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Issue: Throughout medical school, and especially during clerkships, students experience changing work and learning environments and are exposed to new academic, interpersonal, and professional challenges unique to clinical learning. Given the siloed nature of clinical rotations, students often "fall through the cracks" and may repeatedly struggle through clerkships without support and coaching from which they would otherwise benefit. Many institutions have grappled with creating feed forward processes, that is, educational handoffs in which information is shared among faculty about struggling students with the intention of providing longitudinal support to ensure their success, while protecting students from negative bias that may follow them throughout the remainder of their medical school tenure. Evidence: Here, the authors describe the feed forward processes of four medical schools. Each school's process relies on close collaboration between course directors and deans to identify students and develop intervention plans. Course leadership and administration are typically the primary drivers for long-term follow-up with students. The number of participants in the process varies, with only one school directly involving students. Two schools hold larger, regularly scheduled meetings with up to 12 faculty present in their institution's feed forward process. Across these institutions, students can "graduate" from the feed forward process once they achieve competency in the areas of concern. Implications: The authors believe the most important outcome achieved is the formalization and adherence to a feed forward process. Thus, risk to students in the form of negative bias is mitigated by the flow of information, the extent to which information is available, and permitting students to be part of the process. These exemplars give insight into variable approaches to feed forward systems adopted by medical schools and demonstrate highly visible methodologies by which educational leadership empower students and educators toward a shared goal of student progress and achievement.
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Description Though they become responsible for leading teams and supervising more junior learners early in their career, physicians receive little formal leadership training. The "see one, do one, teach one" approach to behavioral modeling and mentorship does not serve the modern young physician well. The complex nature of modern healthcare demands that physicians learn to work within the teams they will often come to lead. Within these teams, members often look to physicians to fill leadership roles. This review will examine effective leadership as defined by the business community, review attempts to incorporate leadership training into graduate medical education programs and discuss the benefits of leadership training in medical residency programs.
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BACKGROUND AND OBJECTIVE: Simulation-based skill trainings are common; however, optimal instructional designs that improve outcomes are not well specified. We explored the impact of just-in-time and just-in-place training (JIPT) on interns' infant lumbar puncture (LP) success. METHODS: This prospective study enrolled pediatric and emergency medicine interns from 2009 to 2012 at 34 centers. Two distinct instructional design strategies were compared. Cohort A (2009-2010) completed simulation-based training at commencement of internship, receiving individually coached practice on the LP simulator until achieving a predefined mastery performance standard. Cohort B (2010-2012) had the same training plus JIPT sessions immediately before their first clinical LP. Main outcome was LP success, defined as obtaining fluid with first needle insertion and <1000 red blood cells per high-power field. Process measures included use of analgesia, early stylet removal, and overall attempts. RESULTS: A total of 436 first infant LPs were analyzed. The LP success rate in cohort A was 35% (13/37), compared with 38% (152/399) in cohort B (95% confidence interval for difference [CI diff], -15% to +18%). Cohort B exhibited greater analgesia use (68% vs 19%; 95% CI diff, 33% to 59%), early stylet removal (69% vs 54%; 95% CI diff, 0% to 32%), and lower mean number of attempts (1.4 ± 0.6 vs 2.1 ± 1.6, P < .01) compared with cohort A. CONCLUSIONS: Across multiple institutions, intern success rates with infant LP are poor. Despite improving process measures, adding JIPT to training bundles did not improve success rate. More research is needed on optimal instructional design strategies for infant LP.
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Medicina de Emergência/educação , Internato e Residência , Manequins , Pediatria/educação , Punção Espinal/normas , Educação Médica/métodos , Humanos , Lactente , Estudos ProspectivosRESUMO
RESUMEN La Universidad Médica Pinareña, inmersa en dar respuesta a las demandas que el proceso formativo requiere, ha precisado lograr un clima institucional Didáctico - Pedagógico que diera respuesta a la formación de su claustro profesoral para enfrentar los retos que las condiciones actuales demandan, lo que hizo necesario proponer una estrategia de desarrollo que permitiese una estructura funcional de un Grupo de Estudios Didáctico para la Educación Médica, determinando su misión, visión y funciones. Para ello se tomaron en consideración los métodos teóricos y empíricos, que permitieron dar sustento a partir de la detección de los problemas didácticos que se presentaban en la Universidad de Ciencias Médicas Dr. Ernesto Che Guevara de la Serna de Pinar del Río. El trabajo demostró los logros alcanzados por el Grupo durante la etapa que se analiza, estableciendo los desafíos, que como retos, culminarán en paso de Grupo a Centro de Estudios Didácticos de la Educación Médica Superior para las Carreras de la Salud.
ABSTRACT Pinar del Rio Medical University is concerned about those demands that the educative process requires and it has created a didactic- pedagogical method for the professorial staff in order to face those challenges demanded by the current conditions, so it was necessary to propose an strategy being able to create a functional structure by a didactic study group in the medical education for determining its purpose, its objective and functions. With this purpose, those theoretical and empirical methods capable of allowing the detection of the didactic problems present in Pinar del Rio "Ernesto Che Guevara de la Serna" Medical School were considered. It was demonstrated the achievements obtained by this group of professors and it was established the challenges that will permit the change from a group to a centre of high medica education for health majors.
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RESUMEN Con el objetivo de analizar el grado de competencia de los metodólogos en cuanto a la regulación 210, la cual norma el desarrollo del Proceso Docente Educativo, se realizó un estudio descriptivo transversal en la Facultad de Ciencias Médicas de Pinar del Río. El universo estuvo constituido por los 162 Metodólogos que se desempeñan actualmente en los distintos territorios incluidos la sede central. Se tomó como muestra a los 147 evaluados en la primera convocatoria a dicho examen, distribuidos en todos los territorios y abarcando por igual todos los escenarios formativos, lo que representó el 87,5% de evaluados. Se aplicó un instrumento evaluativo, constituido por 5 preguntas de respuestas breves y ensayo corto, explorando contenidos de la Resolución 210, muestreando los conocimientos sobre la dinámica de colectivos de año, planificación docente, control del proceso docente, trabajo metodológico y evaluación. Los datos obtenidos fueron procesados a través del método porcentual aritmético relacionando los resultados con carreras, categoría docente y escenario donde se desempeñan los Metodólogos. Se demostró que el grado de preparación de los asesores de las carreras en cuanto a reglamentos evaluadas no es satisfactorio, aspecto en el cual la Sede Central, no mostrándose diferencias significativas con relación a los territorios, resultando las temáticas evaluadas de mayor grado de dificultad las correspondientes a la dinámica de los colectivos de año y planificación docente con comportamiento similar por carrera y categoría docente.
ABSTRACT A descriptive cross sectional study was carried out at Pinar del Rio medical school aimed at studying the grade of competition of methodologists according to the regulation 210 which establishes the development of the teaching process. The universe was comprised of 162 methodologists working in the different territories including the central venue. The first 147 evaluated in the first examination were taken as the sample, being present in every territory and including similarly all the formative sceneries; it represented 87,5% of those who were evaluated. A five - question questionnaire for giving brief answers and a short trial was conducted trying to explore the contents of Resolution 210, sampling the knowledge on an annual collective dinamic, the teaching planning, the control of teaching process, methodological work and evaluation. Data were processed using the arithmetical percentual method relating the results to the teaching category and the scenery where methodologists work. It was found that the level of knowledge of the advisers on the regulations evaluated is not satisfactory. It was not found any significative difference among the central venue and the territories being the dinamic of the Group and the teaching planning the most difficult aspects having a similar behaviour by major and teaching category.