Exploring developmental assignments shaping experience-driven acquisition of leadership competencies in young clinicians.

BACKGROUND: Experiential leadership development is well documented in the corporate sector, but those models cannot be applied as is, in the healthcare domain. The current study proposes a framework for the healthcare sector to enable experiential leadership development for young clinicians. The authors identify developmental assignments (DAs) and explore those characteristics [developmental assignment characteristics; DACs] therein that help develop leadership competencies in young clinicians. METHODS: As part of a qualitative exploratory study in Pakistan, the authors conducted 16 semi-structured interviews with senior clinicians in leadership positions with post-graduate residents under their supervision from different medical specialties. The participants were selected through purposive sampling, ensuring a maximum variation sample. Focusing on participants' experiences and perspectives related to experience-driven leadership development, the authors used a multi-level theoretical framework for analysis. RESULTS: The thematic analysis resulted in 19 subthemes with four overarching themes for both objectives. The authors categorized the developmental assignments (DAs) into clinical, academic, and administrative assignments. These assignments can be utilized for leadership development by ensuring that they have the requisite characteristics built into their context and structure. These developmental assignment characteristics (DACs) can range from learner-driven to supervisor-driven. The learner-driven characteristics include autonomy, high levels of responsibilities, unfamiliar assignments, working across boundaries, managing diversity, making a commitment, and creating change. The supervisor-driven characteristics include briefing, debriefing, accountability, and learner-assignment matching. The authors also developed a learner-assignment matching (LAM) framework to guide supervisors in customizing and adjusting the level of each DAC in a DA. CONCLUSION: A modern healthcare educational system can utilize studies like this to enable supervisors to develop required leadership skills in young clinicians along with clinical skills.

Entrustment in physician-patient communication: a modified Delphi study using the EPA approach.

BACKGROUND: Competency based curricula across the globe stress on the importance of effective physician patient communication. A variety of courses have been used to train physicians for this purpose. However, few of them link competencies with practice resulting in confusions in implementation and assessment. This issue can be resolved by treating certain specific patient communication related tasks as acts of entrustment or entrustable professional activities (EPAs). In this study, we aimed to define a competency-based framework for assessing patient physician communication using the language of EPAs. METHODS: A modified Delphi study was conducted in three stages. The first stage was an extensive literature review to identify and elaborate communication related tasks which could be treated as EPAs. The second stage was content validation by medical education experts for clarity and representativeness. The third stage was three iterative rounds of modified Delphi with predefined consensus levels. The McNemar test was used to check response stability in the Delphi Rounds. RESULTS: Expert consensus resulted in development of 4 specific EPAs focused on physician-patient communication with their competencies and respective assessment strategies all aiming for level 5 of unsupervised practice. These include Providing information to the patient or their family about diagnosis or prognosis; Breaking Bad news to the patient or their family; Counseling a patient regarding their disease or illness; Resolving conflicts with patients or their families. CONCLUSIONS: The EPAs for Physician-patient communication are a step toward an integrative, all-inclusive competency-based assessment framework for patient-centered care. They are meant to improve the quality of physician patient interaction by standardizing communication as a decision of entrustment. The EPAs can be linked to competency frameworks around the world and provide a useful assessment framework for effective training in patient communication. They can be integrated into any post graduate curriculum and can also serve as a self-assessment tool for postgraduate training programs across the globe to improve their patient communication curricula.

Referral writing: Consensus building on a tool for writing structured referrals.

Competency in referral writing skill is needed by doctors for which they are not adequately trained. Although there has been a lot of discussion on improvement of skills for writing consultation letters, still priority is not given to this important task. Ideally there should be a course with assessment for teaching and learning medical referral writing skills for students. Currently, there is no such tool to assess the way communication letters are written. An 18-point assessment scale has been developed through Delphi technique to improve the quality of referral letters. The objective of the present study was to design a structured Proforma for writing referrals, with the consensus of seven participants using Delphi. The place of study was Rawalpindi medical university and allied hospitals. Results were finalised after the acceptance of structured referral by selected participants through Delphi. The response rate was 70%. The validity and interrater reliability were calculated using SPSS25. The Cronbach's alpha was 0.7 and Kappa was 0.3. Both were statistically significant. The designed Proforma for writing referrals, with its interrater reliability calculated, seems effective for writing effective and structured referrals. The study further recommends training junior doctors in making effective referrals.

Assessing team in team objectively structured bedside assessment (TOSBA).

