Applicant perceptions of selection methods for health professions education: Rationales and subgroup differences.

CONTEXT: Applicant perceptions of selection methods can affect motivation, performance and withdrawal and may therefore be of relevance in the context of widening access. However, it is unknown how applicant subgroups perceive different selection methods. OBJECTIVES: Using organisational justice theory, the present multi-site study examined applicant perceptions of various selection methods, rationales behind perceptions and subgroup differences. METHODS: Applicants to five Dutch undergraduate health professions programmes (N = 704) completed an online survey including demographics and a questionnaire on applicant perceptions applied to 11 commonly used selection methods. Applicants rated general favourability and justice dimensions (7-point Likert scale) and could add comments for each method. RESULTS: Descriptive statistics revealed a preference for selection methods on which applicants feel more 'in control': General favourability ratings were highest for curriculum-sampling tests (mean [M] = 5.32) and skills tests (M = 5.13), while weighted lottery (M = 3.05) and unweighted lottery (M = 2.97) were perceived least favourable. Additionally, applicants preferred to distinguish themselves on methods that assess attributes beyond cognitive abilities. Qualitative content analysis of comments revealed several conflicting preferences, including a desire for multiple selection methods versus concerns of experiencing too much stress. Results from a linear mixed model of general favourability indicated some small subgroup differences in perceptions (based on gender, migration background, prior education and parental education), but practical meaning of these differences was negligible. Nevertheless, concerns were expressed that certain selection methods can hinder equitable admission due to inequal access to resources. CONCLUSIONS: Our findings illustrate that applicants desire to demonstrate a variety of attributes on a combination of selection tools, but also observe that this can result in multiple drawbacks. The present study can help programmes in deciding which selection methods to include, which more negatively perceived methods should be better justified to applicants, and how to adapt methods to meet applicants' needs.

Evaluation of the impact of technical physicians on improving individual patient care with technology.

BACKGROUND: The rapid introduction of technical innovations in healthcare requires that professionals are adequately prepared for correct clinical use of medical technology. In response to the technological transformation of healthcare, a new type of professional, the Technical Physician (TP), was created and is trained to improve individual patient care using technology tailored to the needs of individual patients. This study investigates the TPs' impact on patient care in terms of innovation, effectiveness, efficiency, and patient safety. METHOD: Semi-structured, in-depth interviews were conducted with 30 TPs and 17 medical specialists (MSs) working in academic or teaching hospitals in the Netherlands. The pre-structured and open-ended interview questions focused on: 1) the perceived impact on innovation, effectiveness, efficiency, and safety, and 2) opportunities and challenges in daily work. RESULTS: TPs and MSs unanimously experienced that TPs contributed to innovation. A majority indicated that effectiveness (TP 57%; MS 71%) and efficiency (TP 67%; MS 65%) of clinical practice had increased. For safety, 87% of TPs but only 47% of MSs reported an increase. The main explanation given for TPs positive impact was combining medical and technical knowledge. Mainly organizational barriers were mentioned as a potential cause for a less visible contribution of TPs. CONCLUSION AND DISCUSSION: TPs and MSs unanimously agreed that TPs contributed to innovating patient care through their integrative medical and technical competencies. Most TPs and MSs also reported increased effectiveness, efficiency, and safety of patient care due to the TPs' work. TPs and MSs expected that the TPs' impact on direct and indirect patient care will be enhanced once organizational barriers are removed.

The process of slowing down in clinical reasoning during ultrasound consultations.

OBJECTIVES: In clinical reasoning, clinicians need to switch between automatic and effortful reasoning to solve both routine and non-routine problems. This requires the ability to recognise when a problem is non-routine and adapt one's reasoning mode accordingly, that is to 'slow down' the reasoning process. In the current study, we explored the process of these transitions between automatic and effortful reasoning by radiologists who performed ultrasound examinations during consultations at the polyclinic. METHODS: Manifestations of slowing down in clinical reasoning were explored in 41 out-patient consultations performed by five radiologists. Interviews before and after the consultations were combined with observations during the consultations to obtain proactively planned triggers, slowing down manifestations and situationally responsive initiators. Transcripts of the interviews and field notes of the observations were coded. The constant comparative method was used to classify slowing down manifestations. RESULTS: In thirteen of the 41 consultations, slowing down moments were observed. Four manifestations of slowing down were identified: shifting, checking, searching and focusing. These manifestations mainly differed in how long radiologists maintained effortful reasoning, varying from very short periods (shifting and checking) to sustained periods (searching and focusing). Unexpected patient statements and ambiguous ultrasound images initiated the slowing down moments. DISCUSSION: The results from this study contribute to understanding how clinicians transition from automatic to effortful reasoning. Also, this study revealed two sources of initiators of this transition in radiologists' consultations: statements made by the patient and conflicting or ambiguous visual information, in this case from ultrasound images. Natural variations in patient statements and visual information can be used as input of what might be meaningful variation in the domain of radiology education to support expertise development.

