Including patients and caregivers in assessment in the pediatric competence by design curriculum: A national consensus study.

Although evidence supports diverse assessment strategies, including patient/caregiver involvement in Competency-Based Medical Education (CBME), few residency programs formally include patients/caregivers in assessment. We aimed to determine the milestones for which patient/caregiver inclusion would be valuable in the Canadian Pediatric Competence By Design (CBD) curriculum.Program directors from 17 Canadian pediatric residency programs were invited to participate in a Delphi study. This Delphi included 209 milestones selected by the study team from the 320 milestones of the draft pediatric CBD curriculum available at the time of the study. In round 1, 16 participants representing 13 institutions rated the value of including patients/caregivers in the assessment of each milestone using a 4-point scale. We obtained consensus for 150 milestones, leaving 59 for re-exposure. In round 2, 14/16 participants rated remaining items without consensus. Overall, 67 milestones met consensus for 'valuable,' of which 11 met consensus for 'extremely valuable.' The majority of these milestones related to communication skills.Patient/caregiver assessment is valuable for 21% of milestones in the draft pediatric CBD curriculum, predominantly those relating to communication skills. This confirms the perceived importance of patient/caregiver assessment of trainees in CBME curricula; formal inclusion may be considered. Future directions could include exploring patients/caregivers' perspectives of their roles in assessment in CBD.

The perceptions and experiences of medical students in a pediatric buddy program: a qualitative study.

BACKGROUND: Partnership programs between medical students and patients provide students with non-clinical experiences that enhance medical learning, especially with respect to humanistic care. We explored the perceptions and experiences of medical students in a pediatric oncology buddy program. METHODS: Using a basic interpretive qualitative approach, we conducted interviews with 15 medical students at three time points: before meeting his/her buddy (pre-interview), four months into the partnership (4-month interview), and at the end of the partnership (post interview). We then conducted a thematic analysis of the interview data. RESULTS: All students in the program who met the study criteria (N = 15/16) participated. The medical students highlighted that: (a) providing support to buddies and their families is important; (b) providing care to children with serious illnesses is emotionally difficult; (c) developing deep connections with buddies and their families is rewarding; and (d) gaining empathy and personal fulfillment from buddies and their families is inevitable. CONCLUSIONS: This study provides an understanding of medical students' perceptions and experiences in a pediatric oncology, non-clinical buddy program. Tailored one-on-one partnerships between medical students and pediatric oncology patients play an important role in medical education and contributes to the teaching of humanistic care.

Meaningful relationships as a driving force in the experience of parents of a child living with polyposis conditions.

While much research has been conducted on the experiences of individuals with inflammatory bowel diseases, there remains a dearth of research conducted on those affected by polyposis conditions. As a result, little is known about the lived experiences of those with polyposis conditions, especially in the cases of parents of pediatric patients with these conditions. Using a hermeneutical phenomenological qualitative research approach, this study sought to explore the lived experiences of parents of children with polyposis conditions, with specific attention paid to the processes in which parents engage in order to adapt to their realities. In total, three major themes were revealed from the experiences of seven participants. Parents discussed the importance of building collaborative relationships with family physicians, building reassuring relationships with other parents, and building educative relationships with their child. These findings demonstrate the need for family-centered care practices by physicians, and role of relevant relationships as a driving force in helping parents in the management of their child's illness.

Nursing students' use of social media in their learning: a case study of a Canadian School of Nursing.

BACKGROUND: Social media has diverse applications for nursing education. Current literature focuses on how nursing faculty use social media in their courses and teaching; less is known about how and why nursing students use social media in support of their learning. OBJECTIVES: The purpose of this study was to explore how nursing students use social media in their learning formally and informally. METHODS: This exploratory qualitative case study of a Canadian School of Nursing reports on the findings of interviews (n = 9) with nursing students to explore how they use social media in their learning. Data were analyzed using a combined deductive and inductive coding approach, using three cycles of coding to facilitate category identification. RESULTS AND CONCLUSIONS: The findings demonstrate that participants use social media for formal and informal learning and specifically, as a third space to support their learning outside of formal institutional structures. Social media plays a role in the learning activities of nursing students studying both face-to-face and by distance. Accordingly, social media use has implications for learning theory and course design, particularly regarding creating space for student learning communities.

Exploring the connections between programmatic assessment and program evaluation within competency-based medical education programs.

Programmatic assessment and program evaluation are both important within competency-based medical education (CBME) programs. Given this importance, there is value in evaluating programmatic assessment as well as using the information collected in programmatic assessment for the evaluation of CBME programs. In order to help facilitate these two activities, this paper distinguishes between programmatic assessment and program evaluation as well as highlights the connections between them. In doing so, it shows that programmatic assessment and program evaluation, when employed appropriately, can complement each other and contribute to the overall effectiveness of CBME programs.