Team objectively structured bed side assessment (TOSBA) is one of the tools used by medical students to assess teamwork. The aim of this study was to measure the team scores and to correlate team performance scores with individual performance in final year medical students using TOSBA. It was a quasi-experimental study including 100 students, divided into 22 teams comprising of 4-6 members. TOSBA sessions were setup for module assessment of teams. Their individual and team performance scores were measured. Correlation between individual and team scores was calculated using Pearson correlatio n test. Results of the study showed seven (7) high scoring, eight (8) medium scoring and seven (7) low scoring teams. Team scores had a statistically significant correlation with individual scores (p<0.05). Reliability of the tool was 0.58 with a high convergent validity. TOSBA is a tool that can be used for individual and team assessment during clerkships.

Healthcare needs of the Muslim patient community in the undergraduate medical curriculum - Are we there?

OBJECTIVE: Muslim patients have a unique set of healthcare needs that are related to their faith. These are generally not formally addressed in the medical curricula. The study aimed to recommend additional content that would better tailor the undergraduate curriculum to cater to the needs of this large cohort - Muslim patients. This is with the expectation that patients would have their faith-related health queries resolved by healthcare providers. METHODS: A quantitative descriptive survey design was adopted. A 46-item questionnaire formulated through a literature review was put forth to experts using the Delphi Technique. Experts were selected based on having an academic rank of associate professor and above or medical education credentials. Three iterative rounds were conducted for exploring consensus over a period of five months. Panel agreement of >70% was the criteria for inclusion. RESULTS: Items were categorized under 7 subject themes: Medicine, Psychiatry, Surgery, Gynecology, Obstetrics, Medical Ethics, and Islamic Studies. Consensus was eventually reached for 41 out of 46 items. These topics included but were not limited to "The Muslim patient in Ramadan to: fast or not to fast?" and "Muslim women and decision-making on pregnancy termination". CONCLUSION: The study suggested that the topics proposed herein were in fact legitimate faith-related healthcare needs of Muslim patients. Their inclusion would add value to the undergraduate medical curriculum and would train practitioners to improve patient outcomes more holistically.

Study of curriculum of Doctor of Physical therapy programme based on World Federation of Medical Education standards.

OBJECTIVE: To evaluate the curriculum for Doctor of Physical Therapy (DPT) programme based on World Federation of Medical Education (WFME) standards. METHODS: A questionnaire was constructed based on WFME 'Should' and 'Must' standards. It was validated by five experts in two rounds. It is comprised of Items/ questions with Yes/No options. The questionnaire was filled by the DPT Faculty and final year students at Riphah International University, Islamabad from March 01, to April 30, 2017. RESULTS: The key weakness identified were students participation in program management, evaluation, mission statement, program designing, curriculum committee, students activities and organization, and other matters relevant to students, followed by the use of external examiners, reliability and validity of assessment tools, scrutiny of assessments by external examiners and feedback to the students on assessment. The integration of behavioral and social sciences, readiness of graduates for postgraduate studies, institutional autonomy and academic freedom for curriculum development and designing, and opportunity for the participation of other stakeholders were identified as strengths. CONCLUSIONS: As per WFME standards the curriculum for DPT program needs improvements in student's assessments and their participation in program management, evaluation, mission statement and designing, along with facilitation in student's activities, organizations. Strengths of the curriculum were integration of behavioral and social sciences, readiness for postgraduate studies, institutional autonomy and academic freedom for the development and designing of curriculum, and the participation of other stakeholders.

Educational impact of Mini-Clinical Evaluation Exercise: A game changer.

BACKGROUND AND OBJECTIVE: Workplace based assessment has a strong educational impact in terms of student's clinical performance by steering their learning towards the desired learning outcomes. Educational impact is hardly measured in the sphere of medical education and this study is an attempt to measure educational impact of post graduate residents. The aim of this study was "To explore educational impact of Minicex (Mini-clinical evaluation exercise) on residents with respect to their learning". METHODS: A mixed convergent parallel method was selected, participants were identified through non-probability convenience sampling, total 10 participants were chosen for data collection, all of them experienced four minicex encounters which generated their scores (the quantitative data), after first two Minicex encounters each participant was interviewed using a structured interview technique, similarly, after 3rd and 4th Minicex encounters. Data was entered in the SPSS version -21 to calculate descriptive statistics. Inferential statistics were determined using ANOVA to calculate improvement in score over time and P-value to report statistical significance. Qualitative analysis was done using thematic analysis approach with the help of themes based on interview questions: priori theme. NVIVO was used for triangulation of themes accordingly. RESULTS: The results indicate statistically significant improvement in scores and p values were considered significant at 0.05. Also, qualitative analysis provided reasons for improvement in scores and residents' satisfaction such as feedback, motivation, self-directed learning, peer assisted learning. CONCLUSION: The study concluded that residents learning behavior and, their satisfaction from assessment method can be enhanced through work place based assessment particularly in context of minicex (mini-clinical evaluation exercise) so encouraging its use in similar situations. However, the scope for generalization of results remains limited owing to a small sample size.

