An examination of eating disorder education and experience in a 1-month adolescent medicine rotation: what is sufficient to foster adequate self-efficacy?

Objective Medical students and professionals report receiving limited education/training related to treating eating disorders. Because medical professionals are the point of initial contact for these patients and are involved necessarily in their treatment, sufficient knowledge on identification and intervention are imperative. This research set out to examine the impact of the eating disorder education and experience offered through a 1-month Adolescent Medicine rotation at a medical university on medical student/resident self-efficacy. Methods The 1-month rotation includes a standardized patient (SP) simulation, 1.5 h of didactic education, and 1 day observing the MD, nutritionist and psychologist within the outpatient Multidisciplinary Child/Adolescent Eating Disorders Clinic. All residents' (n = 132) eating disorder self-efficacy was assessed before (PRE) completing simulation and didactic session and again at the end of the 1-month rotation (END). Self-efficacy was also assessed after simulation and before the didactic session for group 1 (n = 92) and after simulation and didactic session for group 2 (n = 40). Results For group 1, self-efficacy was not significantly impacted PRE to POST. For group 2, self-efficacy significantly improved PRE to POST. POST to END changes were significant for both groups; however, group 2 scored significantly better across all self-efficacy areas at END. Conclusion Resident training in eating disorders requires more than is offered in many residency programs. SP simulation is strengthened as an effective training tool in assessing and promoting resident self-efficacy if it is followed by didactic education. Clinical observation and extended practice that includes ongoing guidance/feedback on performance is recommended in fostering self-efficacy.

Evaluating Evidence-Based Practice Knowledge and Beliefs Through the e-Learning EBP Academy.

BACKGROUND: This research examined evidence-based practice (EBP) knowledge and beliefs before and after a 3-month e-learning program was implemented to build EBP capacity at a large children's hospital. METHOD: Ten clinicians completed the development, implementation, and evaluation of the e-learning education, comprising phase one. Revision and participation by 41 clinicians followed in phase two. Participants in both phases completed the EBP Beliefs and Implementation Scales preintervention, postintervention, and 6 months after postintervention. RESULTS: EBP beliefs and implementation increased immediately and 6 months after postintervention, with statistically significant increases in both phases. Participants in both phases applied knowledge by completing mentor-supported EBP projects. CONCLUSION: Although EBP beliefs and implementation scores increased and e-learning provided flexibility for clinician participation, challenges arose, resulting in lower-than-expected completion. Subsequent revisions resulted in hybrid education, integrating classroom and e-learning with project mentoring. This funded e-learning research contributes knowledge to the growing specialty of professional development. J Contin Educ Nurs. 2017;48(7):304-311.

Medical student self-efficacy, knowledge and communication in adolescent medicine.

OBJECTIVE: To evaluate student self-efficacy, knowledge and communication with teen issues and learning activities. METHODS: Data were collected during the 8-week pediatric rotation for third-year medical students at a local children's hospital. Students completed a self-efficacy instrument at the beginning and end of the rotation; knowledge and communication skills were evaluated during standardized patient cases as part of the objective structured clinical examination. Self-efficacy, knowledge and communication frequencies were described with descriptive statistics; differences between groups were also evaluated utilizing two-sample t-tests. RESULTS: Self-efficacy levels of both groups increased by the end of the pediatric rotation, but students in the two-lecture group displayed significantly higher self-efficacy in confidentiality with adolescents (t(35)=-2.543, p=0.02); interviewing adolescents, assessing risk, sexually transmitted infection risk and prevention counseling, contraception counseling were higher with marginal significance. No significant differences were found between groups for communication; assessing sexually transmitted infection risk was marginally significant for knowledge application during the clinical exam. CONCLUSIONS: Medical student self-efficacy appears to change over time with effects from different learning methods; this higher self-efficacy may increase future comfort and willingness to work with this high-risk, high-needs group throughout a medical career.

Adolescent health care and the trainee: roles of self-efficacy, standardized patients, and an adolescent medicine rotation.