Patients' and parents' perspectives of and experiences with assessing nursing students' paediatric clinical practice.

PURPOSE: To explore patients' and parents' involvement in the formative assessment of undergraduate nursing students' paediatric clinical practice. METHODS: We conducted semi-structured interviews with paediatric patients between 14 to 18 years old and parents who received care from a nursing student while admitted to a paediatric tertiary care hospital in Canada. We analysed the data using qualitative content analysis as well as Lincoln and Guba's criteria for establishing trustworthiness. The Consolidated criteria for reporting qualitative studies (COREQ) checklist was completed for the quality appraisal of this article. FINDINGS: Three categories emerged from the data: 1) how patients and parents are currently involved in the formative assessment of nursing students' paediatric clinical practice; 2) how patients and parents would prefer to be involved in the formative assessment of nursing students' paediatric clinical practice; and 3) the potential benefits and challenges of involving patients and parents in the formative assessment of nursing students' paediatric clinical practice. CONCLUSION: This study provided an understanding of patients' and parents' past encounters with nursing students and the elements of care that they have assessed as well as those that they would prefer to assess and provide feedback on, while considering the potential benefits and challenges of their involvement. The findings of this study will assist clinical instructors in determining how and when to involve patients and parents in the assessment of nursing students. Academic institutions offering nursing programmes should consider the study findings when improving or changing formative assessment strategies.

Leveraging social media for medical education: Learning from patients in online spaces.

Social media has applications for teaching, learning, and patient involvement in medical education. It has the potential to eliminate hierarchies in educational interactions, thereby allowing patients to communicate, collaborate, and share information with learners. This commentary suggests that we should consider patients as experts who are available on social media platforms and can therefore play a role in medical education. Specifically, it highlights how patients can serve as teachers in social media-based medical education and how patients' narratives and experiences volunteered in online spaces can help cultivate patient-centred care practices. This article aims to explore how medical students, residents, and practicing physicians can learn from patients on social media and the implications of this learning on medical education more broadly.

Resident duty hours: Families' knowledge and perceptions in the paediatric intensive care unit.

BACKGROUND AND OBJECTIVES: Resident duty hours remain a controversial topic in the literature. Competing interests include patient safety, resident education, and resident well-being. No studies, however, have sought family members' perspectives on duty hours in the paediatric context. This study aimed to explore family members' knowledge of trainee duty hours, and their perspectives on the balance between shift duration and hand-off frequency. METHODS: We surveyed family members of patients admitted ≥ 24 hours in the paediatric intensive care unit at an academic center. We simultaneously collected daily logs of hours worked by trainees. Descriptive statistics were used to analyze survey responses and trainee duty hours. RESULTS: One-hundred and one family members responded (75%). Respondents demonstrated knowledge of trainees working long duty hours but reported lower averages than the trainee logs (55 versus 66 hours per week and 16 versus 24 hours per shift). Elements related to both potential trainee fatigue and hand-offs raised concern in more than half of respondents. When asked to choose between a familiar trainee working a prolonged shift, or an unfamiliar trainee at the start of their shift, respondents were divided (52% versus 48%, respectively). CONCLUSIONS: Family members of critically ill paediatric patients are aware that trainees provide patient care while working long duty hours with minimal sleep. Despite this awareness, long shifts retain value with some families, possibly due to continuity. Changes to duty hours and hand-off frequency may pose an unrealized harm on family-centered care, as well as patient-provider relationships, and further study is warranted.

Exploring residents' reactions to and use of parent feedback in a pediatric emergency department: A grounded theory study.

BACKGROUND: Competency-based medical education (CBME) involves workplace-based assessment. In pediatrics, patients' parents can participate in this assessment and generate feedback for residents. Prior to routinely collecting parent feedback, it is important to investigate residents' perspectives on it. AIM: To explore residents' reactions to and use of written parent feedback. METHODS: Using a grounded theory approach, we interviewed residents who received written parent feedback at the mid- and end-points of a pediatric emergency training rotation. RESULTS: Twenty-five residents participated. The residents reacted positively to the feedback. They thought that it complements educators' feedback, can elucidate parents' perspectives and needs, and is something that residents want and need. Although the residents thought that non-specific negative parent feedback is not useful, they believed non-specific positive and constructive parent feedback to be encouraging and useful. They delineated how they use non-specific positive parent feedback to boost their self-confidence and reassure themselves that parents perceive their clinical practices as appropriate. They also elucidated how they use constructive parent feedback to understand what is important to parents, become aware of their own behaviors, and modify their clinical practices. CONCLUSIONS: The findings encourage educators in pediatrics to include parents in resident assessment, especially in the CBME era.

