: We developed 5 scenarios using SPs and an observation form. We included paramedic students and emergency medical service (EMS) providers in our study. They were involved in the simulations. RESULTS: A total of 24 paramedic students and 33 EMS providers participated in our study. Sixteen (84%) of 19 teams recognized the possibility of MERS as a measure of their awareness in the baseline evaluation. The participants lacked donning and doffing personal protective equipments, which revealed their baseline level of preparedness for MERS. Certain improvements in donning and doffing personal protective equipment were observed in the posttraining evaluation. The participants provided positive feedback on the training program. CONCLUSIONS: The training program was appropriate for both paramedic students and EMS providers. A positive educational climate was created. Because the main concerns of this study were awareness and preparedness, which required human interaction, the SP methodology was the optimal simulation modality.

Development and evaluation of the evidence-based medicine program in surgery: a spiral approach.

BACKGROUND: Evidence-based medicine (EBM) aims to provide skills that help physicians answer clinically important questions, determine new evidence, and incorporate the acquired knowledge in practice. EBM skills are necessary for the practice of modern medicine, since physicians should use up-to-date knowledge and information to justify their medical decisions. PURPOSE: We aimed to evaluate the EBM program implemented at Hacettepe University School of Medicine. METHODS: In 2004, a spiral program for the teaching and practice of EBM was developed for the first 3 years of medical school. Following this program, a practice of EBM was included in the fourth year during the surgery clerkship, after an introductory lecture. The students worked within collaborative teams of 3-5 and practiced EBM with actual cases seen in the surgical service in which they were involved. Each student was asked to complete a questionnaire that evaluated the more theoretical program from the first 3 years and the practical application in the fourth year. RESULTS: Nearly half of the students stated that the preclinical years of the EBM program were 'adequate', but only 30% of the students indicated that the program was practical. They stated that 'more practical approaches were used in the fourth year, whereas more theory-based approaches were used during the preclinical years'. More than 75% of the students declared that the practice of EBM in the fourth year was useful and appropriate for team-based learning. CONCLUSIONS: The EBM program was evaluated as 'adequate'. EBM courses should be included in the entire curriculum in an integrated manner. The students understand the main philosophy of EBM in the clinical year when involved in its practical application with actual patients.

Age and sex estimation by metric measurements and fusion of hyoid bone in a Turkish population.

The hyoid bone is of great importance in forensic medicine practice and it has been studied for various forensic purposes; however, there have been few studies dealing with age and sex estimation using the hyoid bone. Using discriminant function analysis this study attempts to determine the utility of metric measurements and non-metric variations of the hyoid bone in terms of estimation of sex and age in a Turkish population and to find out differences with other populations by comparison of obtained results with the literature. For this purpose, the hyoid bones of 85 cadavers of known sex and age were extracted and 33 measurements were made with a computer program following photography with a camera. In addition to these measurements, the degree of fusion of the greater cornua to the hyoid corpus was examined. Out of 33 measurements, 18 showed significant sex-related differences. There was a sharp rise in hyoid bone fusion in both males and females after the age of 60 years. However, no marked sex-related differences were observed regarding fusion. The unstandardised canonical discriminant function was estimated based on three variables, and the correct classification ratio was 77.4% for males and 81.3% for females. The obtained findings suggest that measurements of hyoid bone can be used for sex estimation in the Turkish population.

The impact of clinical visits on communication skills training.