PURPOSE: Pediatric residents often cite a lack of confidence with adolescents owing to minimal exposure during training. Self-efficacy has been evaluated in a general context but not in relation to perception of knowledge and communication skill. Study objectives were to evaluate resident self-efficacy during a month-long adolescent rotation and to assess knowledge and communication skills in their relationship to self-efficacy. METHODS: Data were collected as part of the adolescent medicine rotation for pediatric residents at a local children's hospital. Residents completed 2 standardized patient cases at the beginning of the rotation and a self-efficacy instrument before/after the cases and at the end of the rotation. The study assessed trends in self-efficacy using repeated-measures analysis of variance and χ tests to examine relationships between self-efficacy and knowledge as well as communication in preventative and sexually transmitted infection adolescent health. RESULTS: Resident (n = 44) self-efficacy levels significantly changed over all time points and were significantly related to knowledge and communication levels. Although self-efficacy levels decreased immediately after the standardized patient cases, all self-efficacy items were significantly higher at the end of the rotation. Residents confident or very confident in general health topics were deficient in asking basic history items and residents confident or very confident in high-risk topics often did not actually assess these areas with patients. CONCLUSIONS: Residents' personal assessments on paper may differ from actual clinical interactions. Standardized patient cases expose resident strengths and weaknesses with adolescents, and a month-long adolescent rotation allows for repetitive experiences with special adolescent health care topics with associated increase in self-efficacy, knowledge application, and communication skill.

High-fidelity hybrid simulation of allergic emergencies demonstrates improved preparedness for office emergencies in pediatric allergy clinics.

BACKGROUND: Simulation models that used high-fidelity mannequins have shown promise in medical education, particularly for cases in which the event is uncommon. Allergy physicians encounter emergencies in their offices, and these can be the source of much trepidation. OBJECTIVE: To determine if case-based simulations with high-fidelity mannequins are effective in teaching and retention of emergency management team skills. METHODS: Allergy clinics were invited to Arkansas Children's Hospital Pediatric Understanding and Learning through Simulation Education center for a 1-day workshop to evaluate skills concerning the management of allergic emergencies. A Clinical Emergency Preparedness Team Performance Evaluation was developed to evaluate the competence of teams in several areas: leadership and/or role clarity, closed-loop communication, team support, situational awareness, and scenario-specific skills. Four cases, which focus on common allergic emergencies, were simulated by using high-fidelity mannequins and standardized patients. Teams were evaluated by multiple reviewers by using video recording and standardized scoring. Ten to 12 months after initial training, an unannounced in situ case was performed to determine retention of the skills training. RESULTS: Clinics showed significant improvements for role clarity, teamwork, situational awareness, and scenario-specific skills during the 1-day workshop (all P < .003). Follow-up in situ scenarios 10-12 months later demonstrated retention of skills training at both clinics (all P ≤ .004). CONCLUSION: Clinical Emergency Preparedness Team Performance Evaluation scores demonstrated improved team management skills with simulation training in office emergencies. Significant recall of team emergency management skills was demonstrated months after the initial training.

Improving resident self-efficacy in pediatric palliative care through clinical simulation.

CONTEXT: Pediatric residents have limited training and practice experience with palliative care. This study examined whether clinical simulation improved resident self-efficacy in pediatric palliative care. METHODS: Residents were surveyed on their self-efficacy and how they perceived the importance of pediatric palliative care; they were then randomized into either a control group or an intervention group. The intervention group participated in two simulated pediatric palliative care scenarios. The residents' responses before and after the intervention were analyzed to determine whether simulation training had influenced their responses. RESULTS: Although there were no differences in responses on the importance of pediatric palliative care, respondents were more comfortable with suggesting that conferences are needed with families of children who have life-limiting conditions in order to explain do-not-resuscitate orders. CONCLUSION: Simulation improved pediatric residents' self-efficacy with end-of-life discussions.

The use of a parent support group in the outpatient treatment of children and adolescents with eating disorders.

Our objective was to measure parents' level of satisfaction and perceived benefits gained from participating in a parent support group as part of an outpatient treatment program. We mailed surveys to 261 parent/guardian participants. Results reflected high satisfaction with the support group. Parents indicated that it assisted them in understanding eating disorders symptoms and treatment and supporting their child struggling with an eating disorder. Additionally, the group was a source of emotional support. Results suggest that inclusion of a parent support group in the outpatient treatment of children and adolescents with eating disorders has important implications for parents.

The development of a competency-based assessment rubric to measure resident milestones.

BACKGROUND: The outcomes-based assessment rubric is a novel systematic instrument for documenting improvement in clinical learning. APPROACH: This article describes the development of a rubric aimed at introducing specific performance indicators to measure the Accreditation Council for Graduate Medical Education competencies. RESULTS: The potential benefits and implications for medical education include specifying performance indicators and outcomes, ensuring that assessment is coherent and consistent for all residents, measuring resident outcomes based on real-life criteria, providing opportunities for residents to demonstrate proficiency in a specific competency and outcome level, and improving the quality of assessment.