Residents' breastfeeding knowledge, comfort, practices, and perceptions: results of the Breastfeeding Resident Education Study (BRESt).

BACKGROUND: Physicians have a significant impact on new mothers' breastfeeding practices. However, physicians' breastfeeding knowledge is suboptimal. This knowledge deficit could be the result of limited breastfeeding education in residency. This study aimed to explore pediatric residents' breastfeeding knowledge, comfort level, clinical practices, and perceptions. It also investigated the level and type of education residents receive on breastfeeding and their preferences for improving it. METHODS: Descriptive, cross-sectional, self-reported online questionnaires were sent to all residents enrolled in a Canadian general pediatric residency program, as well as to their program directors. Resident questionnaires explored breastfeeding knowledge, comfort level, clinical practices, perceptions, educational experiences and educational preferences. Program director questionnaires collected data on current breastfeeding education in Canadian centers. For the resident survey, breastfeeding knowledge was calculated as the percent of correct responses. Demographic factors independently associated with overall knowledge score were identified by multiple linear regression. Descriptive statistics were used for the program director survey. RESULTS: Overall, 201 pediatric residents, and 14 program directors completed our surveys. Residents' mean overall breastfeeding knowledge score was 71% (95% CI: 69-79%). Only 4% (95% CI: 2-8%) of residents were very comfortable evaluating latch, teaching parents breastfeeding positioning, and addressing parents' questions regarding breastfeeding difficulties. Over a quarter had not observed a patient breastfeed. Nearly all agreed or strongly agreed that breastfeeding promotion is part of their role. Less than half reported receiving breastfeeding education during residency and almost all wanted more interactive breastfeeding education. According to pediatric program directors, most of the breastfeeding education residents receive is didactic. Less than a quarter of program directors felt that the amount of breastfeeding education provided was adequate. CONCLUSION: Pediatric residents in Canada recognize that they play an important role in supporting breastfeeding. Most residents lack the knowledge and training to manage breastfeeding difficulties but are motivated to learn more about breastfeeding. Pediatric program directors recognize the lack of breastfeeding education.

Digital storytelling in health professions education: a systematic review.

BACKGROUND: Digital stories are short videos that combine stand-alone and first-person narratives with multimedia. This systematic review examined the contexts and purposes for using digital storytelling in health professions education (HPE) as well as its impact on health professionals' learning and behaviours. METHODS: We focused on the results of HPE studies gleaned from a larger systematic review that explored digital storytelling in healthcare and HPE. In December 2016, we searched MEDLINE, EMBASE, PsycINFO, CINAHL, and ERIC. We included all English-language studies on digital storytelling that reported at least one outcome from Levels 2 (learning) or 3 (behaviour) of The New World Kirkpatrick Model. Two reviewers independently screened articles for inclusion and extracted data. RESULTS: The comprehensive search (i.e., digital storytelling in healthcare and HPE) resulted in 1486 unique titles/abstracts. Of these, 153 were eligible for full review and 42 pertained to HPE. Sixteen HPE articles were suitable for data extraction; 14 focused on health professionals' learning and two investigated health professionals' learning as well as their behaviour changes. Half represented the undergraduate nursing context. The purposes for using digital storytelling were eclectic. The co-creation of patients' digital stories with health professionals as well as the creation and use of health professionals' own digital stories enhanced learning. Patients' digital stories alone had minimal impact on health professionals' learning. CONCLUSIONS: This review highlights the need for high-quality research on the impact of digital storytelling in HPE, especially on health professionals' behaviours. PROSPERO REGISTRATION NUMBER: CRD42016050271 .

Twelve tips for planning and conducting a participatory evaluation.

Participatory evaluation involves a partnership between program evaluators and stakeholders. This paper provides tips for planning and conducting a participatory evaluation of a medical education program. The tips highlight the need to recognize the importance of judgment in participatory evaluation, assess the appropriateness of participatory evaluation for the setting, determine a predominant stream of participatory evaluation, and select stakeholders for participation carefully. The tips also suggest that one should initiate participation at the program planning stage, engage a participatory evaluator, develop an evaluation framework, associate participatory evaluation with more than just qualitative methods, and use technology to facilitate participation. Furthermore, the tips illuminate that while individuals can use participatory evaluation to build evaluation capacity, it is important that they use three dimensions (i.e. control of decision-making, stakeholder selection, depth of participation) for determining the level of "participatory-ness," as well as publish and reflect on their use of participatory evaluation.

