Professionals' views on the development process of a structural collaboration between child and adolescent psychiatry and child welfare: an exploration through the lens of the life cycle model.

This study, as a part of a participatory action research project, reports the development process of an innovative collaboration between child and adolescent psychiatry and child welfare, for adolescent girls with multiple and complex needs. The findings emerge from a qualitative descriptive analysis of four focus groups with 30 professionals closely involved in this project, and describe the evolution of the collaborative efforts and outcomes through time. Participants describe large investments and negative consequences of rapid organizational change in the beginning of the collaboration project, while benefits of the intensive collaboration only appeared later. A shared person-centred vision and enhanced professionals' confidence were pointed out as important contributors in the evolution of the collaboration. Findings were compared to the literature and showed significant analogy with the life cycle model for shared service centres that describe the maturation of collaborations from a management perspective. These findings enrich the knowledge about the development process of collaboration in health and social care. In increasingly collaborative services, child and adolescent psychiatrists and policy makers should be aware that gains from a collaboration will possibly only be achieved in the longer term, and benefit from knowing which factors have an influence on the evolution of a collaboration project.

Content validity of workplace-based portfolios: A multi-centre study.

BACKGROUND: Portfolios are used as tools to coach and assess students in the workplace. This study sought to evaluate the content validity of portfolios as reflected in their capacity to adequately assess achieved competences of medical students during clerkships. METHODS: We reviewed 120 workplace portfolios at three medical universities (Belgium and the Netherlands). To validate their content, we developed a Validity Inventory for Portfolio Assessment (VIPA) based on the CanMEDS roles. Two raters evaluated each portfolio and indicated for each VIPA item whether the portfolio provided sufficient information to enable satisfactory assessment of the item. We ran a descriptive analysis on the validation data and computed Cohen's Kappa to investigate interrater agreement. RESULTS: The portfolios adequately covered the items pertaining to the communicator (90%) and professional (87%) roles. Coverage of the medical expert, collaborator, scholar and manager roles ranged between 75% and 85%. The health advocate role, covering 59%, was clearly less well represented. This role also exhibited little interrater agreement (Kappa < 0.4). CONCLUSIONS: This study lends further credence to the evidence that portfolios can indeed adequately assess the different CanMEDS roles during clerkships, the health advocate role, which was less well represented in the portfolio content, excepted.

Report of the MEDINE2 Bachelor of Medicine (Bologna First Cycle) tuning project.

BACKGROUND: European Higher Education institutions are expected to adopt a three-cycle system of Bachelor, Master and Doctor degrees as part of the Bologna Process. Tuning methodology was previously used by the MEDINE Thematic Network to gain consensus on core learning outcomes (LO) for primary medical degrees (Master of Medicine) across Europe. AIMS: The current study, undertaken by the MEDINE2 Thematic Network, sought to explore stakeholder opinions on core LO for Bachelor of Medicine degrees. METHOD: Key stakeholders were invited to indicate, on a Likert scale, to what extent they thought students should have achieved each of the Master of Medicine LO upon successful completion of the first three years of university education in medicine (Bachelor of Medicine). RESULTS: There were 560 responses to the online survey, representing medical students, academics, graduates, employers, patients, and virtually all EU countries. There was broad consensus between respondents that all LO previously defined for primary medical degrees should be achieved to some extent by the end of the first three years. CONCLUSIONS: The findings promote integration of undergraduate medical curricula, and also offer a common framework and terminology for discussing what a European Bachelor of Medicine graduate can and cannot do, promoting mobility, graduate employability and patient safety.

Learning intimate examinations with simulated patients: the evaluation of medical students' performance.

BACKGROUND: For fifth-year's undergraduates of the medical school, a project with simulated patients (Intimate Examination Associates, IEA) was implemented in 2002 at the University of Antwerp. In this project, students from the new curriculum (NC) learned uro-genital, rectal, gynaecological and breast examination in healthy, trained volunteers and received feedback focused on personal attitude, technical and communication skills. Former curriculum (FC) students however trained these skills only during internship in the sixth year after a single training on manikins. AIMS: This study assessed the effect of learning intimate examinations with IEA's by comparing students from FC and NC on four different outcome parameters. METHODS: Three groups were compared: FC after internships without IEA training, NC after internships with IEA training and fifth year NC immediately after the IEA training. Four assessment instruments: an OSCE using checklists and global rating scales to assess the technical skills, a score list on students attitudes and performance filled in by the IEA's, a student questionnaire on self-assessed competence and a questionnaire on the frequency of performing intimate skills during internships. RESULTS: Both NC groups scored globally better in the OSCE (significance for male examination). Sub-scores for 'completeness' and 'systematic' approach was significantly higher in both NC groups for male and female examinations. NC students reported better self-assessed competence and performance concerning gynaecological and urological clinical and communication skills during internship. The best results were obtained after IEA training and internship was done for the four outcomes. IEA's are influenced by the 'experienced' students after internship: FC and NC after internship both scored better than the fifth year NC who only received the IEA training so far. CONCLUSION: Learning intimate examinations with IEA's has a positive effect on the performance of medical students. This beneficial effect is on its turn reinforced during internships.

Unintentional failure to assess for experience in senior undergraduate OSCE scoring.

CONTEXT: One goal of undergraduate assessment is to test students' (future) performance. In the area of skills testing, the objective structured clinical examination (OSCE) has been of great value as a tool with which to test a number of skills in a limited time, with bias reduction and improved reliability. But can OSCEs measure undergraduate internship expertise in basic clinical skills? METHODS: Undergraduate students (n = 32) were given a questionnaire listing 182 basic clinical skills. We asked them to score the number of times they had performed each skill during their internships (a 12-month period in Year 6). We assessed the students at the end of Year 5 (before the start of their internships) and again at the start of Year 7 (undergraduate training takes 7 years in Belgium, with internships during Year 6), using a 14-station OSCE assessing basic clinical skills. Global ratings were used to score performance. The relationship between internship experience and the OSCE Year 7 score was analysed using a linear regression model, controlling for variation in OSCE scores from Year 5. A multi-level analysis was performed considering students as level-1 units and stations as level-2 units. RESULTS: Year 7 OSCE scores (post-internships) were not affected by the number of times that students practised basic medical skills during their internships. DISCUSSION: Scores on OSCEs do not seem to reflect clinical expertise acquired during internships. Other more integrated assessment methods may prove to be more valid for testing final undergraduate skills levels.

Laparoscopy training in Belgium: results from a nationwide survey, in urology, gynecology, and general surgery residents.

BACKGROUND: The purpose of this study was to investigate the exposure of Belgian residents in urology, general surgery, and gynecology to laparoscopic surgery and to training of laparoscopic skills in dedicated training facilities. METHODS: Three similar specialty-specific questionnaires were used to interrogate trainees in urology, general surgery, and gynecology about their exposure to laparoscopic procedures, their acquired laparoscopic experience, training patterns, training facilities, and motivation. Residents were contacted via their Belgian specialist training organization, using Survey Monkey as an online survey tool. Data were analyzed with descriptive statistics. RESULTS: The global response rate was 58%. Only 28.8% of gynecology respondents, 26.9% of urology respondents, and 52.2% of general surgery respondents felt they would be able to perform laparoscopy once they had finished their training. A total 47% of urology respondents, 66.7% of general surgery respondents, and 69.2% of gynecology respondents had a surgical skills lab that included laparoscopy within their training hospital or university. Most training programs did not follow the current evidence about proficiency-based structured simulation training with deliberate practice. CONCLUSION: Belgian resident training facilities for laparoscopic surgery should be optimized.