OBJECTIVE: The aim of the study is to evaluate a communication skills training program, and to investigate the relationship between communication skills and clinical visits. METHODS: This descriptive study was conducted at Hacettepe University Faculty of Medicine. 216 of the students (48.4%) took part in the study. They are evaluated at three steps of the program. Additionally, qualitative data were collected by interviewing with students and standardized patients. RESULTS: A paired t-test showed a significant difference between students' mean pretest scores (8.58+/-1.69) and posttest scores (11.26+/-1.74) (p<0.01). There was a significant difference between the progress test scores according to the site of visitation (p<0.01), but not between the posttest scores. The mean progress test scores of the students who visited the outpatient clinics (10.61+/-1.41 for group 2, 10.80+/-1.34 for group 4) were higher than those visiting the health centers (9.68+/-1.56 for group 1, 10.12+/-1.38 for group 3). CONCLUSIONS: Our study showed that the program was effective in achieving communication skills. Students can be better trained for communication skills while practicing in both skills laboratories and real settings. PRACTICAL IMPLICATIONS: The possible variations in the educational environments and the staff should be taken into account when planning the program.

Developing and evaluating professionalism.

Professional behaviour, being one of the domains of professionalism, is an area of medical education that has long been of concern to medical educators. At Hacettepe University, our main goal is to have students become conscious of professional identity, values, responsibilities and the physician-patient relationship. We welcome our new students with an opening ceremony on their first day and two months later, the students start the course called "Health-Illness Concepts and Medical Professional Identity". Students are expected to discuss the subjects given to them as scenarios or arguments. The aim of our study is to determine whether the course leads to a positive change in students' attitudes, indicating the attainment of those attributes that reflect professionalism. On the first and the last days of the course, a questionnaire was delivered to the students. Any positive change in preferences between the two questionnaires is identified as an achievement of that attribute. As a result we found that in all of the seven attributes there were positive changes in the students' attitudes. Positive changes varied from 48% to 84% and all were statistically significant. Using more interactive techniques helped the students to make larger percentage changes in their awareness of these professional attributes.

The first medical humanities programme in Turkey.

THE MEDICAL HUMANITIES: The arts and humanities have been considered a recreational activity related to the interests and talents of the doctor, rather than to their practice of medicine. GOOD MEDICAL PRACTICE COURSE: At Hacettepe University, the 'good medical practice course' was added to the curriculum in September 2004. The goals of this course are to help the students achieve the skills and attitudes of a good doctor and to become competent in caring for and communicating with patients. IMPLEMENTATION: As a part of the programme, in the first 3 years students prepared 526 projects concerned with medical humanities in the broad areas of 'medicine and art', 'medicine and history' and 'man and medicine'. They presented 72 of the projects as short communications at the Medical Humanities Congress and the remaining projects as posters. Each project was also to be prepared as a portfolio. PROGRAMME EVALUATION: At the end of the programme, a questionnaire was given to both the students and the tutors to evaluate the course. The part of the programme rated most difficult was the medical humanities section, according to 67.1% of the students. They commented that it took a great deal of time to research and prepare the projects. PROPOSED CHANGES: The new concept and the extra workload, in addition to new medical knowledge, confused all the students. We have made some changes to the programme and have decided to develop a number of new activities. CONCLUSION: 'Medical humanities' is a new concept for almost all the students and the faculty; it needs to be well defined.

The evaluation of first aid and basic life support training for the first year university students.

In Turkey, the first aiders are few in quantity and yet they are required in many settings, such as earthquakes. It was thought that training first year university students in first aid and basic life support (FA-BLS) techniques would serve to increase the number of first aiders. It was also thought that another problem, the lack of first aid trainers, might be addressed by training medical students to perform this function. A project aimed at training first year university students in FA-BLS was conducted at Hacettepe University. In the first phase, medical student first aid trainers (MeSFAT) were trained in FA-BLS training techniques by academic trainers and in the second phase, first year university students were trained in FA-BLS techniques by these peer trainers under the academic trainers' supervision. The purpose of this study was to assess the participants' evaluation of this project and to propose a new program to increase the number of first aiders in the country. In total, 31 medical students were certified as MeSFATs and 12 of these trained 40 first year university students in FA-BLS. Various questionnaires were applied to the participants to determine their evaluation of the training program. Most of the participants and the authors considered the program to be successful and effective. This method may be used to increase the number of first aid trainers and first aiders in the community.