Has the new Kirkpatrick generation built a better hammer for our evaluation toolbox?

Although Kirkpatrick's original outcome-focused model is widely used to evaluate medical education programs, it is subject to criticism. To combat this criticism and address the complexities of learning environments, the New World Kirkpatrick Model has emerged. This brief article describes key aspects of the New World Kirkpatrick Model for program evaluation. Specifically, it highlights three major criticisms of Kirkpatrick's original model and discusses the ways in which this new model attempts to rebut them. By doing so, this article hopes to encourage medical teachers to try the New World Kirkpatrick Model in the evaluation of their complex educational programs and investigate its strengths and weaknesses.

Fellowship training: a qualitative study of scope and purpose across one department of medicine.

BACKGROUND: Fellowship training follows certification in a primary specialty or subspecialty and focusses on distinct and advanced clinical and/or academic skills. This phase of medical education is growing in prevalence, but has been an "invisible phase of postgraduate training" lacking standards for education and accreditation, as well as funding. We aimed to explore fellowship programs and examine the reasons to host and participate in fellowship training, seeking to inform the future development of fellowship education. METHODS: During the 2013-14 academic year, we conducted interviews and focus groups to examine the current status of fellowship training from the perspectives of division heads, fellowship directors and current fellows at the Department of Medicine, University of Ottawa, Canada. Descriptive statistics were used to depict the prevailing status of fellowship training. A process of data reduction, data analysis and conclusions/verifications was performed to analyse the quantitative data. RESULTS: We interviewed 16 division heads (94%), 15 fellowship directors (63%) and 8 fellows (21%). We identified three distinct types of fellowships. Individualized fellowships focus on the career goals of the trainee and/or the recruitment goals of the division. Clinical fellowships focus on the attainment of clinical expertise over and above the competencies of residency. Research fellowships focus on research productivity. Participants identified a variety of reasons to offer fellowships: improve academic productivity; improve clinical productivity; share/develop enhanced clinical expertise; recruit future faculty members/attain an academic position; enhance the reputation of the division/department/trainee; and enhance the scholarly environment. CONCLUSIONS: Fellowships serve a variety of purposes which benefit both individual trainees as well as the academic enterprise. Fellowships can be categorized within a distinct taxonomy: individualized; clinical; and research. Each type of fellowship may serve a variety of purposes, and each may need distinct support and resources. Further research is needed to catalogue the operational requirements for hosting and undertaking fellowship training, and establish recommendations for educational and administrative policy and processes in this new phase of postgraduate education.

The development of the PARENTS: a tool for parents to assess residents' non-technical skills in pediatric emergency departments.

BACKGROUND: Parents can assess residents' non-technical skills (NTS) in pediatric emergency departments (EDs). There are no assessment tools, with validity evidence, for parental use in pediatric EDs. The purpose of this study was to develop the Parents' Assessment of Residents Enacting Non-Technical Skills (PARENTS) educational assessment tool and collect three sources of validity evidence (i.e., content, response process, internal structure) for it. METHODS: We established content evidence for the PARENTS through interviews with physician-educators and residents, focus groups with parents, a literature review, and a modified nominal group technique with experts. We collected response process evidence through cognitive interviews with parents. To examine the internal structure evidence, we administered the PARENTS and performed exploratory factor analysis. RESULTS: Initially, a 20-item PARENTS was developed. Cognitive interviews led to the removal of one closed-ended item, the addition of resident photographs, and wording/formatting changes. Thirty-seven residents and 434 parents participated in the administration of the resulting 19-item PARENTS. Following factor analysis, a one-factor model prevailed. CONCLUSIONS: The study presents initial validity evidence for the PARENTS. It also highlights strategies for potentially: (a) involving parents in the assessment of residents, (b) improving the assessment of NTS in pediatric EDs, and

Education in the Waiting Room: Description of a Pediatric Emergency Department Educational Initiative.

OBJECTIVE: The aim of this study was to understand parents' awareness of and reactions to a slide presentation based waiting-room educational initiative. METHODS: This was a prospective observational study at a Canadian tertiary-care pediatric emergency department (ED) with an annual census of 68,000 visits. An anonymous parental survey was developed de novo, and parents were asked to complete the survey during their low-acuity ED visit over a 2-week study period. Descriptive statistics were used to describe responses and themes. RESULTS: Parents completed 520 surveys (733 approached, 70.9% response rate). Eighty-three percent of respondents had previously sought care in the ED. Most parents (68.9%) were aware of the slide presentation, but only 33.7% were able to watch it in its entirety (20 minutes' duration). Of those who watched the whole presentation, 62.9% understood that lower-acuity cases are assessed in the ambulatory zone of the ED, and sicker children are assessed in the acute zone (89.4%), 79.9% felt the presentation helped them to understand how the ambulatory zone functions, and 83.2% appreciated the current wait-time information. General questions about common health concerns were answered correctly in 58.3% (fever), 56.0% (gastroenteritis), 50.5% (abdominal pain/constipation), 35.7% (earache), and 17.0% (head injury). CONCLUSIONS: The majority of parents were aware of this waiting-room educational initiative, but there was variable uptake of information. Parents watching the entire presentation appreciated the information provided, especially wait-time information, and felt it improved their experience. Knowledge of common health conditions was low; novel methods of knowledge transfer must be utilized and evaluated.