Interdisciplinary expertise in medical practice: Challenges of using and producing knowledge in complex problem-solving.

Purpose: Clarification of interdisciplinary expertise as the ability to deal with the cognitive and epistemological challenges of multi- and interdisciplinary problem-solving-such as in developing and implementing medical technology for diagnoses and treatment of patients in collaborations between clinicians, technicians, and engineers-and of the higher-order cognitive skills needed as part of this expertise. Method: Clarify the epistemological difficulties of combining scientific knowledge, methodologies and technologies from different disciplines in problem-solving, by drawing on recent developments in the philosophy of science. Conclusion: We argue that interdisciplinary expertise involves the cognitive ability to connect, translate and establish links between disciplinary knowledge, as well as the metacognitive ability to understand and explain the role of the disciplinary perspective-consisting of, e.g. basic concepts, theories, models, methodologies, technologies, and specific ways of measuring, reasoning and modeling in a discipline-in how knowledge is used and produced.

How simulated patients contribute to student learning in an authentic way, an interview study.

INTRODUCTION: Simulated patients (SPs) play an instrumental role in teaching communication skills and enhancing learning outcomes. Prior research mostly focused on the SP's contribution to students' learning outcomes by providing feedback afterwards. A detailed understanding of the contribution of the SP during SP-student encounters is currently lacking although the majority of the interaction between SPs and students occurs during the SP-student encounter. Therefore, this study focuses on how SPs see their contribution to meaningful student learning experiences during SP-student encounters. METHODS: We interviewed fifteen simulated patients from one institution. We explored their perspectives on meaningful learning experiences during SP-student encounters through in-depth, semi-structured interviews and analyzed using thematic analysis. RESULTS: SPs view their contribution to meaningful student learning during SP-student encounters from two perspectives. A collective perspective as a member of the community of SPs and an individual perspective. From the collective perspective, SPs believe that the fact that students deal with multiple varied SP-student encounters over time is of value for meaningful learning. From the individual perspective, we noticed that SPs think, act, and react from three different positions. First, as the patient in the role description, second, as a teaching aid and third, as an individual with personal experiences, beliefs, and values. SPs mentioned that the ratio between these different positions can vary within and between encounters. CONCLUSIONS: According to SPs, we should value the variation between SPs, thereby creating meaningful variation in authentic interactions in SP-student encounters. SPs should be allowed to act and react from different positions during SP-student encounters, including their role description, as teaching aid, and based on their own experiences. In this way, SP-student encounters are optimized to contribute to meaningful student learning through authenticity.

Effectiveness of Flexible Bronchoscopy Simulation-Based Training: A Systematic Review.

BACKGROUND: The implementation of simulation-based training (SBT) to teach flexible bronchoscopy (FB) skills to novice trainees has increased during the last decade. However, it is unknown whether SBT is effective to teach FB to novices and which instructional features contribute to training effectiveness. RESEARCH QUESTION: How effective is FB SBT and which instructional features contribute to training effectiveness? STUDY DESIGN AND METHODS: We searched Embase, PubMed, Scopus, and Web of Science for articles on FB SBT for novice trainees, considering all available literature until November 10, 2022. We assessed methodological quality of included studies using a modified version of the Medical Education Research Study Quality Instrument, evaluated risk of bias with relevant tools depending on study design, assessed instructional features, and intended to correlate instructional features to outcome measures. RESULTS: We identified 14 studies from an initial pool of 544 studies. Eleven studies reported positive effects of FB SBT on most of their outcome measures. However, risk of bias was moderate or high in eight studies, and only six studies were of high quality (modified Medical Education Research Study Quality Instrument score ≥ 12.5). Moreover, instructional features and outcome measures varied highly across studies, and only four studies evaluated intervention effects on behavioral outcome measures in the patient setting. All of the simulation training programs in studies with the highest methodological quality and most relevant outcome measures included curriculum integration and a range in task difficulty. INTERPRETATION: Although most studies reported positive effects of simulation training programs on their outcome measures, definitive conclusions regarding training effectiveness on actual bronchoscopy performance in patients could not be made because of heterogeneity of training features and the sparse evidence of training effectiveness on validated behavioral outcome measures in a patient setting. TRIAL REGISTRATION: PROSPERO; No.: CRD42021262853; URL: https://www.crd.york.ac.uk/prospero/.

