Novel Performance Rating Instruments for Gynecological Procedures in Primary Care: A Pilot Study.

BACKGROUND AND OBJECTIVES: Improving training and confirming the acquisition of gynecological procedure skills for family physicians (FPs) is crucial for safe health care delivery. The objectives of this study were to (a) develop performance rating instruments for four gynecological procedures, and (b) pilot them to provide preliminary validity evidence using modern validity theory. METHODS: Sixteen academic FPs and gynecologists participated in a modified Delphi technique to develop procedure-specific checklists (PSCs) for four procedures: intrauterine device insertion, endometrial biopsy, punch biopsy of the vulva, and routine pessary care. We modified a previously validated global rating scale (GRS) for ambulatory settings. Using prerecorded videos, 19 academic FPs piloted instruments to rate one first-year and one second-year family medicine resident's performance. They were blinded to the level of training. We compared the mean scores for PSCs and GRS for each procedure using paired samples t tests and Cohen's d to estimate effect sizes. RESULTS: Consensus on items for the final PSCs was reached after two Delphi rounds. PSC and GRS scores were numerically higher for the second-year resident than the first-year resident for every procedure, with statistically significant differences for six of eight comparisons (P<.05). All comparisons demonstrated large effect sizes (Cohen's d>0.8). Both instruments received high scores for ease of use by raters. CONCLUSIONS: We developed novel performance rating instruments for four gynecological procedures and provided preliminary validity evidence for their use for formative feedback in a simulation setting. This pilot study suggests that these instruments may facilitate the training and documentation of family medicine trainees' skills in gynecological procedures.

"Walking on eggshells": experiences of underrepresented women in medical training.

INTRODUCTION: Medicine remains an inequitable profession for women. Challenges are compounded for underrepresented women in medicine (UWiM), yet the complex features of underrepresentation and how they influence women's career paths remain underexplored. This qualitative study examined the experiences of trainees self-identifying as UWiM, including how navigating underrepresentation influenced their envisioned career paths. METHODS: Ten UWiM family medicine trainees from one Canadian institution participated in semi-structured group interviews. Thematic analysis of the data was informed by feminist epistemology and unfolded during an iterative process of data familiarization, coding, and theme generation. RESULTS: Participants identified as UWiM based on visible and invisible identity markers. All participants experienced discrimination and "otherness", but experiences differed based on how identities intersected. Participants spent considerable energy anticipating discrimination, navigating otherness, and assuming protective behaviours against real and perceived threats. Both altruism and a desire for personal safety and inclusion influenced their envisioned careers serving marginalized populations and mentoring underrepresented trainees. DISCUSSION: Equity, diversity, and inclusion initiatives in medical education risk being of little value without a comprehensive and intersectional understanding of the visible and invisible identities of underrepresented trainees. UWiM trainees' accounts suggest that they experience significant identity dissonance that may result in unintended consequences if left unaddressed. Our study generated the critical awareness required for medical educators and institutions to examine their biases and meet their obligation of creating a safer and more equitable environment for UWiM trainees.

Correction: Natural Language Processing to Identify Digital Learning Tools in Postgraduate Family Medicine: Protocol for a Scoping Review.

[This corrects the article DOI: 10.2196/34575.].

Natural Language Processing to Identify Digital Learning Tools in Postgraduate Family Medicine: Protocol for a Scoping Review.

BACKGROUND: The COVID-19 pandemic has highlighted the growing need for digital learning tools in postgraduate family medicine training. Family medicine departments must understand and recognize the use and effectiveness of digital tools in order to integrate them into curricula and develop effective learning tools that fill gaps and meet the learning needs of trainees. OBJECTIVE: This scoping review will aim to explore and organize the breadth of knowledge regarding digital learning tools in family medicine training. METHODS: This scoping review follows the 6 stages of the methodological framework outlined first by Arksey and O'Malley, then refined by Levac et al, including a search of published academic literature in 6 databases (MEDLINE, ERIC, Education Source, Embase, Scopus, and Web of Science) and gray literature. Following title and abstract and full text screening, characteristics and main findings of the included studies and resources will be tabulated and summarized. Thematic analysis and natural language processing (NLP) will be conducted in parallel using a 9-step approach to identify common themes and synthesize the literature. Additionally, NLP will be employed for bibliometric and scientometric analysis of the identified literature. RESULTS: The search strategy has been developed and launched. As of October 2021, we have completed stages 1, 2, and 3 of the scoping review. We identified 132 studies for inclusion through the academic literature search and 127 relevant studies in the gray literature search. Further refinement of the eligibility criteria and data extraction has been ongoing since September 2021. CONCLUSIONS: In this scoping review, we will identify and consolidate information and evidence related to the use and effectiveness of existing digital learning tools in postgraduate family medicine training. Our findings will improve the understanding of the current landscape of digital learning tools, which will be of great value to educators and trainees interested in using existing tools, innovators looking to design digital learning tools that meet current needs, and researchers involved in the study of digital tools. TRIAL REGISTRATION: OSF Registries osf.io/wju4k; https://osf.io/wju4k INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34575.

Does general experience affect self-assessment?

BACKGROUND: The assessment of clinical competence is critical in medical education. Understanding the effect of general experience on a physician's self-assessment would help design more effective curricula and evaluations of procedural skills in postgraduate training and continuing professional development (CPD). In this observational study, we assessed the effect of general experience on the correlation between confidence and competence amongst experienced clinicians (ECs) and postgraduate trainees (PGTs) when learning an office-based procedure in pessary care. METHODS: We recruited 19 first-year family medicine residents and 18 family medicine faculty members in two outpatient academic clinics. All participants attended a simulation-based workshop for a routine gynaecological office procedure. We used a confidence survey as a measure of the participants' self-assessed competence and an objective structured clinical examination (OSCE) to evaluate participants' competence before and after the workshop. The assessment of clinical competence is critical in medical education RESULTS: We found no significant correlation between confidence and competence at baseline for either group (EC, r = 0.25, p = 0.35; PGT, r = 0.15, p = 0.60). After the workshop, we observed a statistically significant correlation between confidence and competence for ECs (r = 0.60, p = 0.01), but not for PGTs. The change in this correlation was not statistically significant for either group, however. DISCUSSION: Our findings suggest that ECs are not any more accurate in the assessment of their competence compared with PGTs. All procedural skills curricula can benefit from OSCE-format evaluation to better evaluate the improvement in performance of participants.