A qualitative exploration of which resident skills parents in pediatric emergency departments can assess.

BACKGROUND: Residents must strive for excellence in their nontechnical skills (NTS). However, NTS have not traditionally been well-assessed in pediatric emergency departments (EDs). One underutilized assessment strategy is to have parents assess the residents caring for their children. Prior to involving parents in resident assessment, it is essential to identify which NTS parents in pediatric EDs can assess. AIM: To explore which resident NTS parents in pediatric EDs can assess. METHODS: An exploratory qualitative study design was used. It included interviews with faculty members involved in the supervision and assessment of residents in a pediatric ED and residents who had experience working in a pediatric ED, as well as focus groups with parents who had visited a pediatric ED at least twice in the past year. RESULTS: Participants in this study suggested that parents, if provided with the opportunity, can assess residents' communication skills, comfort in a pediatric setting, adaptability, and collaboration. CONCLUSIONS: This study demystifies how parents can become involved in the assessment of residents' NTS. The findings will inform the development of assessment strategies and could be used to develop assessment instruments that enable parents to become actively involved in the assessment of residents in pediatric EDs.

Lumbar puncture simulation in pediatric residency training: improving procedural competence and decreasing anxiety.

BACKGROUND: Pediatric residents must become proficient with performing a lumbar puncture (LP) during training. Residents have traditionally acquired LP skills by observing the procedure performed by a more senior resident or staff physician and then attempting the procedure themselves. This process can result in variable procedural skill acquisition and trainee discomfort. This study assessed changes in resident procedural skill and self-reported anxiety when residents were provided with an opportunity to participate in an interactive training session and practice LPs using a simulator. METHODS: All pediatric residents at our institution were invited to participate. Residents were asked to report their post-graduate year (PGY), prior LP attempts and self-reported anxiety scores as measured by the standardized State-Trait Anxiety Inventory - State Anxiety Scale (STAI-S) prior to completing an observed pre-test using an infant-sized LP simulator. Staff physicians observed and scored each resident's procedural skill using a previously published 21-point scoring system. Residents then participated in an interactive lecture on LP technique and were given an opportunity for staff-supervised, small group simulator-based practice within 1 month of the pre-test. Repeat post-test was performed within 4 months. RESULTS: Of the pediatric residents who completed the pre-test (N = 20), 16/20 (80 %) completed both the training session and post-test. Their PGY training level was: PGY1 (38 %), PGY2 (25 %), PGY3 (25 %) or PGY4 (12 %). Procedural skill improved in 15/16 residents (paired t-test; p < 0.001), driven by a significant improvement in skill for residents in PGY1 (P = 0.015) and PGY2 (p = 0.003) but not PGY3 or PGY4. Overall anxiety scores were higher at baseline than at post testing (mean ± SD; 44.8 ± 12.1 vs 39.7 ± 9.4; NS) however only PGY1 residents experienced a significant reduction in anxiety (paired t-test, p = 0.04). CONCLUSION: LP simulation training combined with an interactive training session may be a useful tool for improving procedural competence and decreasing anxiety levels, particularly among those at an earlier stage of residency training.

Learning theory and its application to the use of social media in medical education.

BACKGROUND: There is rapidly increasing pressure to employ social media in medical education, but a review of the literature demonstrates that its value and role are uncertain. OBJECTIVE: To determine if medical educators have a conceptual framework that informs their use of social media and whether this framework can be mapped to learning theory. METHODS: Thirty-six participants engaged in an iterative, consensus building process that identified their conceptual framework and determined if it aligned with one or more learning theories. RESULTS: The results show that the use of social media by the participants could be traced to two dominant theories-Connectivism and Constructivism. They also suggest that many medical educators may not be fully informed of these theories. CONCLUSIONS: Medical educators' use of social media can be traced to learning theories, but these theories may not be explicitly utilised in instructional design. It is recommended that formal education (faculty development) around learning theory would further enhance the use of social media in medical education.