The contribution of simulated patients to meaningful student learning.

INTRODUCTION: Communication training with simulated patients (SPs) is widely accepted as a valuable and effective means of teaching communication skills. However, it is unclear which elements within SP-student encounters make these learning experiences meaningful. This study focuses on the SP's role during meaningful learning of the student by giving an in-depth understanding of the contribution of the SP from a student perspective. METHODS: Fifteen bachelor Technical Medicine students were interviewed. Technical medicine students become technical physicians who optimize individual patient care through the use of personalized technology. Their perceptions of meaningful learning experiences during SP-student encounters were explored through in-depth, semi-structured interviews, and analyzed using thematic analysis. RESULTS: Three main themes were identified that described what students considered to be important for meaningful learning experiences. First, SPs provide implicit feedback-in-action. Through this, students received an impression of their communication during the encounter. Implicit feedback-in-action was perceived as an authentic reaction of the SPs. Second, implicit feedback-in-action could lead to a process of reflection-in-action, meaning that students reflect on their own actions during the consultation. Third, interactions with SPs contributed to students' identity development, enabling them to know themselves on a professional and personal level. DISCUSSION: During SP encounters, students learn more than just communication skills; the interaction with SPs contributes to their professional and personal identity development. Primarily, the authentic response of an SP during the interaction provides students an understanding of how well they communicate. This raises issues whether standardizing SPs might limit opportunities for meaningful learning.

Development and Evaluation of a Proficiency-based and Simulation-based Surgical Skills Training for Technical Medicine Students.

This article was migrated. The article was marked as recommended. Objective Surgical graduate training to achieve practice-ready students is needed, yet is often lacking. This study developed and evaluated a proficiency-based, simulation-based course for basic surgical skills at graduate level. Learning outcomes were measured at the level of knowledge and skills and evaluated with a post-course questionnaire after students' clinical rotations. Methods The surgical skills course was anchored to surgical patient flow and covered topics and skills related to pre-, intra-, and post-operative care, including case-based medical reasoning, patient safety, infection management, operating theatre etiquette, scrubbing and donning, instrument handling, local anaesthesia, excision of tissue, and suturing. Students were assessed on knowledge and procedural skills. Results 155 graduate Technical Medicine students from academic years 2015-2016 and 2016-2017 entered this 10-week, 3 ECTS credits graduate Surgical Skills course. Pass rates of the knowledge test were 78%, and 87% for the procedural skill assessment. Graduate students reached proficiency level in a simulation-based basic surgical skills course. Students stated to go with confidence to the operating room and felt competent in performing four basic surgical skills. Conclusion Based on this study, we recommend that proficiency-based training using simulation should be standard in surgical curricula before students are allowed to practice on patients.

Reliability of Observational Assessment Methods for Outcome-based Assessment of Surgical Skill: Systematic Review and Meta-analyses.

BACKGROUND: Reliable performance assessment is a necessary prerequisite for outcome-based assessment of surgical technical skill. Numerous observational instruments for technical skill assessment have been developed in recent years. However, methodological shortcomings of reported studies might negatively impinge on the interpretation of inter-rater reliability. OBJECTIVE: To synthesize the evidence about the inter-rater reliability of observational instruments for technical skill assessment for high-stakes decisions. DESIGN: A systematic review and meta-analysis were performed. We searched Scopus (including MEDLINE) and Pubmed, and key publications through December, 2016. This included original studies that evaluated reliability of instruments for the observational assessment of technical skills. Two reviewers independently extracted information on the primary outcome (the reliability statistic), secondary outcomes, and general information. We calculated pooled estimates using multilevel random effects meta-analyses where appropriate. RESULTS: A total of 247 documents met our inclusion criteria and provided 491 inter-rater reliability estimates. Inappropriate inter-rater reliability indices were reported for 40% of the checklists estimates, 50% of the rating scales estimates and 41% of the other types of assessment instruments estimates. Only 14 documents provided sufficient information to be included in the meta-analyses. The pooled Cohen's kappa was .78 (95% CI 0.69-0.89, p < 0.001) and pooled proportion agreement was 0.84 (95% CI 0.71-0.96, p < 0.001). A moderator analysis was performed to explore the influence of type of assessment instrument as a possible source of heterogeneity. CONCLUSIONS AND RELEVANCE: For high-stakes decisions, there was often insufficient information available on which to base conclusions. The use of suboptimal statistical methods and incomplete reporting of reliability estimates does not support the use of observational assessment instruments for technical skill for high-stakes decisions. Interpretations of inter-rater reliability should consider the reliability index and assessment instrument used. Reporting of inter-rater reliability needs to be improved by detailed descriptions of the assessment process.