The association of age with glycaemic and cholesterol control in patients with type 2 diabetes mellitus.

OBJECTIVE: To find the risk of dyslipidaemia in diabetic patients of different age groups. METHODS: This cross-sectional study was conducted at Holy Family Hospital, Rawalpindi, and Pakistan Ordnance Factories Hospital, Wah Cantonment, Pakistan, from February to July 2014, and comprised type 2 diabetic patients. Patients' body mass index was calculated and biochemical tests were performed for high-density lipoprotein, total cholesterol, low-density lipoprotein, triglyceride and glucose. Data was analysed using SPSS 20. RESULTS: Of the 40 patients, 17(42.5%) were men and 23(57.5%) women. The blood glucose control of younger age group (30-40 years) was 234±90.37mg/dl compared to older age group (60-70 years) with a mean of 173.4±54.2 mg/dl. Serum triglyceride levels of the youngest age group (30-40 years) were the highest with a mean value of 216±137 mg/dl. There was a significant association between age and triglyceride levels (p=0.03) , while the serum high-density lipoprotein level of this group was lowest with a mean of 29.6±13.4 mg/dl. CONCLUSIONS: There was a significant association between triglyceride levels in the youngest age group of patients with type 2 diabetes.

Introducing regular formative assessment to enhance learning among dental students at Islamic International Dental College.

OBJECTIVE: To evaluate the effectiveness of Formative Assessment in enhancing learning among dental students, and to interpret the assessment from students' perspective in this regard. METHODS: The experimental non-randomised controlled study was conducted from January to June 2013 at Islamic International Dental College, Islamabad, and comprised first year Bachelor of Dental Surgery students attending regular physiology lectures and tutorials. Summative assessments conducted at the end of each unit were included as pre-intervention tests. After one month's planning, central nervous system unit was delivered in a month's trial with four formative assessment and feedback sessions (one per week). Likert scale-based student feedback questionnaire was administered. Post-intervention summative assessment was done by Multiple Choice and Short Essay Questions. Data was analysed using SPSS 17. RESULTS: Out of 68 students, 64(94.1%) agreed that a conducive environment was maintained and 62(90%) agreed that such sessions should be continued throughout the year; 59(87%) reflected that the feedback provided by the teacher was timely and positive and ensured equitable participation; 56(82%)agreed that it enhanced their interest in the subject; 56(68%) agreed that they were now more focussed; and43(63%)were of the opinion that they have progressed in the subject through these sessions. There was highly significant improvement in the monthly post-intervention test scores compared to pre-intervention test (p=0.000). CONCLUSIONS: Formative assessment sessions enhanced motivation and learning in first year dental students. Organised regular sessions with students' feedback may contribute to the development of pedagogic practice.

Continuum of medical education: objectivity in instructional method, learning and assessment.

OBJECTIVE: To find the effect of objectivity practiced during instruction and assessment on learning. METHOD: Fifty first year BDS students of Islamic International dental college, Islamabad were selected for a descriptive case series study extending from January to mid February 2007. Before starting the haematology module, specific learning objectives were defined. Interactive student centered instructional method was adopted in the form of interactive lectures and small group discussions. Assessment tool selected for measuring predefined objectives were to choose one best and the correct statement MCQS. Students were informed of the assessment pattern and practiced. Out of 65 test items 58 required a correct choice while 7 MCQS were objectively structured with "choose one best answer," mixed in the main test pool and marked with an asterisk. RESULT: Evaluation survey showed dissatisfaction regarding the traditional lecture system. Although students were satisfied with the learning environment but majority disagreed with the reliability and validity of the current assessment method. After introducing the reforms in the instructional method and assessment pattern, the level of student satisfaction became high and their feedback was positive regarding the learning experience. The qualifying criteria for the 50 students was achieving 50% in both type of MCQS. In objectively structured choose one best type, 80% of the students scored more than 50% marks (i.e. 4 out of 7). In choose the correct statement, 96% of the students scored more than 50% marks (i.e., 29 out of 58). Final scoring for 65 test items showed that 96% of the students scored more than 50% marks. CONCLUSION: Introducing objectivity in instruction, learning and assessment gives good outcome in medical education. Learners groomed in such an environment are critical thinkers as evidenced by test results of, objectively structured choose one best type.