Psychologists' judgements of diagnostic activities: deviations from a theoretical model.

In this article, we describe an investigation into the diagnostic activities of practicing clinical psychologists. Two questionnaires were filled in by 313 psychologists. One group of psychologists (N = 175) judged the necessity of diagnostic activities; the other group (N = 138) selected the activities they would actually perform. Results showed that more participants thought that diagnostic activities were necessary than there were participants who intended to actually perform those activities. Causal analysis, by generating and testing diagnostic hypotheses to form an integrated client model with an explanation for the problem, was judged least necessary and would not be performed. We conclude that a discrepancy exists between the number and types of activities psychologists judged to be necessary and they intend to actually perform. The lack of attention for causal analysis is remarkable as causal explanations are crucial to effective treatment planning.

Perceptual Speed and Psychomotor Ability Predict Laparoscopic Skill Acquisition on a Simulator.

OBJECTIVE: Performing minimally invasive surgery puts high demands on a surgeon's cognitive and psychomotor abilities. Assessment of these abilities can be used to predict a surgeon's learning curve, to create individualized training programs, and ultimately in selection programs for surgical training. The aim of this study was to examine the influence of cognitive and psychomotor ability on the training duration and learning rate. DESIGN: A prospective quasiexperimental field study regarding the influence of cognitive and psychomotor ability, baseline measures of time to complete task, damage to tissue, and efficiency of movement, age, and gender on the number of sessions needed to reach a predefined performance level on a laparoscopy simulator. The same variables were investigated as predictors of the learning rate. SETTING: The study was performed at the Experimental Center for Technical Medicine at the University of Twente, The Netherlands. PARTICIPANTS: In all, 98 novices from the Master program of Technical Medicine followed a proficiency-based basic laparoscopic skills training. RESULTS: Perceptual speed (PS) predicted training duration (hazard ratio = 1.578; 95% CI = 1.084, 2.300; p = 0.017). Cognitive (b = -0.721, p = 0.014) and psychomotor ability (b = 0.182, p = 0.009) predicted the learning rate of time to complete the task. Also, the learning rate for participants with higher levels of PS was lower (b = 0.167, p = 0.036). Psychomotor ability also predicted the learning rate for damage to tissue (b = 0.194, p = 0.015) and efficiency of movement (b = 0.229, p = 0.004). Participants with better psychomotor ability outperformed other participants across all sessions on all outcome measures. CONCLUSIONS: PS predicted training duration in a basic laparoscopic skills training and the learning rate for the time to complete the task. Psychomotor ability predicted the learning rate for laparoscopic skill acquisition in terms of time to complete task, damage to tissue, and efficiency of movements. These results indicate early automation of basic laparoscopic skill. Careful selection of the cognitive abilities tests is advised for use in training programs and to identify individuals who need more training.

Performance variables and professional experience in simulated laparoscopy: a two-group learning curve study.

OBJECTIVE: Virtual reality simulators are increasingly used in laparoscopy training. Such simulators allow objective assessment of performance. However, both low-level variables and overall scores generated by the simulator can be hard to interpret. We present a method to generate intermediate performance variables and show how the resulting variables can be used to investigate the development of laparoscopic skills. DESIGN: A beginner group (n = 16) and a group with intermediate laparoscopic experience (n = 9) participated in a 5-session, basic skills training course hosted by the Department of Technical Medicine at the University of Twente. Multiple simulator-generated variables were aggregated into 4 performance variables: duration, left-hand motion, right-hand motion, and damage. Differences in performance were analyzed in relation to proficiency values. RESULTS: Damage performance differentiated the most between groups and proficiency values; motion performance variables differentiated the least. The more experienced group outperformed the beginner group at damage by the end of the course. CONCLUSIONS: Differentiating between duration, left-hand motion, right-hand motion, and damage is a useful way to investigate laparoscopic performance development. Different performance variables follow different trajectories toward expertise. Valid and reliable clinical damage parameters are needed to investigate the relation of real-world damage to simulator damage.